Summary
Fire fighters face a higher risk of cancer—but risk does not mean inevitability. In this episode of Listen Up L27, Dr. Marcie Hamrick, Medical Director at Station 2 Clinic, breaks down what the research actually shows about cancer risk in fire fighters, why exposures matter, and how lifestyle plays a major role. The conversation covers proven cancer screenings available through Station 2 Clinic, the importance of early detection, and what fire fighters should know about newer screening options like blood tests, whole-body MRI, and ultrasound—plus their limitations. A clear, practical discussion focused on informed decisions, prevention, and staying on top of recommended screenings.
Transcript
[00:00:00] Dr. Marcie Hamrick:
We know that the risk for cancer is associated with those fire fighters who have been at more fires over the course of their careers. That does point in the direction that those exposures increase risk.
[00:00:16] Jen Pennington:
Hey Seattle fire fighters, welcome to Listen Up L27. I have Dr. Marcie Hamrick here from Station 2 Clinic. She’s the medical director, and today we’re going to be talking about cancer screening.
Dr. Hamrick, fire fighters often hear that they’re at a higher risk for certain cancers. What do we actually know about that risk, and why is it higher?
[00:00:38] Dr. Marcie Hamrick:
Yeah, we do know that fire fighters are at higher risk of cancer than non-fire fighters. Overall, it’s believed that fire fighters have about a 9% higher risk of a cancer diagnosis and roughly a 14% higher risk of a cancer-related death.
So it’s not nothing.
If you look at the cancers that fire fighters are known to have more frequently than non-fire fighters—for instance, testicular cancer—fire fighters are about twice the risk. That sounds scary.
But if you look at lifetime risk, for any male in the U.S., the incidence of testicular cancer is about 1 in 250. That’s four people out of every thousand in the general population.
Among fire fighters, because that risk is doubled, it means about eight people out of 1,000 in their lifetime will be diagnosed with testicular cancer. So it is an increased risk, but it still means 992 people out of 1,000 will not get testicular cancer.
There are some cancers that are more common in the general population—for instance, prostate cancer. Fire fighters have about 1.25 times the risk of being diagnosed. In the general population, about 125 people per 1,000 men will be diagnosed over their lifetime. For fire fighters, that increases to about 156 people per 1,000.
So again, it is a higher risk, but it doesn’t necessarily mean that you’re definitely going to get cancer at some point in your life.
In terms of why fire fighters have a higher risk of cancer, a lot of it is related to exposure to carcinogens in smoke and exhaust.
We know that the risk for cancer is associated with those fire fighters who have been at more fires in their careers. That does point in that direction—that those exposures increase risk.
I also think about long-term exposure to chemicals, including those that historically have been in fire-fighting foam, which have been linked to increased cancer risk.
Lifestyle factors also contribute, including sleep deprivation, alcohol use, obesity, and eating a lot of red meat—particularly processed red meats.
[00:03:34] Jen Pennington:
Wow. So a lot of factors go into this—and definitely something to really consider.
Let’s also talk a little bit about cancer risk as it relates to lifestyle.
[00:03:48] Dr. Marcie Hamrick:
A lot of times people think genetics plays a strong role in cancer, particularly if they have one or more relatives who’ve been diagnosed.
In reality, genetics accounts for only about 10–20% of cancer risk.
Lifestyle factors—including sleep, nutrition, alcohol use, and occupational exposures—often make up about 80–90% of cancer risk, including for fire fighters.
[00:04:26] Jen Pennington:
So you get a double whammy there.
[00:04:29] Dr. Marcie Hamrick:
Absolutely.
[00:04:29] Jen Pennington:
When you talk about some of these lifestyle-related factors, what are a few things fire fighters can do to lower their odds?
[00:04:43] Dr. Marcie Hamrick:
The first thing I think of is using protective equipment at work. Line-of-duty exposures significantly increase cancer risk.
That means using full PPE throughout the entire incident, including wearing SCBA during salvage and overhaul, immediately doing gross decontamination of PPE after coming out of a fire, and properly storing PPE.
One thing that’s gone out of habit is using baby wipes on the head and neck after fires. I recently read a study that showed a 58% reduction in carcinogen levels in the blood of fire fighters who used wipes compared to those who didn’t. That’s a really important step that sometimes gets overlooked.
In addition, showering as soon as possible and storing PPE away from living areas are key.
Those on-the-job practices are the first major bucket of ways fire fighters can reduce cancer risk.
[00:06:03] Jen Pennington:
And the culture has changed, too. Years ago, having a dirty fire helmet was almost a badge of honor. I interviewed a fire fighter who later developed cancer, and he talked about that shift.
He showed me his helmet now—it’s pristine. His cancer is in remission, he’s doing great, and he’s still an active fire fighter.
Seeing the difference between what that helmet looked like before and what it looks like now really shows how much the fire service has changed around gear cleanliness.
[00:06:59] Dr. Marcie Hamrick:
Fortunately, our growing knowledge and education about risk have positively influenced behaviors around taking care of yourselves.
I’m glad the culture is moving in that direction, and I want to encourage fire fighters to keep that going.
[00:07:22] Jen Pennington:
So Dr. Hamrick, what cancer screenings are available through Station 2 Clinic right now?
[00:07:28] Dr. Marcie Hamrick:
Every time someone comes in for their fire fighter medical exam, we do lab work, including a urine sample, which screens for bladder and kidney cancer.
We do blood testing that looks at blood counts, which can reveal blood cancers. We check a prostate cancer test called PSA, and we do a comprehensive chemistry panel that can suggest cancers like multiple myeloma.
We refer fire fighters for lung imaging to evaluate for mesothelioma. While it’s not common, it can be serious.
For colon cancer screening, we talk about starting at age 40—earlier and more frequently than the general population. That can be done with an annual stool test or a colonoscopy, which we recommend at least every five years.
We refer women fire fighters for mammograms starting at age 40 and encourage women to stay up to date on Pap smears.
During the physical exam, we focus on areas where fire fighters have increased risk. We do thorough skin exams, lymph node exams, and palpation of the thyroid gland—all with cancer screening in mind.
We also have a low threshold for evaluating new or worsening symptoms that could potentially represent cancer.
[00:09:12] Jen Pennington:
That’s just another reason to stay up on your AFFMEs and get them done every year.
[00:09:19] Dr. Marcie Hamrick:
Yet another reason, yes.
[00:09:22] Jen Pennington:
Some fire fighters may have heard about newer screening options like the Galleri test, whole-body MRI, or ultrasound screening. Can you give us an overview of what those tests do—and their limits?
[00:09:42] Dr. Marcie Hamrick:
There are several advanced cancer screening tests on my radar, but I always evaluate whether they help more than they cause harm.
One option is a multi-cancer early detection blood test, most commonly the Galleri test. It looks for tumor signals associated with about 50 types of cancer.
The challenge is that it doesn’t detect early-stage cancers very well. For stage 1 cancers, it detects only about 16%. Stage 2 cancers are detected about 40% of the time.
It’s not until advanced cancers that detection reaches around 90%. For comparison, colonoscopy has a sensitivity of about 95%.
There’s currently no evidence that this test reduces cancer mortality, and a negative result does not reliably rule out cancer.
[00:12:16] Jen Pennington:
So it can lead to a lot more testing.
[00:12:25] Dr. Marcie Hamrick:
Exactly—more testing, anxiety, and cost.
Whole-body MRI is another option fire fighters ask about. About 95% of people who undergo one will have at least one abnormal finding, and over 90% of those findings are not clinically meaningful.
But they still require follow-up testing, which can create stress and expense. Again, no proven mortality benefit.
[00:13:49] Jen Pennington:
Wow.
What about ultrasound screening?
[00:13:54] Dr. Marcie Hamrick:
Some companies market whole-body ultrasound screening. It looks at organs like the thyroid, liver, ovaries, and abdomen.
The upside is no radiation and relatively low cost. The downside is false positives and incidental findings, with no demonstrated mortality benefit.
[00:14:27] Jen Pennington:
So someone probably shouldn’t rely on just one of these tests alone.
[00:14:27] Dr. Marcie Hamrick:
Right. These tests tend to over-diagnose and can lead to over-treatment of cancers or abnormalities that may never cause harm.
The screenings recommended by NFPA—such as colonoscopy, blood work, and mammograms—are tried and true. We know they save lives.
[00:15:04] Jen Pennington:
Let’s talk about deciding what’s right for you.
[00:15:22] Dr. Marcie Hamrick:
If someone is considering advanced cancer screening, it’s important to understand that something abnormal is likely to be found—and that it may or may not be life-threatening.
Consider your individual risk factors, family history, occupational exposures, and be prepared for follow-up testing. That process can be stressful, so going in informed is key.
[00:16:14] Jen Pennington:
And members can talk with their Station 2 provider to figure out what makes sense for them.
[00:16:28] Dr. Marcie Hamrick:
Absolutely. Your provider can help review your risk factors, screenings you’ve already done, and make sure you’re up to date on recommended screenings—which are the highest-yield tools we have.
If you pursue advanced screening, it’s also important to know who will manage follow-up care. That makes a big difference.
[00:17:12] Jen Pennington:
And you have a strong referral network if something does stand out.
[00:17:21] Dr. Marcie Hamrick:
We do. I’m also thinking about pilot projects to help build better evidence around cancer screening for fire fighters.
Some departments are using whole-body MRI or ultrasound screening. I’ve been reviewing those results and talking with other departments.
I think Station 2 Clinic could contribute to that research in a thoughtful way—using advanced screening for the right people, understanding the pros and cons, and learning from the outcomes.
[00:18:26] Jen Pennington:
Let’s end with the bottom line. What do you want fire fighters to remember about cancer screening and early detection?
[00:18:37] Dr. Marcie Hamrick:
Follow up on the referrals you receive during your fire fighter medical evaluation.
These screenings work best when cancer is caught early—often when you feel fine. Given the increased risk fire fighters face, it’s worth sucking it up and going to your screening appointments.
That’s my strongest advice.
[00:19:17] Jen Pennington:
That might have to be my soundbite: suck it up and go get your AFFME.
[00:19:23] Dr. Marcie Hamrick:
That’s right.
[00:19:24] Jen Pennington:
Thank you so much, Dr. Hamrick. I really appreciate you being here today and look forward to talking with you more.
[00:19:32] Dr. Marcie Hamrick:
Thanks, Jen.
[00:19:35] Jen Pennington:
Thanks for joining us. Listen Up L27 is a Seattle Fire Fighters Healthcare Trust production, produced by The Rhizome Collaborative. I’m your host, Jen Pennington. Until next time—stay safe and stay healthy.
