Read Time: 7 Minutes
Takeaways:
- Legislation drove action. House Bill 65 (2025) expanded presumptive cancers to 15 and funded a three-year statewide screening initiative built on years of collaboration among firefighters, lawmakers, insurers, and researchers.
- Screening plus research strengthens prevention. Comprehensive MRI, CT, blood, and specialty exams are paired with environmental exposure research and long-term survivorship planning to better understand cancer risk in firefighters.
Impact: Researchers at Huntsman Cancer Institute are advancing environmental exposure science, survivorship research, and long-term data strategies to strengthen firefighter cancer prevention and early detection efforts statewide.
Firefighter Cancer Risk and the Legislation That Changed Screening in Utah
For more than 20 years, conversations about firefighter cancer risk have been quietly building in Utah. What began as discussions with the firefighters union has grown into a nationally watched effort to expand cancer protections, invest in research, and catch disease earlier, before symptoms ever appear.
Kurt Hegmann, MD, MPH, Dr. Paul S. Richards Endowed Chair in Occupational Safety and Health for University of Utah Health and director of the Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), has been part of that journey from the beginning.
“In 2015, Utah lawmakers made a few cancers presumptively work-related for firefighters if they were exposed in the line of duty,” Hegmann explains. Those early bills—Senate Bill 135 (2015) and later Senate Bill 159 (2023)—laid the groundwork.
A 2023 study bill sponsored by Senator Curt Bramble directed experts at RMCOEH to more closely examine firefighter cancer risk and exposure data. That report became the basis for House Bill 65, passed in 2025, which expanded the list of presumptive cancers to 15 and provided state funding for a three-year cancer screening project.
The legislation was the result of negotiations among firefighters, lawmakers, and insurance representatives, reflecting years of collaboration across stakeholder groups.
Since September 2025, more than 130 firefighters have already been screened.
What Screening Includes: MRI, CT, and Comprehensive Exams
The screenings are comprehensive: blood tests, “forever chemical” tests, urology and dermatology exams, occupational and preventive medicine evaluations, a low-dose CT scan for lung cancer, and a full MRI from head to torso. Clinical testing is coordinated through the RMCOEH, with the University of Utah’s MRI research group having designed a screening protocol.
The urgency behind the effort became personal for Hegmann during a visit to Arizona several years ago. He traveled with six firefighters to observe a free screening program at the Vincere Cancer Center in Scottsdale.
“Three asymptomatic cancers in six guys,” he recalls. “On the drive back to the airport, I thought about how some days small things happen—and then there are days you get out of bed and your life changes.”
That experience helped fuel momentum to build a Utah-based screening program grounded in research and tailored to firefighters’ specific risks.
Expanding the Research Lens
At Huntsman Cancer Institute, Judy Ou, PhD, MPH, an environmental epidemiologist and assistant professor of pediatrics at the University of Utah (the U), has been working alongside colleagues to support the initiative and expand its research potential.
Ou studies how environmental exposures influence cancer risk and survivorship outcomes in vulnerable populations, including those diagnosed early in life and occupational cohorts like firefighters. Her work uses novel statistical, data science methods, and primary data collection to explore how environmental triggers may affect cancer etiology and augment the long-term toxicities of cancer treatments.
“Our primary purpose was to show our support and speak positively about the program,” she says. But the opportunity extends far beyond screening alone.
“Usually these firefighters are young people,” Ou explains. “Even when treatment is done, survivorship is a long road.” Many face additional health challenges like hearing loss, chronic fatigue, or potential cardiotoxic side effects from cancer therapies, and even second cancers. And firefighters are often expected to return quickly to demanding work or work while they are being treated for cancer, which can last from a few months to several years depending on the type of cancer and its stage of diagnosis.
In collaboration with Anne Kirchhoff, PhD, MPH, investigator at Huntsman Cancer Institute and professor of pediatrics at the U, and James Vanderslice, PhD, investigator at Huntsman Cancer Institute and chief of the Division of Public Health in the Department of Family and Preventive Medicine at the U, Ou’s National Institutes of Health-funded research builds on her broader work in environmental health and cancer survivorship. This includes studies on air pollution’s impact on cardiovascular and respiratory outcomes among cancer survivors, which has been supported through competitive extramural funding. These projects explore how environmental factors contribute to long-term health risks, a perspective that directly informs thinking about firefighters’ occupational exposures.
She and Hegmann have also discussed building a long-term survivorship cohort to better understand outcomes over time.
One of the long-term research goals is to link firefighter exposure and health outcome data with the Utah Population Database. Access to comprehensive records could allow researchers to retrospectively identify firefighters and examine which cancers and other diseases occur most frequently—strengthening both scientific knowledge and prevention strategies for occupational exposures. This approach mirrors Ou’s past work linking environmental exposures, air pollution, and health outcomes using the same database resources.
Occupational Exposure, Wildfires, and Cancer Risk
The environmental questions are equally pressing. How should personal protective equipment exposed to wildfire smoke be stored? How is climate change affecting carcinogen exposure? What happens when contaminants are unknowingly brought home?
“I remember learning about firefighter cohorts in Florida and other states,” Ou says, “where harmful chemicals were unknowingly being brought home and mixed in the wash.” Simple changes, like hosing off gear outside, can reduce secondary exposure to families.
“These firefighters may have young children and families,” she adds. “Utah is such a family-focused place. We have to think about how exposures affect not just the firefighter’s cancer risk, but the household’s cancer risk too.”
Ou notes that many firefighters face a difficult tradeoff—working in a profession that provides stable income and health insurance, while also carrying elevated exposure to carcinogens. “People are living in a world full of carcinogens,” she says. “This study highlights the difficult choices people have to make.”
Building Trust to Improve Firefighter Cancer Research Participation
The research landscape presents challenges. Participation in research nationwide hovers between 5–15%, making trust and long-term partnership essential.
“We want to see people before they get cancer,” Ou says. “That means cultivating relationships and buy-in.”
Future plans include strengthening relationships with fire departments across Utah. Hegmann regularly meets with fire chiefs across the state—from full-time departments to volunteer units—presenting findings and outlining next steps.
“Coordination is critical,” he says. “All of these departments operate differently.”
A linchpin in this effort is Utah Valley University’s Utah Fire Rescue Authority (UFRA) in Provo, which is the headquarters for training firefighters in Utah. UFRA is the statutory lead with RMCOEH in the firefighter cancer screening project and has the key firefighter contact information involving all departments, ranging from large, full-time urban agencies such as the Unified Fire Authority to small volunteer departments, each with different schedules, staffing structures, and resource constraints that make statewide coordination both complex and essential.
Early Detection of Cancer in Firefighters Saves Lives
The results so far are both encouraging and sobering.
“All of the firefighters we’ve screened who were diagnosed with cancer were asymptomatic,” Hegmann says. “And so far, we caught all of them early.”
That simple fact underscores the power of screening grounded in science.
Firefighters run toward danger to protect their communities. Through expanded legislation, coordinated screening, and growing research partnerships, Utah is working to ensure someone is running toward them, too