He was only 30 and had been in the Boston Fire Department less than a decade. But as he investigated his diagnosis of Hodgkin’s lymphoma in October 2020 and sought successful treatment, he learned he and others wore gear that contained the toxic industrial compound PFAS.

“You always hear about the dangers. You just never think it’s going be you,” said Ranahan, who stopped working due to the cancer and is among thousands of firefighters nationwide who sued PFAS manufacturers and companies that make firefighting gear and foam, seeking damages for their exposure.

“These guys put this on day in and day out to protect neighborhoods and wherever they are working,” he said.

Does firefighting gear cause cancer?

The multi-layered coats and pants worn by firefighters have become the latest battleground over PFAS, or per- and polyfluorinated substances. It’s found in everything from food packaging to clothing and is associated with health problems including several types of cancer. In 2023, the Environmental Protection Agency for the first time proposed limits on the chemicals in drinking water.

The news that PFAS compounds are in their gear — primarily meant to repel water and contaminants like oil and prevent moisture-related burns — is worrisome to firefighters.

What are the chances of a firefighter getting cancer?

Cancer has replaced heart disease as the biggest killer of firefighters, and the International Association of Fire Fighters or IAFF attributes 66% of firefighter deaths between 2002 and 2019 to cancer. And firefighters have a 9% higher risk of getting cancer and a 14% higher risk of dying than the general population, according to Preventative Diagnostic Center. And firefighters are at an even higher risk of getting several types of cancer, according to IAFF, including twice as likely to get testicular cancer and mesothelioma than the general population.

Firefighters are exposed to a laundry list of carcinogens coming from fires burning hotter and faster than ever before — often due to increased petroleum products in homes. But as they learn more about PFAS, a growing number are convinced their personal protective equipment or PPE is sickening them.

“We had no idea that the gear that we were putting on every day was essentially loaded with PFAS,” said IAFF General President Edward Kelly, who was elected in 2021 on a campaign in part to address dangers of PFAS in gear.

“As more scientific data availed itself, it became obvious that our greatest exposure to carcinogens is our daily donning and doffing of PPE bunker gear,” he continued.

Firefighter cancer lawsuits

One defendant in the lawsuits, 3M Co., said in a statement that it “manufactures a variety of personal protective equipment products that meet nationally recognized standards to help protect first responders facing high-hazard environments.” In 2024, Massachusetts and Connecticut banned the use of PFAS in firefighter gear, and 3M announced it would stop manufacturing PFAS by the end of 2025 and would work to discontinue using the chemicals in its products.

Another defendant, W. L. Gore & Associates, says the PFAS compound PTFE used in its clothing is nontoxic and safe.

“Based on the body of available and reliable science, Gore concludes its firefighting products are not the cause of cancers impacting firefighters, who by the nature of their important work are sometimes exposed to cancer-causing chemicals from fires,” said company spokesperson Amy Calhoun.

And PFAS are not that simple to eradicate—a 2023 study found that firefighting gear without the chemicals may not be as effective as gear with them. The American Chemistry Council said in a statement that “PFAS-based materials are the only viable options for some key equipment that meet the vital performance properties required for firefighting gear.”

Heightened concerns about gear

The PFAS has been in the gear for decades. But the wife of retired Worcester, Massachusetts fire lieutenant Paul Cotter, who was diagnosed with prostate cancer in October 2014, raised concerns about it in 2016. Until then, many firefighters had not heard of PFAS or did not know it was in their gear.

Gear makers told Diane Cotter there were only trace amounts of PFAS and it was safe. “I was attacked by firefighters when discussing the idea that chemicals in the gear could be causing cancer,” she said.

Cotter sent patches of gear to Graham Peaslee, a University of Notre Dame professor who studies PFAS, for testing.

“It was loaded with PFAS. That was the first eye opening moment that there may be more than just trace amounts,” said Peaslee, who also found the chemicals on gloves and in firehouse dust.

“They come off and they pose risks,” he said.

Courtney Carignan, an exposure scientist and epidemiologist at Michigan State University, said she found PFAS at twice the levels of the general population in the blood of more than half of the 18 firefighters she tested in Nantucket and Fall River, Massachusetts. She also found PFAS in gear was transferred to the skin of firefighters.

But Carignan is still investigating how much the gear contributed to increased levels of PFAS in the blood and whether PFAS exposure may be causing or contributing to cancer.

“Even though we know PFAS is in the gear, we still don’t know how much exposure that is,” she said.

How to prevent cancer as a firefighter

The revelation of PFAS in the gear sparked a campaign by firefighters to find safer alternatives and to hold companies responsible. They hope their work will prevent cases of cancer among firefighters and help save lives.

Lawsuits on behalf of firefighters argue they were exposed to significant PFAS levels and companies knew the gear contained PFAS and that it can cause serious health problems. The suits also allege companies misrepresented their products as safe.

The IAFF, which represents more than 350,000 U.S. and Canadian firefighters, decided in 2021 to no longer accept sponsorships or advertising from the chemical industry and to oppose PFAS in turnout gear. A Congressional bill introduced in 2023 would accelerate the search for safer alternatives and support firefighter training to reduce exposure from existing gear.

Seven states including Washington, New Hampshire and New York passed bills requiring companies to disclose PFAS in their gear, according to Safer States, a coalition of environmental health groups. Several more states introduced or enacted bills this year that provide funds to purchase PFAS-free gear or prohibit manufacture or sale of gear containing the chemicals, according to Emily Sampson, an environment policy analyst at the National Conference of State Legislatures.

Firefighter Cancer Awareness Month

The IAFF has designated January as Firefighter Cancer Awareness Month to provide resources and support to firefighters and their families. This January as firefighters take on historically damaging wildfires in Los Angeles, the need for public awareness is greater than ever.

Each week in January, IAFF is sharing resources on cancer prevention and risk reduction. But there’s a long road ahead to reduce the rate of cancer diagnosis among the nation’s firefighters.

No easy fix

For most fire departments, there is no easy fix. Replacing gear is expensive — one set can cost upwards of $4,000 — and finding alternatives has proven challenging. Some companies are promoting a PFAS-free outer layer but that doesn’t solve the problem because the other two layers still contain PFAS, the IAFF said.

Among the hurdles, according to a IAFF lawsuit filed in March, is that the National Fire Protection Association or NFPA standard for gear can only be met with PFAS-infused material. The suit accuses the NFPA of working with several gear makers to maintain that requirement. It seeks damages and an end to the standard.

Chris Dubay, NFPA vice president and chief engineer, said in a statement that the standard “does not specify or require the use of any particular materials, chemicals or treatments for that gear.” He said the group has no “special agreements or relationships with any company or organization” in development of standards.

“The manufacturers who are producing this gear owe it to the fire service to come up with an alternative,” Brockton Fire Chief Brian Nardelli, who has heard of companies promoting gear with less PFAS but is reluctant to buy it for his 231-member department without more proof.

Instead, his department tries to limit firefighter exposure to gear that’s been integral to firefighter identity. They would take it everywhere, including charity events. Now, Brockton discourages firefighters from wearing turnout gear in living quarters and encourages them to wash it after fires. It’s stored on trucks and is only to be worn for serious calls like fires and car accidents.

“Guys have seen everyone who has gotten cancer, guys dying from cancer,” said William Hill, the president of the Brockton Fire Fighters Local 144 who was successfully treated for testicular cancer. “Being told that PFAS is in the gear, guys don’t want to take the chance of being overexposed.”

A version of this story originally published on Fortune.com on Sept. 14, 2023.

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