More exposed to cancer – Norwegian firefighters pushing for legal change

In 2022, the firefighter occupation was classified as carcinogenic to humans by the WHO’s International Agency for Research on Cancer (IARC). With this classification, the IARC has determined that firefighters, who overall are healthier and fitter than the average population, face a considerably heightened risk of developing certain cancers.  

Researchers found the most evidence for a link to bladder cancer and mesothelioma—a type of cancer that primarily originates from the lining of the lungs. The IARC also pointed to increased occurrences of colon cancer, prostate cancer, testicular cancer and melanoma of the skin, but said that so far it was not possible to establish a causal relationship here.

Complex exposure

Nordic studies formed part of the knowledge base for the IARC’s conclusions. A Norwegian survey found 845 cancer cases in 3.881 firefighters working across 15 Norwegian fire departments.

“That is a 15 per cent higher cancer risk compared to the population average,” says Niki Marjerrison. She is a researcher at the University of Oslo, who also works on projects run by the Cancer Registry of Norway.

Researchers are trying to find out why firefighters develop cancer more often than other occupational groups.

“It is challenging to look into this because the types of exposure are so complex,” says Marjerrison.

What and how much risk

One of the things looked at in the project “Cancer risk among firefighters” was the risk for types of cancer that are known to be linked to substances firefighters are often exposed to. These include soot, asbestos, fluorine compounds in foam, diesel fumes and lead.

Even if protective gear is being used correctly, chemicals can enter the body through airways or the skin. 

Marjerrison says the survey shows there is extra risk connected to developing cancer of the urinary tract, larynx, and the lining of the lungs.

Unwise choices

Tommy Kristoffersen heads Firefighters Against Cancer. The organisation highlights the cancer risk in the profession, conducts awareness campaigns among employees and employers, lobbies municipalities to invest in preventive measures and works to strengthen the safety net for colleagues affected by cancer. 

Kristoffersen has worked in the fire service for 28 years. He says awareness of preventative action is completely different now than before.

“Throughout the years, we have done many things wrong and made many unwise choices. We did not know how big the cancer risk was and we did not focus much on preventative routines and measures,” he says. 

Things are now going in the right direction, believes Kristoffersen. He says there is far more awareness today among individual firefighters and at fire stations than earlier. One measure is the introduction of clean and dirty zones in fire stations.

“Yet there are sadly still politicians in Norwegian municipalities who are not willing to invest in the measures that are needed to get the fire station to an acceptable level,” says Kristoffersen. 

There is also more awareness around occupational hygiene and protective equipment.  

“But even if we use the best protective equipment on the market, firefighters are exposed every time they put out a fire. No firefighter can protect themselves 100 per cent from being exposed,” says Kristoffersen.

Responsibility when someone becomes ill 

Firefighters Against Cancer are also working to secure a proper safety net for firefighters who develop cancer. 

“We deliberately send firefighters into the smoke and we know they will be exposed. They carry out an important job for society. They save lives and property. But when they develop cancer and become seriously ill, they are left to their own devices. They suffer a silent death,” says Kristoffersen.

He believes society must also take responsibility when a firefighter develops cancer. Today, it is hard to get acceptance for the fact that the job is the reason behind a cancer diagnosis, which means victims cannot access compensation.

Strict regulations

The Norwegian Union of Municipal and General Employees has for many years worked to secure firefighters the right to have cancer accepted as occupational damage. The union collaborates with Firefighters Against Cancer and the Norwegian Cancer Society. 

Firefighters Against Cancer participate in Bergen City Maraton (relay) and Holmenkollstafetten in Oslo. They run in full gear. Photo: Firefighters against cancer

The Union argues that the evidence requirements are too strict. Today, each firefighter must document which substances they have been exposed to and demonstrate that these are the cause of the illness.

“This is incredibly demanding. The burden of proof put on the individual firefighter is near impossible,” says Anne-Gry Rønning-Aaby. She is a lawyer for the Union of Municipal and General Employees and has worked on cases involving firefighters with cancer for many years.

She has taken some members’ cases all the way to the Norwegian Supreme Court to secure occupational compensation. Some cases have succeeded, others have not.

Fought and lost

The best-documented case is that of Henry Sørensen. He was a smoke diver for 15 years before developing prostate cancer. Sørensen applied for workers’ compensation from the Norwegian Labour and Welfare Administration, NAV, but was turned down.

With support from the Union of Municipal and General Employees, he took his fight for having his cancer recognised as an occupational injury to the Supreme Court.

Anne-Gry Rønning-Aaby represented Sørensen. The Union argued that the cancer had developed as a result of exposure to smoke from fires and chemicals that he was exposed to throughout his career as a firefighter, and presented comprehensive research surrounding this. But the Supreme Court disagreed and supported NAV.

"It is remarkable that even though the Supreme Court agreed firefighters are exposed to a range of chemical substances that are or might be carcinogenic, and that 'nearly all research shows firefighters collectively to have a heightened risk of being diagnosed with prostate cancer', and when research consistently finds a 15 to 30 per cent increased incidence in prostate cancer in firefighters and more than 50 per cent in younger firefighters compared to the rest of the population, this was not considered sufficient documentation to establish causality," says  Rønning-Aaby.

The organisation Firefighters Against Cancer does a lot of attitude-building in the workplace. Photo: Firefighters Against Cancer. 

The reason was that the Supreme Court, despite extensive research, finds that the uncertainty is too great to consider it 'more likely than not that exposure in the firefighting profession' is what causes the cancer because it cannot be ruled out with a reasonable degree of certainty that coincidences, biases in the material or the confounding with other causes are responsible.

Lawyer Rønning-Aaby says that with requirements for scientific documentation at that level, it is nearly impossible for a firefighter to prove that cancer is caused by the profession.

“The demands for evidence are too strict,” she argues.

Wants to change the rules

The Union of Municipal and General Employees and Firefighters Against Cancer believe today’s legislation does not work as intended when it comes to covering the costs of participating in the labour market and serving society and providing economic compensation if your job ruins your health. Cancer must be included in the occupational ill health list for this group, they argue.

They point to Canada, Australia and the USA, countries with different workers’ compensation systems. There, the burden of proof is the opposite of what it is in Norway; it is not up to the worker to prove that a cancer diagnosis is caused by their job. 

“When research so clearly shows firefighters run a higher risk of developing cancer, Norwegian legislators must change the legislation,” argue both Rønning-Aaby at the Union of Municipal and General Employees and Kristoffersen from Firefighters Against Cancer.