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Toni Stefani- A Firefighter’s Fight

Retired firefighter Captain Tony Stefani started with the San Francisco Fire Department in 1974. The 28-year veteran retired as the Captain of Rescue 1 in 2003. After being diagnosed with transitional cell carcinoma in 2001, he founded the San Francisco Firefighters Cancer Prevention Foundation and now serves as its President.

I was the Captain at Rescue One in San Francisco, one of the busiest firehouses in the United States. It is an extremely busy firehouse and rest is something you don’t often get. Keeping in top physical condition was very important.

In January of 2001, I went out for a morning run. As I headed back to the gym, I reached a point where I could barely walk. I was exhausted and just did not feel right. When I got back to the gym restroom, I urinated only blood, gross hematuria. I immediately went to my physician with a sample, and within a few days, I had an ultrasound which detected a mass in my right renal pelvis, up in my kidney. They tried to reach the tumor but could not, so I was referred to my surgeon, Dr. Marshall Stoller at UCSF. It turned out to be transitional cell carcinoma. Because it was located in my kidney, it was considered Upper Tract Urothelial Carcinoma (UTUC). On March 27, 2001, I had a radical nephrectomy removing the kidney entirely.

That’s my bladder cancer story. Of course, I had a follow-up every three months with cystoscopy for about two years. Eventually, they were spaced further and further apart. After 12 years, my surgeon said, “Okay, we’re at the point now where you’re basically cancer free. Go out and live your life.” And that’s the way I am now. I’m going on 18 years after my diagnosis and surgery.

Within two years after I was diagnosed, another firefighter came down with transitional cell carcinoma. There were five of us at Station 1 with bladder cancer. Two of us had UTUC transitional cell carcinoma in the renal pelvis, and the other three had bladder cancer. Only two of us are still alive. 

Tony Stefani, second from left, and members of the San Francisco Station One Fire Department

When I started in the Department in 1974, we very seldom wore self-contained breathing apparatus while fighting fires. As years went on in the mid-eighties, California OSHA made it mandatory that firefighters wear self-contained protective breathing equipment (SCBA’s) at working fires which is basically compressed air. We wore SCBA’s when we were fighting fires. But during the overhaul process, after the fire was out, they were taken off.

Unfortunately, the overhaul process is probably the most toxic time because these products of combustion are “off gassing” various chemicals, different polymers and everything that they’re made up of. We were all exposed to suspected toxic carcinogenic chemicals.

My doctor explained, “Okay you got a kidney, that’s a filtering system. It is not going to completely eliminate some of these carcinogenic properties that firefighters face. When the carcinogens come in contact with the urothelium, the tissue lining the bladder and the renal pelvis of the kidneys, there is a possibility of getting a mutation in your genes, and somewhere down the line contracting some form of cancer.” And that’s what’s been happening to many in our line of work.

The culture of my profession is changing now because of the greater awareness of the high rates of cancer in firefighters and other first responders – bladder and kidney cancer being two of them. Now with the turnout coats and the bunker gear that firefighters wear on the job, we take steps after working a fire we call gross decontamination. This is where firefighters are basically washed off with a hose. Firefighters get back on their rig to go back to quarters, and their equipment is cleaned.

In San Francisco we have $8,000 heavy duty washing machines that extract these toxins. While those contaminated clothes are being cleaned, the firefighter now wears a second set of turnout gear that is clean. In the old days, I probably washed my turnouts maybe three times in 28 years. I never cleaned up. When you’re around other fire companies, the guys who were the filthiest were held in the highest esteem because it was thought “those are the guys were fighting all the fires.”

Fortunately, this culture is slowly changing in a positive direction. The days that firefighters keep their turnouts without cleaning them are rare because firefighters are more aware of how important it is to have this equipment clean. That old way is behind the times because new information is available, not only to major metropolitan cities but small departments with volunteers, which makes up the most significant number of firefighters. The word about carcinogenic dangers on work clothes is out and is benefitting those on the job today.

However, standard operating procedures (SOPs) are not uniform across the United States. Every department has its own practices in place. In San Francisco, the SOPs have been standardized in the last few months. Our San Francisco Firefighters Cancer Prevention Foundation (SFFCPF) has pushed for standardization for nearly 13 years. It has taken this long for the administration to make this change.

Even now, there are hardheaded folks out there who say, “Hey, I’m fine. I can take the smoke, there’s nothing that’s going to bother me or hurt me.” At least until they get sick somewhere down the line or good friends from their station get sick. Then they come to the realization that they made a big mistake.

China Basin Fire, 1991. Tony Stefani, on the right.

I was motivated to start the SFFCPF because of the number of individuals with cancer at the firehouse where I worked. When I was sick, San Francisco did not have the Firefighters Cancer Presumptive Law in place. It was tough for me to prove that I got cancer because of the exposures I had on the job. We are not human guinea pigs, but the cities’ workers-comp division want you to explain why you think your cancer was job-related.

After they removed my kidney and I recuperated, I had used up all my sick and vacation time. I got to a point where I had no income. I was a Captain at the time. There were 200 officers in San Francisco, and each of them donated one day of leave time to me. That was over a year’s worth of actual service time. Their generosity made sure I had a paycheck on the table until I got to the point where I was able to retire. There was no way I could monetarily pay that back. This Foundation is a way for me to say “thank you” to those who helped me during my time of need. The SFFCPF has been dedicated to the detection and prevention of cancer for both active and retired firefighters since 2006.

We’ve been very successful at making changes in the firefighter culture by providing funding for various science-based studies that show the direct correlation between our job and elevated rates of cancer. We also identified of our 12 firefighters both active and retired, through our bladder cancer screenings, that did not know they had cancer.

We are now able to fund genomic testing for firefighters. We pay up to $3,000 to have their tumor genomes profiled to see if there is a targeted therapy for their particular type of cancer. We pay up to a $1,000 for second opinions. We also provide some travel expenses for a San Francisco firefighter and his/her family, to travel a top-notch cancer center for a type of treatment that may not be readily available here.

We have no paid employees; nobody makes a penny. We now have cancer navigators that will help a firefighter who is diagnosed. The navigator can tell them the studies that we’ve been involved with and the doctors that we recommend for second opinions and what direction we think they might want to investigate.

I hope those reading this article come to the realization of how dangerous our profession is, not only the possibility of being killed at a working fire but also the greater than one in two chance of getting sick at some point. Would I do it all over again? That is easy to answer, absolutely! It truly is the greatest job in the world.

 

About the Firefighters Cancer Presumptive Law:

Many states cover firefighters for one or more cancers under workers’ compensation because of presumptive legislation. This presumptive legislation contains broad or nonspecific language that can be interpreted to cover any cancer experienced by a firefighter. Most commonly those are leukemia, non-Hodgkin lymphoma, brain cancer, bladder cancer, and gastrointestinal cancer.

San Francisco adopted this law in 2014, after one of the studies that they were involved in with the Center for Disease Control’s National Institute for Occupational Safety and Health (NIOSH). NIOSH sent out three epidemiologists to San Francisco in 2010 to see if there was a direct correlation between firefighting and elevated rates of cancer. The law is nationwide, but it’s up to each municipality to adopt it.

Find out if your state has adopted this legislation: www.FirstResponderCenter.org/cancer/toolsresources/presumptive-legislation-firefighter-cancer-state/