What's it like to be a firefighter diagnosed with cancer? What are the thoughts and emotions that come with such significant news?
Most of what we know about firefighters and their increased exposures to chemicals, chemical compounds and carcinogens, and elevated rates of certain cancers compared to the general population have come from research that focused almost exclusively on male firefighters.
My wife of 37 years is a 10-year breast cancer survivor and an eight-month survivor of lung cancer following successful surgery in December, so I’ve seen up close the impact of cancer. But I wanted to know about women who are firefighters and cancer survivors.
I connected with several female firefighters for a virtual panel discussion about their experiences with cancer. The women who shared their experiences with us:
- Jennifer Dawkins – Vancouver (British Columbia) Fire Rescue Services
- Tina Guiler – Miami Metro-Dade Fire Rescue
- Cathy McCray – Loudon County (Virginia) Fire Rescue
- Laura Baker – Tucson (Arizona) Fire Department
Diagnosis: “They saw something”
The moment of diagnosis is one that stays with many cancer patients their entire life – a date they will never forget. These life-changing moments also underscore the importance of regular check-ups for early diagnosis and seeking help right away if you can tell something is “off” with your body.
Avsec: When did you learn you had cancer?
Dawkins: I was going through the testing/diagnosis process through the fall after I had a routine mammogram on Sept. 27, 2019. I was told they “saw something,” so I went back for an ultrasound after which they scheduled me for two biopsies. I had both tests done in late-November. One of the biopsies came back positive. They told on Dec. 10 that I had breast cancer, specifically invasive ductal carcinoma.
McCray: I wasn’t feeling the greatest and had some ongoing abdominal pain for a few days. I went to the ER and a scan showed a mass that had spread to multiple organs and lymph nodes. They immediately thought that it was cancer and found a specialty surgeon before they even came into my room to tell me what they had found. I was transferred to another hospital and admitted on May 30, 2018, with stage 3C ovarian cancer.
Baker: I learned I had cancer shortly after seeing my doctor for a small lump I found while at a speaking engagement in Colorado for women in the fire service. Fortunately, my spouse asked me to get it checked soon. As much as I usually procrastinate, this time I did not and saw my doctor the following week. On Oct. 22, 2013, I was given the news from my personal care physician.
Guiler: I learned I had cancer after doing a routine mammogram and ultrasound check-up. I was told they saw something that looked like breast cancer and you need to schedule a biopsy. I did and the results were positive for breast cancer in my lymph nodes, which was later confirmed by an MRI and a biopsy.
Initial emotions: “I was in shock”
While research and new treatments are improving survival rates and quality of life (the five-year relative survival rate for women with localized breast cancer is 90%), a cancer diagnosis is still a tremendous shock to the system, as we hear from these firefighters.
Avsec: My wife said hearing the words “breast cancer” created a pain she never thought could exist. What was your reaction?
Dawkins: I was initially fearful. The unknowns were the worst part of the experience. I honestly didn’t think the typical “why me?” but rather, “of course me (with an eye roll).” As I learned more about my prognosis, it became clear to me that I needed to use my strength, resilience, and experience to educate myself and others.
McCray: I remember thinking that this couldn’t be happening to me and how was I going to tell my mom. I didn’t want her to have to go through this. I remember that I immediately tried to prioritize who to call for notifications to be made about work and my part-time job of teaching as an adjunct instructor.
It was exceedingly difficult to be in that hospital room and try to comprehend what was happening. I don’t know if I felt scared, I’m sure that I did. I just did not want to go through this. My life was changing drastically, and I could only control me.
Baker: I was in shock initially. I was driving and had to pull over to hear the news. I immediately went into “survival mode” thinking “OK, what do I have to do to beat this, to survive?” I had an 11-year-old daughter and my partner, who I believed was the person I had been waiting for all my life, so I did not feel like I had any options but to survive. I did not get stuck on “why me” but did want to know “What am I to learn from all of this?”
Guiler: My initial thoughts were, “I can’t believe I have cancer when I am taking care of my Mom” who had been diagnosed with cancer the year before. I was in shock for a while, but that day changed my life forever.
Family, friends, caregivers: “They stepped up to be there for me”
According to the ACS, most people diagnosed with cancer today are treated in the outpatient setting; they don’t have to stay in the hospital. And during this time, they often need help, support and encouragement. Many studies have found that cancer survivors with strong emotional support adjust better to the changes cancer brings to their lives, have a more positive outlook, and often report a better quality of life.
Avsec: I’ve had the role of primary giver three times in life and it’s a big job. Tell me about your caregivers.
Dawkins: I was and always have been incredibly open about the whole experience. I would like to think this made it easier for people. I knew zero about breast cancer and feel it is important to share for the benefit of educating.
I have some amazing people in both my work life and personal life that have been great during this time. I have mostly surrounded myself with strong, positive, and empowering people for the better part of my adult life, so it is no surprise they stepped up to be there for me.
My mom stayed with me for a few weeks post-surgery. During chemo, I had some close friends who assisted me as needed; that need was exacerbated by the COVID-19 lockdown.
McCray: I never imagined I would have the support that I did, but I did not want them to see me in the shape that I was in. I could hardly handle it. My family has a strong Christian belief and they became pillars for me. I received numerous calls, texts, visits and gifts from family, friends, and coworkers.
When I was released from the hospital, I moved home to my mom’s place. My friends and coworkers stepped up and moved my things from my apartment to her house. It became real when I moved. My life had come full circle. I had left home to start my life [and fire service career], and I was returning to the very place where I’d wanted out.
My mother and sister-in-law took care of whatever I needed the most. I didn’t realize how much I needed them. It was very humbling.
Baker: I am in a breakfast club of 100 “women at the top” of their profession, and I received so many cards, texts and calls from people who wanted to send their love and prayers.
My boss (an assistant chief), along with a woman from the breakfast club (herself a breast cancer survivor) bought me a couch for my office so that I could take naps if I needed. It was such a nice gift and show of support. I only took one nap, but knowing it was there, and knowing my boss supported it, was very comforting. All the love and support that I received is something that just gave me strength and comfort.
My beloved wife, Jacki, was my caregiver. She was my rock. She supported me and stepped up to help with whatever was needed. She was at every treatment by my side and took care of me. Jacki picked up all the work at home and supported me and our daughter throughout my treatment. Jacki recently lost her battle with occupational lung cancer.
Guiler: My friends were great in the beginning, always came to my chemo appointments to help me and sit with me. Dropped food off at my house. Did things around my house. But after chemo was over, everyone local thought I was OK and didn’t come around as much.
I did receive a lot of cards and various gifts from my “Triple-Fers” [Fabulous Female Firefighters] and from female firefighters I didn’t even know. A few of my coworkers did call and come by to help if I needed anything. I didn’t ask for much help.
I flew my life-long friend in for my surgery and she stayed with me a week. I had friends take me and my mom to some chemo treatments.
My Mom was sick with cancer and going through treatments herself, but she helped me when I couldn’t help myself. Otherwise, I asked for help or I just took care of myself. I had to help my mom and both my elderly (90+ years old) grandparents, too. I was taking care of three people besides myself during my treatments.
Treatment: “It was extensive”
Those cancer treatments that have made such a dramatic impact on survival rates are no “walk in the park.” Cancer treatment options include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, stem cell or bone marrow transplant, and hormone therapy.
Most patients will require more than one of those treatments, depending upon their type of cancer and the extent to the cancer’s development.
Avsec: Tell me about your treatment plan after your diagnosis.
Dawkins: I had a single mastectomy on Jan. 4, 2020, which included placement of a tissue expander in preparation for my reconstructive surgery later. The tests of my lymph nodes came back clear, but after oncotype testing, they determined my cancer was aggressive and I would need chemotherapy. I began chemo on Feb. 28 (one treatment every three weeks) and finished in May 2020. Doctors replaced the tissue expander with an implant and did nipple reconstruction on July 10. Technically, I’m still in recovery and am taking letrozole, an estrogen blocker, for the next five years.
McCray: My cancer had metastasized to my colon, stomach, kidneys, lymph nodes and some other areas. My surgery took place on June 6, 2018, and it was extensive. I was discharged from the hospital on June 11, started chemo on July 5, and completed treatments on Oct. 18. I’ve had some follow-up procedures related to post-surgery issues and still see my oncologist quarterly and my surgeon bi-annually.
Baker: I had a [medical] port put in on Nov. 5, 2013, and chemo started Nov. 13, 2013. I completed my chemo treatment in April 2014, and my last surgeries in August 2014.
Guiler: I started my chemo treatments in June 2018 and completed my treatments in August 2019.
Working during treatment: “I tried to be strong”
Most cancer survivors experience some side effects because of their diagnosis or treatment. The type of side effects depends on a person’s diagnosis, treatment type selected, and their overall health. Naturally, this will impact the ability to continue working.
Avsec: If you were able to work, what was that like? If you took time off, what was that like?
Dawkins: At the time, I was an acting lieutenant in my fire company, but I was working for a few weeks as a lieutenant with recruitment, as we were in a hiring process at the time.
Once diagnosed, I [took leave]. I did not know anything about breast cancer. As I progressed with further testing, it was important to me to try everything to be in a calm headspace as I managed the steps forward. For firefighters in British Columbia, breast cancer is a presumptive cancer covered by legislation, so I was not required to work during treatment. That was passed in 2017, and I’m grateful for the work done by the many IAFF locals and the BC Professional Firefighters Association. Because of the legislation, I did not have to worry about money and could focus my energy on fighting the cancer.
McCray: At the time of diagnosis, I was assigned to a heavy rescue company.
I did not work initially because of surgery and chemo. I was off work for about five months, and I felt so inadequate. I tried to keep my mind on work and was worried that they would give up on me. I tried to be strong when I could because I felt like somehow it would prepare me for going back to work.
I worked so hard to get my job, and I never imagined that I would be stricken with an illness that would try and keep me from it. I hid myself and was very ashamed. I try not to be ashamed now, but it is difficult. I don’t really know if I was ready or fully prepared to return to work when I did, but I have seen first-hand the support and unconditional love that they have given me, sometimes despite me.
On Nov. 5, 2018, I returned to light duty in an administrative position at the training academy. I was released to full duty on March 7, 2019, and I’m currently assigned to a tower ladder as a technician (driver/operator).
Baker: I was a deputy chief of fire prevention at the time of diagnosis. I had worked in the field from 1994-2007, promoted to a deputy chief of training in September 2007 and moved to prevention in March 2010.
I continued to work after diagnosis. I knew of a couple women who were firefighters who had gotten breast cancer early in their careers, and I knew they continued to work through treatment and being on the frontline. So, I figured I could also keep working, as my work schedule was four 10-hour days per week.
I was able to figure out a routine that worked. My treatments were every 21 days for 8 cycles on Thursdays. So, I took my day off on Thursday. By Friday, I was still on a steroid, so it got me through the day. By the weekend, I just crashed, rested, and slept most of those two days.
Guiler: I had just bid a fire inspector position one year before I was diagnosed. I did continue to work – as much as possible – during my treatments. It was extremely hard. I had bad neuropathy in both my feet and hands. It was painful to walk or stand a lot. I took a lot of breaks. When I had to take leave from work, I slept almost the entire time during my chemo treatments.
After my surgeries and radiation, I stayed home with my mom and we took care of each other when we could. But I felt very alone after chemo treatments because not many people came around. My Mom and I both had low immune systems, and I didn’t want a lot of people in the house so we wouldn’t get sick.
Advice to fellow firefighters: “Don’t let your guard down”
The bottom line is firefighter can certainly be hazardous to your health. But fortunately, we know so much more now about the dangers faced on the job – and how to best avoid them.
Avsec: What advice do you have for your fellow firefighters, especially your sister firefighters, related to cancer prevention and treatment?
Dawkins: I strongly believe that mental wellness is an important factor in prevention. I like to think that my coping mechanisms have been great over my 20-plus years on the job; however, there is a cumulative factor here. The calls we go to, coupled with the fire hall [station] behaviors can manifest itself in many ways.
Don't shy away from connecting with other women, we have similarities, even if you think we don't! Therapy can be helpful even if you believe "that's not me.” One day years later, you will realize that was you!
Use your firefighting PPE for every call. Do not shy away from joining a safety committee if your department still wears dirty gear or does not use SCBA during EVERY overhaul!
McCray: You must take care of yourself. No one else can do this for you. Find someone you can talk to about anything. You will need to make sure you grow and develop in all areas, physically, mentally and spiritually, to include your mind, will and emotions. Don’t let your guard down with any of it.
If you feel off or simply weird in any part of your body or even in your thought processes and it has been more than a week, please go get checked out. I think just about everybody dreads going to the doctor, but if you ignore things, they turn into bigger things, and then the doctor becomes part of your routine. Don’t let this happen to you.
Guiler: Make sure you get your yearly mammograms and ultrasound tests done. Don’t skip any year. Make sure you wipe your face/neck and exposed arms after a fire before you get into the truck to head back to the station.
Take your unit out of service, and always take a shower and change clothes immediately after a fire. Request your officer let you do that after each fire, or if you are the officer, please take care of your crews and make them shower.
Always wear your SCBA for any fire! It’s an easy equation to remember:
Smoke = chemicals = cancer risk.
Baker: I’m with everything Tina [Guiler] said about wearing your SCBA and PPE all the time and wiping you’re your face, neck and other exposed areas after gross decon. And showering after every fire.
I also agree with Jennifer [Dawkins] about your mental health being extremely important. The fatigue and cumulative effect of firefighting can take its toll and our immune systems can be penetrated if we are not doing “whole” self-care.
And Cathy [McCray] is spot-on with her comments about paying attention to your body and seeking medical care if you don’t feel right. I know when I started in the fire service, I felt invincible, but trust in what we are sharing, trust in our wisdom that you must be diligent, disciplined and focused on your whole health, which includes physical, mental, emotional and spiritual.
After-treatment reflections: “I put energy into surviving”
Many people who has gone through a serious illness or faced significant adversity will tell you that the experience opened their eyes and made the world a bit clearer. This is certainly the case for many cancer survivors who reflect on their experiences.
Avsec: How has your life changed as a result of cancer, and what’s on the horizon for you?
Dawkins: I’m not really "looking back" yet, as I am still waiting for my white blood cells and neutrophils to come up enough for me to return to my fire company. COVID-19 has slowed down my return-to-work ability, as my immune system needs to be 100%.
I do feel strongly in being a cancer crusader and will be sharing my experience for the benefit of all women, including women in the fire service. Education is power. I would not wish this on anyone but also hope to showcase that life goes on!
I am back exercising, including swimming at the outdoor pool and reprogramming my pec muscles to their new normal!
McCray: I was full throttle and so engaged with my job and my priority that most of the time was to make sure that I was conditioned to be prepared for any task that my crew would need.
I was so worried that I was wasn’t going to be strong enough, so I started burning a lot [working at live-fire training sessions] at the training academy. I made sure that I took a beating. I worked a lot of 48s [48-hours on duty, 24-hours off duty] and exercised consistently. I just wanted to be strong and I thought that by working so hard, I would be more confident and stronger for my crew. I am not sure if this was the wrong attitude.
There are a lot of people that do the same thing. I am not sure if they did it for the same reasons as mine, but it is a lot of exposures. I became strong and I took care of my body by working out and eating healthy. These things were not enough, and I didn’t know what was coming. What if I would have put all that energy into protecting myself pre- and post-exposures?
Now I put energy into surviving, but regardless of what goes through my mind in a day, I am blessed and there is no way that I can do this on my own and God has given me a second chance. I may not like where I am at in my life, but I am still here, and I have work to do and someone out there needs my wisdom.
Baker: Looking back on my experience, I feel strongly that my breast cancer was probably acquired from firefighting. During the time of my survival against cancer, I did not think so because I was a chief officer, but the 12-13 years before, we did not take the same safety precautions that we now know will help keep our firefighters safe.
But now we know, and we must believe in the science and the research being done to benefit our firefighters. Sadly, I lost my spouse to occupational lung cancer, and I would do anything to take it all away and have her back. Everything that she had to endure was painful. I pray that we will continue to improve our behaviors, and tactics of firefighting to prevent our sisters and brothers from having to live with this awful disease.
Guiler: If I knew what I know now, I would have always cleaned the soot of my face, neck and arms after a fire. I would have worn my SCBA on little grass fires or trash fires. I would have requested clean gear after fire and not keep using it the rest of the shift. I also would not have kept the dirty gear inside my truck so I could keep breathing in the off-gassing of chemicals from my gear into my lungs.
Don’t do overhaul without all your PPE on and using an SCBA. Yes, it is a pain to wear it and it’s heavy, but it’s not worth getting cancer. Cancer changes your entire life. The treatments are painful and extremely hard on your body and mind. Don’t let peer pressure make you fight any fire without an SCBA on and take that shower. You can’t save anybody if you don’t save yourself first!
Support and sharing
Incredible women, incredible firefighters – and incredible stories of courage and perseverance.
Chief Baker shared the importance of picking your team of doctors, finding those close who will support you throughout, and surrounding yourself with positive people – people who will guide you but support what you feel is right for you.
Adding to her comments, one thing we typically don’t do well is look after our fellow firefighters when they’re out of work with an injury or illness. We may stop by or call to say hello or, more likely, send a text message. I believe that subconsciously we think that by acknowledging that one of our own is “wounded” we’re admitting to ourselves that it (e.g., injury, illness) could happen to us.
Yes, good medical care is necessary for a person to survive a cancer diagnosis. But just as importantly, the cancer patient – as we’ve learned from these four women – also needs family, friends and work colleagues to handle the burdens of everyday living, so that they can focus on one goal: getting well.
I’m extremely grateful to these fellow firefighters for entrusting their stories to me and for allowing me to share them with you. And I hope that reading their stories motivates you –whether you’re a woman or a man – to do everything in your power to protect yourself from the cancer risks posed by the chemicals, chemical compounds and carcinogens found in the smoke from so many of today’s fires.
[Learn more: Protecting female firefighters from occupational cancer]
[Read next: The more I learn about exposure to toxins, the more scared I become]
The situation in San Francisco
In 2012, the San Francisco Fire Department discovered that a startling number of its female firefighters had been diagnosed with breast cancers that year. The department had 117 female firefighters on its rolls when it discovered that 11 firefighters had been diagnosed with breast cancer and one had died, a rate that was six times the national rate for women at the time.
This discovery by the department led to the creation of the Women Firefighters Biomonitoring Collaborative Study, a group with the goal of studying how exposures to chemicals linked to breast cancer, including carcinogens and chemicals that disrupt the body’s normal hormone function. To date, the group has published two Final Peer-Reviewed Publications:
- Integrating exposure knowledge and serum suspect screening as a new approach to biomonitoring: An application in firefighters and office workers. January 2020. Environmental Science & Technology.
- Exposure to perfluoroalkyl substances in a cohort of women firefighters and office workers in San Francisco. February 2020. Environmental Science & Technology.
In a March 24, 2020, article, Female firefighters exposed to cancer-linked chemicals, Heather Buren, a lieutenant and paramedic with San Francisco Fire Department (SFFD), said the number of identified cases of breast cancer for SFFD female firefighters may be higher than was initially discovered in 2012. “Being female in a male-dominated profession … it was a really private thing for them,” she explained.
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