A 2023 Perspective on Female Firefighters and the National Firefighter Registry for Cancer

By Dr. Lindsay Judah, CFO, CTO

With October being Breast Cancer Awareness Month, I wanted to take an opportunity to highlight the realities of cancer among female firefighters and share a new initiative to understand and reduce cancer for women in the fire service. 

According to the U.S. Cancer Statistics, which shares the prevalence of different types of cancers, including all races, ethnicities and professions, female breast cancer was the #1 leading cause of new cancer cases in 2020. Additionally, female breast cancer was the #2 leading cause of death by cancer in 2020; for context, the #1 leading cause of death by cancer was lung or bronchus cancer. A report by the Center for Fire, Rescue, and EMS Health Research, NDRI-USA Inc., entitled, Firefighters and Breast Cancer summarizes important research about breast cancer and its risk factors (occupational exposures) in firefighters. Another study on cancer incidence and mortality from three fire departments by Daniels and colleagues identified nearly half of all cases of cancer and most cases of cancer deaths in female firefighters were due to breast cancer. In this same study, rates of cancer diagnoses and deaths in female firefighters were about 45% higher than observed in the general population. The results were not statistically significant, possibly because of the small number of female firefighters included in the study.

There is hope for change, I am pleased to share information about a new effort by the National Institute for Occupational Safety and Health (NIOSH) to understand and reduce cancer among U.S. firefighters: the National Firefighter Registry (NFR) for Cancer. Female firefighters constitute almost 4% of the U.S. career fire service (and 8% in the volunteer fire service), but few cancer studies have focused on female firefighters due to the limited sample size and participation rates. The NFR is trying to change that by encouraging all female firefighters across the nation to visit the NFR website and enroll. 

Enrolling in the NFR includes creating a secure account, completing the informed consent, and NFR survey. It should take less than 30 minutes. Our existing female firefighter data set is minimal. The only way we can increase the data set is by contributing our personal experiences and related history that you’re willing to share. You may skip questions in the NFR survey that you prefer not to answer. Additionally, firefighters who have not been diagnosed with cancer may provide important data (a diagnosis is not required). The information collected is confidential and will contribute to this important work by NIOSH. The NFR requests participation by all genders, those who have left the profession, retirees, inspectors, investigators, instructors, volunteers and wildland firefighters.

I would also like to take this opportunity to highlight a few female firefighters and supporters of female firefighters. I realized in recent months after reading female firefighter-specific articles and books that there should be more written work published by and for female firefighters. Here are a few books, articles, and research for your review.

Books:

Breathing Fire: Female Firefighters on the Front Lines of California’s Wildfires by Jamie Lowe (2022) Learn about the Line of Duty Death of firefighter Shawna L. Jones and about the experience of incarcerated female firefighters. 

Fighting Fire by Caroline Paul (2011) Stanford grad turned San Francisco firefighter. 

The Fire She Fights by Tracy Moore (2022) I recall Tracy handing her book to me at the 2022 Women in Fire conference. She asked if I was a firefighter and said, “I promise you’ll see yourself in this book.” Her statement was true. Some of the content is heavy. “The courage to fight the fire pales in comparison to the courage required to feel valuable when treated as less-than.”

The Heat of the Moment: A Firefighter’s Stories of Life and Death Decisions by Dr. Sabrina Cohen-Hatton (2020) Many fire service topics are discussed throughout her book, including communication, decision-making, incident command, personal resilience, and situational awareness. “We are all only human.”

Articles & Research:

‘Be a Not-Knower’: The Power of Leading with Humility by Dena Ali (2023) “Leaders who model “not knowing” foster environments where members feel they can explore new ideas and offer solutions.”

Does Sexual Harassment Prevention Training Work? Can It? by Alisa Arnoff, Esq. & John Rukavina, Esq. (2022). “We’ve been focused on reducing liability, but we’re not effectively addressing the prevention of wrongful conduct in the first place.”

Female Firefighters’ Increased Risk of Occupational Exposure due to Ill-Fitting Personal Protective Clothing by Dr. Meredith McQuerry (2023) I had the opportunity to complete a firefighter gear fit study with Dr. McQuerry and her team at Florida State University, she has continued to advocate for functional, safer, and better fitting gear for female firefighters. 

Firefighter Inclusion and the Role of the Company Officer by Shara O’Neal Thompson (2023) “Fire department administrations play a crucial role in establishing an inclusive culture, but it is only effective if company officers implement the department’s policies and practices.  Emphasis on treating all firefighters as insiders and encouraging them to retain their uniqueness will allow them to feel true belongingness with high value.”

Meditations on Middle Management from a Battalion Chief by C.C. Speight (2023) “We must become educated on the issues that affect us within the wider context of public administration. We must learn to identify complex problems prior to attacking them with the same mentality we use to attack fires and cardiac arrests. We must learn to listen and to navigate conflict, to conduct research and to become comfortable with internal and external politics.”

My Epiphany as A New Company Officer by Teresa Jacklyn (2023) Lieutenant shares an important message about the potential of a Line of Duty Death occurring within any jurisdiction. Let’s remember not to otherize things we are not immune to experiencing.

‘Not everyone’s cup of tea’: Mississauga Fire Chief Deryn Rizzi’s Unconventional Climb Up the Ladder by Paige Peacock (2023) “We believe in public safety and that’s the important thing to me.” She shares insight on her journey to Fire Chief which required support from leadership to acknowledge her potential.

“Trying to Eat an Elephant”: The Complexities of Bullying Training in the Fire Service by Dr. Maria Koeppel, Dr. Brittany S. Hollerbach and colleagues (2022) “Bullying in the fire service has long been overlooked, although efforts to understand the phenomenon have increased over the past few decades. Recent research has highlighted high rates of bullying in the fire service, regardless of gender and race.”

Executive Fire Officer (EFO) Paper & Naval Postgraduate School (NPS) Thesis:

Exploring the Role of Psychological Safety and Trust in the Lived Experienced of Women in the Fire Service by Benjamin Fleagle (2023) “A further 30% reported their senior leadership went around them to speak with their firefighters/crews concerning their performance as officers (Firehouse, 2021). These statistics, while not part of a peer-reviewed study, still point to a problem with violations of trust among female firefighters and fire officers with their direct supervisors and senior leadership.” Topics highlighted in the text are dirt shooting, leadership, psychological safety, trust and more.

Working Fire: Recruitment and Retention of Women Firefighters by Heather Marques (2022) Chief shares many great takeaways as it relates to female firefighter recruitment and retention. A few topics include challenges in promotions, females being othered, the importance of male mentors and so much more. “With a focus on both racial diversification and gender integration, the fire service has an opportunity to harness massive pools of untapped talent and reshape its identity.”

I firmly believe in the notion of “if you can see her, you can be her.” My initial experience in the career fire service was unique, in that I was hired by a female Fire Chief in Tallahassee, FL. Additionally, there was a female Battalion Chief overseeing Northside, C-shift. As I saw it, if they could succeed in their roles, there was no reason why I couldn’t aspire to do the same. In fact, I was in the City of Asheville, NC for a Staff Ride last month with the National Fallen Firefighter Foundation® and Battalion Chief Sharon Lippman (now retired, December 15, 1986-January 2, 2012) hollered up the hill toward me, “Lindsay?!” She just happened to be in town for a wedding and we made time to grab a cup of coffee before departing. I told her while we were walking to High Five Coffee that she was an inspiration to me.

She taught me how to read cardiac rhythms, I called her at 5 a.m. after returning from my first house fire to tell her about it and could hear her genuine support, and she even commanded a fire where I dove in the second-story window. She inspired me to physically prepare, to train and learn everything that I could, and I was promoted to District Chief later in my career in Pinellas County, FL. There are opportunities to guide, inspire, and mentor, driven and passionate human beings in the fire and emergency services industry, and some of those human beings are female!

Chief Lippman and I in Asheville, NC, 2023.

References

Center for Disease Control and Prevention. (2023). Cancer Statistics At a Glance. Retrieved from https://gis.cdc.gov/Cancer/USCS/#/AtAGlance/  

Center for Disease Control and Prevention. (2023). National Firefighter Registry (NFR) for Cancer. Retrieved from https://www.cdc.gov/niosh/firefighters/registry.html

Center for Fire, Rescue and EMS Health Research, NDRI-USA Inc., (2022). Firefighters and Breast Cancer. Retrieved from https://firefightercancersupport.org/wp-content/uploads/2022/12/Breast_v6.pdf 

Daniels and colleagues. (2014). Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009). Retrieved from https://oem.bmj.com/content/71/6/388 

Lindsay Judah, DPA, CFO, CTO currently serves as a consultant and previously served as a District Chief in Florida. She’s also an adjunct professor and alumna of Valdosta State University, teaching courses in Organizational Leadership and Public Administration. Her doctoral research focused on implementing innovation in the fire service, specifically UAV programs. She is an Everyone Goes Home® Advocate, serves on the Awards and Scholarship Committee for the Florida City County Management Association and participated on the IFSTA Validation Committee for Chief Officer 5th ed.

The opinions expressed in this article are those of the author and do not represent any organization.

Photo by Stephen Baer