JEFFERSONVILLE, Ind. — It's an invisible threat to firefighters across our country, more deadly than the fires they battle.
Today, cancer is the leading cause of line-of-duty deaths in the fire service. Just last year, nearly 75 percent of those honored at the Fallen Fire Fighter Memorial died of occupational cancer.
This year, a local name will join that list.
In a box marked confidential, Jeffersonville Fire's Chief Dep. Jason Sharp held close to 4,000 documents detailing Bruce DeArk's personal life and decades-long career with the Jeffersonville Fire Department.
"I worked with Bruce when he first got hired," Sharp said.
He knows how unpredictable the job is.
"The runs you did one day will be nothing like you do the next," Sharp said.
Firefighters across the country are trained to face the fire and its immediate hazards, but few are ever prepared for the job's long-term side-effects.
We met Bruce back in 2018, during our week-long series, Battle After the Blaze.
"I was one of those younger guys who thought I was invincible. Nothing's ever going to happen to me," Bruce said.
He was 49, newly married, and chief deputy of the department when he went to the hospital for stomach pains.
"The ER doctor, based on the scan he saw, said, you want me to tell you what's going on? It's not good. It's stage 4 colon cancer," Janet DeArk, Bruce's wife, said.
It's the diagnosis he never saw coming.
"I don't know if I could've done anything different to detect what I had, there's nothing that would've made me go sooner," Bruce said.
He knew firefighters experienced higher cancer rates, but options for testing were limited. At the time, he was younger than the recommended age to get a colonoscopy. Three years later, the age requirements dropped from 50 to 45.
"To know that his illness was attributed to the experiences he had on this job, that was hard. A lot of firefighters started paying attention to things after that diagnosis," Sharp said.
The department immediately added pre-cancer screenings to its annual physicals. It began enforcing new policies after each fire run, like decontaminating firefighters and their gear to reduce exposure to carcinogens, chemicals known to cause cancer.
"You can have all the tools you need, but it's up to the person to use those tools to protect yourself," Bruce said, during our initial interview.
"As Bruce would say, the black helmet is no more, no longer a badge of honor. Clean your gear and that way, you can go home to your family," Janet said.
Over the last two decades, we've learned the fires battled today aren't the same as they were 40-50 years ago.
"We were being taught tactics from the late 70's and 80's on how to fight fires. There was a transition that happened and no one really seemed to notice," Sharp said.
"We went from fires that burned slower, produced a lot less smoke, less toxins, to now where everything is synthetic, producing lots of smoke. High amounts of toxins and carcinogens are being produced faster, fires are burning faster," Dr. James Cripps, a cancer educator for the Colon Cancer Prevention Project, said.
Up until last summer, the World Health Organization (WHO) said cancer was a 'possibility' in this profession. But in July of 2022, the job itself was reclassified as a carcinogen, on par with tobacco and benzene.
"For male firefighters, we see a high rate of testicular cancer, almost two times the national average," Cripps said.
Following testicular cancer, firefighters are suffering at higher rates with mesothelioma, Non-Hodgkin's lymphoma, brain, prostate, pancreatic, and colon cancer. The list goes on.
In women, the rates quadrupled for cervical cancer, almost tripled for cancers of the brain and thyroid and breast cancer accounted for almost half of all female firefighter cases.
"We live in a very toxic world right now and for firefighters, when you add a match to that, it's even more toxic," Janet said.
One national cancer study found firefighters have a 9 percent greater chance of being diagnosed and are 14 percent more likely to die from it than the rest of us.
Last year, of the 469 fallen firefighters added to the national memorial, 348 died from occupational cancer. Each are considered a line-of-duty death, though the requirements are different for each state. Kentucky recognizes just 12 cancers to be considered for a line-of-duty death, while Indiana will recognize most, as long as you can pinpoint the cause, which is problematic.
"It's not a single exposure," Cripps said.
It's the reason for that box of 4,000 documents.
"They said it was the biggest submission they've ever received," Sharp said. "And I take great pride in that. This was one of those times you really want to go above and beyond. His family deserves this."
He flipped through letters from the fire chief, the county health officer and copies of each run Bruce made over the years.
Bruce's 4-year battle with colon cancer ended in February of 2022.
"This one was the hard one, the death certificate," Sharp said.
It rested on top of a stack of evidence, all pointing to the same cause for Bruce's cancer.
"The suffering he went through was unimaginable and with such an amazing attitude," Janet said. "That man died not knowing he was dying. He had not given up ever."
"How the cancer affected his body was unlike anything I'd ever seen," Tori DeArk, Bruce's daughter, said.
Even then, he was on a mission.
"It was just me and him in his hospital room one day. He was like, please remember what this means. It's not a me effort, it's a group effort, that's what the bucket brigade is," Tori said.
Months later, the state of Indiana officially recognized Bruce's death as the first line-of-duty death for Jeffersonville Fire. The designation opened people's eyes to the risks they face well after the blaze.
"There's no doubt in my mind that Bruce touched many lives in here, and with him going through the battle he did, it'll save a lot of lives," Sharp said.
"If he could just save one life and that as a family was why it was so important to us as well," Janet said. "I know of people within this department who've gotten checked because of Bruce and have caught what could have been or what was early colorectal cancer."
Today, all eyes are on a blood test called multi-cancer early detection, or MCED. It's a liquid biopsy, a game changer in the medical field.
"It allows us to look for up to 50 different cancers at one time in a patient's blood and find out if these patients have cancer," Cripps said.
Doctors are already seeing remarkable results in the NHS-Galleri trial.
"Seventy percent of the cancers they've detected would not be detected any other way," Cripps said. "Then, half of the cancers were identified as stage 1 and 2, which is great because we're getting the early detection."
Cripps says the out of pocket cost is high, about $1,000. But that's nothing compared to the price you'd pay for cancer caught in the later stages. He says doctors are already prescribing it for high-risk patients.
"You think about firefighters saving lives and now we're talking about saving their lives. It's a different paradigm definitely from what firefighters are used to. They're always the heroes, worried about everyone else," Cripps said. "It's our time to start worrying about them, making sure they're healthy and they get to enjoy the benefits they've earned."
In partnership with the Firefighter Cancer Support Network (FCSN), the IAFF has designated January as Firefighter Cancer Awareness Month to provide firefighters the necessary tools and guidance to develop life-saving protocols for cancer prevention and to support those with a cancer diagnosis within their departments.
Bringing increased public awareness to occupational cancer in the fire service will help generate greater legislative support for states and provinces to establish presumptive disabilities for all cancers affecting fire fighters.
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