For Fayetteville firefighters, the simple process of having their blood drawn means something big this year: getting tested for over 20 types of cancers.
The blood test, called the OneTest, is new to this year’s Fayetteville Fire Department’s annual physical. OneTest screens a person’s blood for markers of a wide range of cancers, including prostate cancer and mesothelioma. According to OneTest’s website, over 5,000 firefighters from departments across the country are using it to screen for early signs of cancer.
“We want everyone to be happy and healthy and live a full life,” Assistant Fire Chief Adam Ferguson told CityView. “We’re truly committed to everyone going home well and this is just one step in the many things we’re doing for our folks.”
The OneTest uses a machine-learning algorithm to identify molecules in the blood that indicate cancer before symptoms manifest. Its results assess the total risk for 26 cancers, flagging any possible abnormalities. By alerting a person to their increased risk, it allows them to speak with their physician and possibly seek early treatment.
“We know that the risk is real and it’s here and it happens,” Ferguson said. “We’re trying to do all that we can for our folks to reduce the risk for them. But if they do, unfortunately, come down with cancer, we hope that we can catch it early using this because the earlier you catch it, the more treatment options there are.”
Ferguson said the screening took almost a decade for the city’s firefighters to obtain, mostly because of the cost. The OneTest Standard costs about $200 per test. The premium version costs $345 per test and includes specific risk evaluations for eight common cancers, including breast and lung cancers.
The City of Fayetteville allocated over $45,000 to pay for this year’s tests for the 350 professional firefighters that run the Fayetteville Fire Department.
While OneTest helps identify cancers early, the test’s website states that OneTest “should not be the only tool leading to a diagnosis of cancer.” The test also only predicts cancer risk over 12 months so OneTest’s website says it is best if run annually.
Occupational cancer — cancer caused by exposure to carcinogens at a person’s workplace — is the leading cause of line-of-duty firefighter deaths, according to The International Association of Firefighters. Seventy-two percent of the association’s members died from occupational cancer in 2023. A U.S. firefighter is 14% more likely to die of cancer than the general American, according to research from the National Institute for Occupational Safety and Health.
Firefighters are also at higher risk for specific cancers, including skin, brain and colon cancers. According to the Firefighter Cancer Support Network, male firefighters are more than two times more likely to be diagnosed with testicular cancer. Firefighters are also two times more at risk of getting mesothelioma, tumors that develop in the lining of the protective cavities that surround the lungs, abdomen, heart or testicles.
“All the reports, all the research, even the CDC, they all point to the same thing,” Ferguson said. “And that’s that firefighters have a much greater risk of cancer than the general population.”
The Fayetteville Fire Department isn’t immune. Battalion Chief John Bowen was the first city firefighter to have an in-line-of-duty death because of occupational cancer. Bowen died of colon cancer in 2022. He was only 35.
Ferguson said the department has lost at least six active firefighters to cancer tied to firefighting. None were ruled in-line-of-duty deaths since state statute only recognizes six cancers as such: mesothelioma, testicular cancer, cancer of the small intestine, esophageal cancer, oral cavity cancer and pharynx cancer. Ferguson also said the department has likely lost more firefighters to cancer as many are diagnosed further into their retirement and can’t be directly linked back to firefighting.
The department does talk about cancer as part of its Fire Training Academy, educating future firefighters on the risks of cancer through exposure to the multiple carcinogens that come as part of the job. Many are emitted from the metals, plastics and other materials burned in a fire and the soot can get into the lungs and on the skin of firefighters trying to put it out. Firefighting protective gear, called turnout gear, also contains carcinogens like PFAS that can lead to cancer.
Chris Ignacio, a 10-year Fayetteville Fire Department firefighter at Fire Station 17, worries about his increased risk of cancer even while he’s facing down blazes.
“This is such an issue and something that we fear as firefighters,” Ignacio told CityView.
He’s been one of the firefighters asking for cancer screening tests to be made available to the department, particularly as he saw more of the firefighters around him diagnosed with cancer. Finally seeing the test be implemented at this year’s annual physical meant a lot to Ignacio.
“We’re taking the right steps in ensuring that we catch it early,” Ignacio said.
While it took years to get the cancer screening for Fayetteville’s firefighters, the department spent that time taking other cancer-prevention steps. The department started teaching firefighters how to properly clean their equipment since carcinogenic soot often remains on it long after a fire is put out. It purchased a second set of turnout gear for all firefighters so they have something clean to wear when they return to their stations after fighting a fire.
The Fayetteville Fire Department also purchased more extractors, or special washing machines that can remove carcinogens from the turnout gear, and installed them in all 17 fire stations across the city.
“We’re continuously striving to do better for our folks,” Ferguson said.
The state is also making efforts to address cancer rates among its firefighters. Run out of Duke University’s Stapleton Lab, the North Carolina Firefighter Cancer Cohort Study is looking to determine the specific carcinogenic chemicals firefighters are exposed to, whether through fires or their turnover gear. Currently, 263 North Carolinian firefighters are enrolled in the study.
The study is part of the national Fire Fighter Cancer Cohort Study. As of September 2024, over 6,000 firefighters, including those in North Carolina, are participating. The prospective study aims to study firefighters’ real-time exposure to carcinogens to evaluate current firefighting practices and the risks they pose.
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the CityView News Fund.
Robert Scoggins, career fireman at Station Two, passed over a decade ago to cancer. I do not know if it was occupational related, but I hope these screening efforts can be made in his honor. He was one of three firefighters who saved my daughter almost 20 years ago. I am thankful everyday for their quick action and bravery to save our child.