When Cancer Strikes Too Early: What Emerging Research Means for Women in the Fire Service

This article is part of a series of posts led by CHASI Research Associate Len Garis, who has been a long-time partner of CHASI through his work with the National Indigenous Fire Safety Council. His guest blog posts explore a wide range of topics related to firefighting and firefighters in Canada. You can read all of his guest articles at this link. This article was originally written for Firefighter Cancer Awareness Month in January.

Len Garis, Anna Wilkinson

Every January, Firefighter Cancer Awareness Month asks the fire service to confront a difficult certainty: cancer remains the leading cause of line‑of‑duty death. Yet one group continues to sit at the edges of our data — female firefighters.

Their numbers may be small, but the risks they face are not. And while the research base is still developing, early findings point toward a concerning pattern: some female firefighters are reporting cancer diagnoses at younger ages than expected in the general population, often before they qualify for routine screening. When these emerging signals are viewed alongside new evidence from the broader public, the implications for screening policy become increasingly difficult to ignore.

This is not just a health issue. It is a workforce issue, a gender‑equity issue, and a matter of occupational justice.

A Hidden Population With Distinct Exposure Patterns

The 2022 study Female Firefighter Work Related Injuries in the United States and Canada surveyed more than 1,100 active female firefighters.^[1] Although the study focused on injuries, it revealed a pattern relevant to long‑term health: women who reported injuries tended to be older, had more years in service, and had significantly more fires and toxic exposures.

In other words, the longer women serve, the more they accumulate the exposures already linked to cancer in the broader fire service.

The 2023 study Cancer in Female Firefighters^[2] provides additional insight, though with important limitations. Among 256 women who self‑reported cancer or precancerous conditions, researchers observed that:

Women with cancer had more years in the fire service
They reported higher numbers of career fires and toxic exposures
They were less likely to remain in active service
The average age at diagnosis for pre-cancerous lesions was 40.9
The average age at diagnosis of cancer was 44.2

This does not establish a population‑wide diagnosis age — the sample is small and self‑selected — but it does highlight a potential early‑onset pattern that warrants further investigation.

New Age‑at‑Diagnosis Data: What We Can Reliably Interpret

A recent analysis of self‑reported cancer and pre-cancer cases among female firefighters provides additional context. Because the sample size was small, only those types of cancers with ten cases or more are reported.

Cancer Types With more than 10 Cases

Cancer Type	Number of Pre-cancers	Average age at diagnosis of Pre‑Cancer	Cancer N	Average Age at Cancer Diagnosis
Breast	21	45	37	45
Uterus^[3]	31	34.3	12	40.2
Melanoma	34	39.7	22	45.1
Other	51	39	21	39.3

Even with these limitations, a pattern emerges: cancers appear to be occurring in women in their 40s and even 30s — many before our national recommendations suggest that routine screening begins.

This reinforces what the earlier studies suggested: some female firefighters may be experiencing cancer earlier than expected, and current screening guidelines do not reflect the exposure realities of the job.

The Screening Gap: When Eligibility Doesn’t Match Occupational Reality

In Canada, our national guidelines recommend that average risk breast screening begins at age 50, but almost all provinces now have access to screening starting at age 40 or 45. However, many breast screening programs for women aged 40-49 do not issue invitations or recall reminders, and so women must be aware and self-advocate to gain access. Cervical cancer screening begins at age 25, but access to HPV testing — the more accurate method — remains inconsistent across the country. Colon cancer screening starts at age 50, and lung cancer screening, which is also not available across the country, is considered in those individuals who have smoked a pack of cigarettes a day for about 20 years and are 55 or older.

If some female firefighters are reporting cancer diagnoses in their 40s, then our national screening guidelines might not be aligned with occupational risk. While the current available research cannot yet quantify the true incidence or establish causation, it does warrant more research to expose any potential mismatch between exposure and eligibility.

New Evidence From the Public: Screening at 40 Improves Outcomes

A 2025 study in Radiology: Imaging Cancer examined 821 breast cancer cases in women aged 40 and older.^[4] It found that:

Symptom‑detected cancers were 6.6 times more likely to be advanced stage
Symptom‑detected cancers carried a 63% higher risk of breast‑cancer‑related death
Women aged 40–49 — a group not routinely screened in many Canadian jurisdictions — had the highest proportion of symptom‑detected cancers
Screen‑detected cancers were overwhelmingly early stage
Mastectomy rates were significantly higher when cancers were detected due to symptoms

Meanwhile, two studies with Statistics Canada found that women living in a province with an organised breast screening program for women 40-49 had earlier stage cancers at diagnosis, lower mortality and increased survival compared to provinces which did not have programs.^[5]

The conclusion is clear: for the general population, starting screening at 40 improves outcomes.

For a workforce showing signs of even earlier diagnoses, the implications are significant.

What the Evidence Suggests — and What It Cannot Yet Tell Us

The research on female firefighters is still emerging, and the sample sizes remain small. The cancer study relied on voluntary self‑reporting, which introduces selection bias and limits generalizability. These limitations matter — and acknowledging them strengthens, rather than weakens, the argument for action.

What the evidence suggests:

Female firefighters experience occupational exposures known to increase cancer risk
Some are reporting cancer diagnoses at younger ages than the Canadian population
The average reported age at cancer diagnosis falls below national screening guideline recommendations
Broader population research shows clear benefits to earlier screening

What the evidence cannot yet determine:

The true incidence of cancer among female firefighters
Whether the reported earlier diagnoses reflect a broader trend
The precise relationship between exposures and cancer onset

But in occupational health, waiting for perfect data has historically meant acting too late.

Why Female Firefighters May Face Earlier or Elevated Cancer Risks

Female firefighters encounter a constellation of carcinogenic and hormonal stressors:

Carcinogenic exposures: combustion by‑products, diesel exhaust, PFAS, flame retardants, building materials
Shift work and circadian disruption: linked to breast cancer through melatonin and estrogen pathways
PPE not historically designed for women: increasing exposure pathways
Station design and decontamination challenges: cross‑contamination risks
Cultural barriers to reporting symptoms: fear of being perceived as weak
Biological vulnerability: younger breast tissue is more sensitive to carcinogens

These factors do not prove causation, but they do create a risk profile that differs from the general population and is not adequately addressed by current screening guidelines.

What Earlier Screening Could Mean for the Fire Service

If screening policies were aligned with occupational risk, the benefits could be substantial:

Earlier detection and improved survival
Less aggressive treatment
Lower long‑term costs for employers and insurers
Improved retention of experienced female firefighters
A modern, evidence‑aligned safety culture

The fire service has embraced decontamination, clean‑cab policies, and exposure tracking. Screening is the next logical step.

A Precautionary, Evidence‑Aligned Recommendation

Based on the emerging research and the broader screening literature, a reasonable, risk‑aligned screening approach for female firefighters could include:

Breast cancer screening starting at age 40
- Consideration of earlier initiation of screening based on family history (10 years prior to the age at diagnosis of the first degree relative)
- Consideration of high-risk screening if lifetime breast cancer risk >25% https://ibis.ikonopedia.com/
Colon cancer screening starting at age 45
- Consideration of earlier initiation of screening based on family history (10 years prior to the age at diagnosis of the first degree relative)
Cervical cancer screening starting at age 25 with HPV screening
Yearly skin exams
Lung Cancer screening if eligible, starting age 55
On‑duty access to screening and paid medical time
Integration of screening into occupational health programs
Expansion of presumptive legislation to include female‑specific cancers

This is not preferential treatment. It is a precautionary, evidence‑informed approach to prevention.

Honouring the Women Who Serve

Female firefighters step into the same burning buildings, breathe the same smoke, and carry the same burdens as their male colleagues — often while navigating equipment, policies, and cultural expectations that were not designed with them in mind.

They deserve screening policies that reflect the realities of their work, not the assumptions of the general population.

Cancer does not wait for eligibility guidelines.
It does not pause for policy debates.
It does not care about age thresholds.

If we want to honour the women who serve, we must ensure that the tools of prevention — especially screening — are aligned with the risks they face every day.

Firefighter Cancer Awareness Month is the moment to say it clearly:
Female firefighters need earlier screening.
They need better support.
And they need policies that reflect the risks of their profession.

The research may still be growing, but the direction is unmistakable.

Authors

Len Garis is director of research for the National Indigenous Fire Safety Council, Ret. Fire Chief for the city of Surrey, B.C., Research Associate – University of the Fraser Valley associate scientist emeritus with the B.C. Injury Research and Prevention Unit. Contact him at lwgaris@outlook.com.

Anna Wilkinson is a family physician and GP Oncologist at the Ottawa Hospital. She is an Associate Professor in the Department of Family Medicine at the University of Ottawa, Program Director for the PGY-3 FP Oncology program and Regional Cancer Primary Care Lead. Contact: anwilkinson@toh.ca

^[1] Pawer S, Turcotte K, Desapriya E, et al. Female Firefighter Work‑Related Injuries in the United States and Canada: An Overview of Survey Responses. Frontiers in Public Health. 2022.

^[2] Kunz KR, Turcotte K, Pawer S, et al. Cancer in Female Firefighters: The Clinicobiological, Psychological, and Social Perspectives. Frontiers in Public Health. 2023.

^[3] Uterus may include Uterine and/or Cervical cancers

^[4] Munir J, Nisha Y, Islam N, et al. Impact of Method of Detection of Breast Cancer on Clinical Outcomes in Individuals Aged 40 Years or Older. Radiology: Imaging Cancer. 2025.

^[5] https://www.mdpi.com/1767156, https://doi.org/10.1200/JCO.23.00348