On the day after Christmas in 2020, San Francisco firefighter Matt Alba had a seizure. At the hospital, doctors discovered a tumor the size of a pear: It was brain cancer.
It’s a diagnosis that, in Alba’s line of work, is tragically common. Research suggests that firefighters have higher rates of cancer than the general population, including a 26% higher risk for brain cancer. In 2023, nearly three-quarters of active firefighter deaths were due to cancer, the leading cause of death in the profession nationwide.
Though it’s hard to determine a single reason for their elevated cancer risk — firefighters are exposed to a range of toxins in their everyday duties — one obvious point of contact is their gear, known as turnouts. Perfluoroalkyl and polyfluoroalkyl substances, or PFAS — a group of chemicals known for their waterproofing qualities — have been added to firefighter turnouts since the 1970s, years after chemical companies first realized that the compounds were hazardous to human health.
Alba, a battalion chief in the San Francisco Fire Department and head of its health and safety program, has been sounding the alarm for a decade, long before his own diagnosis. And last week, the department he works for took an important step toward addressing the issue — one he hopes will have ripple effects on firefighters across the country.
On May 14, San Francisco became the first major American city to ban PFAS from its firefighters’ protective gear. The ordinance, which was passed by the city’s board of supervisors and now heads to Mayor London Breed for her signature, requires the city’s fire department to provide PFAS-free gear to its nearly 1,500 firefighters by June 30, 2026, at an estimated cost of $10.1 million. The decision joins a statewide ban on PFAS in firefighting foam, which went into effect in 2022.
While everyone comes into contact with PFAS in one way or another — the chemicals are found in everything from rain jackets to drinking water — firefighters have particularly high levels of exposure. Knowing this, they have been leading a cross–country, grassroots effort to make their turnouts safer.
“We have this unique risk in our occupation that is really hard to mitigate sometimes,” said Russell F. Osgood, vice president of education, research and outreach at the nonprofit Firefighter Cancer Support Network. “So removing compounds from things that protect us — to make it less risky for us as far as getting cancer — is a good step.”
Until recently, that has been a challenge, as effective PFAS-free gear has not been readily available. But earlier this year, five fire departments, including San Francisco and Denver, began testing PFAS-free turnouts.
The reception has been positive, said Neil McMillan, director of science and research at the International Association of Fire Fighters, a labor union for firefighters in the U.S. and Canada. Though official results won’t be available until summer, McMillan said that, so far, firefighters have reported “no differences or trade-offs in performance.”
“It used to be that it was a badge of honor to wear a dirty coat — that’s no longer the situation.”
San Francisco’s decision to purchase PFAS-free turnouts comes on the heels of similar announcements in Vancouver, British Columbia, and Concord, New Hampshire. Because of its size, what happens in San Francisco could influence other cities to replace their gear, too, if they can scrape together the funds.
PFAS-free turnouts cost $4,000-$6,000 each, around 30% more than the alternatives. Departments typically provide two sets to each firefighter and must replace them every five to 10 years.
Alba worries that, because of the cost, the transition won’t happen quickly enough, and PFAS-free gear will continue to pose a funding challenge far into the future. “You can see how this will be, for firefighters, a generational problem,” he said.
So Alba is also teaching firefighters how to minimize their contact with PFAS: wearing turnouts only when absolutely necessary, bagging and washing their gear after fires and showering after they return to the station.
“It used to be that it was a badge of honor to wear a dirty coat — that’s no longer the situation,” said Alba, who’s been in the fire service for 26 years. “So I’m grateful for how far we’ve come.”
“But there is so much more that needs to be done to fully eradicate this known carcinogen from our quote-unquote safety equipment,” he added.
Susan Shain reports for High Country News through The New York Times’ Headway Initiative, which is funded through grants from the Ford Foundation, the William and Flora Hewlett Foundation and the Stavros Niarchos Foundation (SNF), with Rockefeller Philanthropy Advisors serving as fiscal sponsor. All editorial decisions are made independently. She was a member of the 2022-’23 New York Times Fellowship class and reports from Montana. @susan_shain
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