When Mike Polek and Joe Olsen, both big, gregarious Philly firefighters, bumped into each other over the summer, they discovered what they thought was an astonishing coincidence.
Olsen said he had just been diagnosed with what his doctor called a rare cancer, and showed off the large red splotches on his arms.
"I looked at his arms," Polek said. "And the cancer on his arms looked just like the cancer on my legs."
Both men have mycosis fungoides, a form of T-cell lymphoma in which white blood cells become malignant and attack the skin. Neither man had ever heard of it before being diagnosed.
They wondered whether their cancers might be job-related. The men had never been assigned to the same station. But Polek often gets called to help other stations, so there's a good chance they had worked together over the years.
For years, researchers have been connecting firefighters' exposure to burning materials with a higher risk of cancer. The largest study of its kind, released last year by the National Institute for Occupational Safety and Health (NIOSH), examined data on 30,000 firefighters from Philadelphia, Chicago and San Francisco. It found "modestly increased all-cancer risk compared with the general population."
"These findings contribute to the evidence of a causal association between firefighting exposures and cancer," the study said.
There are about 1.1 million volunteer and career firefighters in the U.S. They encounter a complex mix of chemical vapors from burning fuel and various synthetic materials. Known carcinogenics such as asbestos, arsenic, benzene, chromium, diesel fumes, carbon monoxide, dioxins, and polychlorinated biphenyls are all common at fire scenes, especially in areas with old buildings and heavy industry. But new materials may also add to risks.
"When I came on the job in 1974, we dealt with a lot of older construction," said Ed Marks, president of Philadelphia Fire Fighter and Paramedic Union Local 22. "Now, you have sofas that are sprayed with synthetics, you have PVC pipes. They burn at a higher temperature. And we're learning now that the smoke and toxins they give off are a problem."
Polek, 43, has been burned while fighting a fire. He has suffered other job-related injuries like a torn rotator cuff and is on sick leave as he recovers from shoulder surgery. Now, he is faced with cancer of uncertain origins. But he says the cancer won't stop him from working.
"I love my job," said Polek, of Engine 63 in East Oak Lane. "It's my second family."
Olsen, 49, said that he, too is able to continue working at Engine 18 in the Northeast.
Patients with mycosis fungoides have a good prognosis with the proper care. But for now, cancer treatments leave Olsen exhausted.
Firefighters "really want to go to work," Olsen said. "It's a strange but true fact of a firehouse."
Robert Daniels, the lead author of the NIOSH study, said that the findings "suggest firefighters are at higher risk of cancers of the digestive, oral, respiratory, and urinary systems when compared to the general population."
But the connection is far from a slam-dunk he said, explaining that more studies are needed. "The effects we observed were small and therefore should be cautiously interpreted," he said.
Connecting cancers to specific environmental exposures is extremely difficult for many reasons. There are hundreds of different kinds of cancer. And there are at least that many potential toxins in the environment.
Timothy Rebbeck, an epidemiologist at Harvard's T.H. Chan School of Public Health, said studies suggest cancer clusters can occur with firefighters. But is it the job that prompted the cancer? Or did the firefighters smoke, or have chemical exposures completely unconnected with the job?
And, he said, it's almost impossible to link a single event, such as a fire, to a specific cancer, because it can take years for cancer to develop.
"There's a latency in the time from an exposure to when a cancer gets diagnosed," Rebbeck said. "And that can be very long."
Tony Sneidar, deputy commissioner of logistics for the Philadelphia Fire Department, said he believes there is "a significant [cancer risk] increase to firefighters compared to the civilian population."
"My take on the way the [NIOSH] study was written is that it gave the facts, but it minimized the cancer risk," said Sneidar, who suspects the risks actually are greater.
"We have a huge task to educate, train and provide equipment," Sneidar said.
One of the biggest safety initiatives includes buying second suits for all firefighters. In the past, firefighters would walk around in their suits long after a fire and reuse gloves and hoods that could be contaminated with chemical residue or asbestos fibers. Some firefighters would go home without showering first.
Pennsylvania law says firefighters can receive workers compensation if they can prove their cancer was caused by job exposures, but such claims routinely get rejected because it's so difficult to make that connection.
Meanwhile, firefighters like Derrick Moffett, 36, are left to wonder if the work they love is compromising their health. He was diagnosed with testicular cancer in 2016.
"When the doctor told me, I jokingly asked for a second opinion," Moffett said. "The doctor said, 'You don't have time for a second opinion.'" He had to have a testicle removed.
The father of seven served on a special crew for Engine 33 in Bridesburg that responded to chemical fires. As part of that, he was assigned to a foam unit, which uses a chemical blanket to suppress fire.
"It's physical and emotional," Moffett said of his cancer. "It's a big war to fight."