Heads Up! Raising Awareness of Occupational Brain Cancer

Note: This article is part of the Firehouse 2024 Cancer Awareness and Prevention Supplement. To read the entire supplement, click here.

“Heads up!” is a shout by a firefighter on the fireground to warn another firefighter about an impending danger. However, this verbal warning isn’t constrained to the operations on the fireground. With his death, Firefighter Jimmy Lanza shouted a warning to me.

Lanza joined FDNY on Jan. 13, 1979. He was a U.S. Navy Vietnam veteran. He assisted in the aftermath of Hurricane Katrina. He was a board member of the FDNY Fire Family Transport Foundation and a commander of American Legion Post 1836. He was a volunteer for the American Red Cross as well as  for the Wounded Warrior Project.

Lanza was my senior firefighter at Ladder 43 in the Spanish Harlem neighborhood of New York City. He welcomed me into the firehouse in 2005 as a new probationary firefighter.

One of my original fire service mentors, Lanza showed me how to become a great firefighter. His death struck close to my heart. He had been retired for only a few years when he was diagnosed with a rare form of brain cancer. He succumbed to his battle at the age of 71.

To the firehouse and the members who served there, Lanza was known affectionately as the overbearing good Samaritan. If an elderly person was standing on a corner, he would help that person to cross the street whether help was needed or not.

Lanza’s battle with brain cancer and his unfortunate death in 2017 have inspired me to learn and to write multiple articles and a thesis about firefighter occupational cancer. They also inspired me to join FDNY’s contamination reduction workgroup; to help to bring a cancer screening program to my department; and to work with national firefighter organizations to create standards to reduce firefighter contamination.

In Lanza’s memory, I write this article to give my fellow brothers and sisters the heads up about brain cancer and to remind them that we can take steps to prevent this terrible disease.

Identifying the enemy
Many firefighters are inadequately aware of the dangers of chemical exposure, the threat that’s posed by occupational brain cancer, symptoms of the disease and the best practices to avoid exposure. Without a clear understanding of these important subjects, firefighters place themselves at an increased risk of developing cancer.

Brain cancer is an abnormal growth of tissue in the brain. There are more than 125 different types of brain cancer.

Brain tumors fall into two categories: high grade (rapidly growing) and low grade (slow growing).

Multiple studies concluded that firefighters are at an increased risk of developing occupational brain cancer.

Grace LeMasters and her fellow authors revealed in “Cancer Risk Among Firefighters: A Review and Meta-analysis of 32 Studies” (Journal of Occupational and Environmental Medicine, November 2006) that firefighters are 1.31 times more likely to develop brain cancer than the general population is.

“Cancer incidence among male Massachusetts firefighters, 1987–2003” (Dongmung Kang et al., American Journal of Industrial Medicine, April 2008) compared Massachusetts police officers and firefighters and found that firefighters had a 90 percent higher risk for brain cancer than police officers.

In “Cancer Incidence and Mortality among Firefighters: An Overview of Epidemiologic Systematic Reviews” (International Journal of Environmental Research and Public Health, March 2021), Elena Laroche and Sylvain L’Esperance noted Tee Guidotti’s studies, which suggested that firefighting might be associated with elevated risk for brain cancer, particularly gliomas. Gliomas are the most common type of primary brain tumor. They develop in the glial cells, which are involved in several brain functions.

Why firefighters?
Firefighters are exposed to many contaminants during the course of their daily tasks and firefighting duties. These contaminants include carcinogens that result from combustion that’s incidental to structural firefighting or from work as a firefighter (for example, diesel exhaust). “Occupational and environmental risk factors of adult primary brain cancers: a systematic review” (J. Gomes et al., International Journal of Occupational and Environmental Medicine, April 2011) found that firefighters might have a higher risk of developing brain neoplasm, because they are exposed to numerous harmful chemicals, many of which are neurotoxic and carcinogenic. Furthermore, the International Agency for Research on Cancer deems the occupation of firefighters to be carcinogenic.

Identifying symptoms
According to Memorial Sloan Kettering Cancer Center (MSK), the signs and symptoms of brain cancer often relate to where in the brain that the tumor developed. Depending on where a brain tumor is located, MSK reports that it can cause temporary problems in consciousness, movement or speech. Other symptoms include seizures, headaches, speech problems, physical weakness (often on one side of the body), imbalance or difficulty walking, and impaired vision or a restricted field of vision, MSK indicates.

While I conducted research for this article, I discovered multiple news stories and articles about firefighters who battled/are battling brain cancer. Within these stories, firefighters listed the symptoms that they encountered.

Spencer, MA, Fire Department Firefighter Pat Murray described his symptoms as an extreme headache, with excruciating pain near his right temple. Albuquerque, NM, Fire Rescue Firefighter Vincent Cordova described his symptoms as a ringing in an ear, which led to deafness in that ear. Laurel, MT, Volunteer Fire Department Firefighter Sean McCleary noticed that he was having speech problems. Philadelphia Fire Department Firefighter Linda Long’s symptoms included dizziness, balance issues, headaches and unexplained fatigue.

Two firefighters who served in the FDNY recently succumbed to brain cancer. With the permission of their respective families, I provide their symptoms.

While building a deck in his backyard, Frank Portelle experienced tingling and numbness in his fingers, which made it difficult for him to hold a drill. During his last tour in the firehouse, a firefighter who was working with him noticed that he wasn’t walking correctly and was slurring his words. Portelle lost his battle to grade IV glioblastoma brain cancer in March 2021.

Steven Reisman experienced a headache that lasted for weeks. No over-the-counter medication was effective at relieving it. Reisman lost his battle to grade IV glioblastoma brain cancer in June 2014 after fighting for 2½ years.

If you or your fellow firefighters are experiencing any of these symptoms or a combination of these symptoms, immediately consult a physician. If deemed appropriate, a physician might recommend seeing a specialist.

Diagnosis, prognosis and treatment
When doctors suspect that a patient might have brain cancer, they most likely will recommend that the patient have some type of diagnostic imaging done. This imaging will be accomplished by either a computerized tomography (CT) scan, a positron emission tomography (PET) scan and/or a magnetic resonance imaging (MRI) scan. These scans help doctors to identify a brain tumor as well as determine the tumor’s size, location and grade— in other words, how quickly that the tumor is growing.

A biopsy of the tumor also will occur. This knowledge helps doctors tailor a treatment plan that best suits the patient’s condition. A treatment plan might include a combination of either surgery, radiation or chemotherapy.

Best practices to prevent
Researchers don’t recommend specific best practices for brain cancer. However, firefighters should utilize best practices that prevent deadly chemicals from entering or coming in contact with their body. These include cleaning their helmet, hood, SCBA and firefighting gear and showering as soon as possible after returning from a fire.

Failure to create and maintain a sense of urgency allows firefighters to remain complacent. Firefighters can be particularly vulnerable to complacent attitudes, because they are exposed to hazardous situations repeatedly and, over time, can become less concerned and cautious about the risks that they face. This complacency can lead firefighters to consciously or unconsciously opt to not wear their PPE, which exposes them to hazards and places them at increased risk for cancer.

No excuses
Lanza, my senior firefighter, continues to inspire me to make changes within my department and to educate my fellow firefighters about occupational cancer. I am sure that many of you know of a colleague who you lost to cancer. Use this person’s memory to change your actions and department.

Change can begin today and can start at any level or rank. There are no excuses. Even if we only save one life, it will be worth it all. 

Heads up!