Colorectal Cancer - 2021 Major Health Alert in the Fire Service Community

Hitting Cancer Below the Belt Inside the Fire House - By: Mindy Conklin

An internal fire has ignited and we are sounding the alarm. According to the National Cancer Institute, the rate of colorectal cancer has doubled in the under 50 year old population.[1] A 2021 study predicts this trend may continue into the foreseeable future with colorectal cancer becoming the leading cancer-related death in people between 20-49 years of age by the year 2040. [2]

Pouring gasoline on this cancerous fire is the risk of toxic exposure for firefighters. In 2010, the National Institute for Occupational Safety and Health (NIOSH) assessed nearly 30,000 fire fighters across the country to explore the possible connection between their work and the development of cancer. The study was a collaborative effort, which also included researchers at the National Cancer Institute and the University of California at Davis Department of Public Health Sciences. Their findings revealed firefighters were likely to experience more cancer, and die more frequently from those cancers, than the general U.S. population. The most prominent cancers were digestive (e.g. colorectal), respiratory, and urinary cancers. [3]

Smaller studies have also revealed firefighters to be at higher than average risk of developing cancer. So what can be done? Hitting Cancer Below the Belt (HCB2) believes it all starts with awareness and offering education to enhance that understanding while delivering services to increase proactive health behaviors. HCB2 has an array of educational assets to attract the attention of community members that includes podcasts, short videos, presentations, appearances with the inflatable colon, and social media messages. We direct our services towards supporting community members susceptible to or at a higher risk of a cancer diagnosis - firefighters included. The news that colorectal cancer is on the rise is one that we can do something about! 

RESCUE SERVICE FACES RISE IN CANCER RATES by: William J. Boger / President, Local 1568 Cancer is a very real and pervasive enemy to firefighters. The fires we used to fight were made of natural products like wood, leather and natural cloth fibers. Now, the fires we fight are filled with carcinogenic mixtures of plastics, synthetics and other chemicals. While we do a good job of protecting ourselves with gear, breathing apparatus and decontamination procedures, the toxins are unfortunately still absorbed into our bodies. In fact, cancer is now the leading cause of firefighter deaths and 66% of firefighter deaths between 2002 and 2019 were from cancer. According to research by the CDC/National Institute for Occupational Health and Safety (NIOSH), firefighters have a 9 percent higher risk of being diagnosed with cancer and a 14 percent higher risk of dying from cancer than the general population. HENRICO PROFESSIONAL FIREFIGHTERS ASSOCIATION LOCAL 1568 - IAFF RICHMOND, VA

HCB2 is nonprofit organization based in Richmond, Virginia. We are motivated to create environments where cancer is challenged to survive. It’s our purpose to see, listen, and serve in the effort to defeat colorectal cancer. Firefighters, we are coming with our hoses! Please feel free to reach out to us at hcb2.org or info@hcb2.org for further discussion and collaboration.

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TOXINS FROM BURNING MATERIALS & COLORECTAL CANCER SCREENING  By: Robert Bard MD DABR FALSM  (Sr. Medical Editor)   www.drrobertbard.com

An internal fire has ignited and we are sounding the alarm. The National Cancer Institute notes the rate of colorectal cancer has doubled in the under 50 year old population. [4] A 2021 study predicts this trend may continue into the foreseeable future with colorectal cancer becoming the leading cancer-related death in people between 20-49 years of age by the year 2040. [5] Pouring gasoline on this cancerous fire is the risk of toxic exposure for firefighters. In 2010, the National Institute for Occupational Safety and Health (NIOSH) assessed nearly 30,000 fire fighters across the country to explore the possible connection between their work and the development of cancer. The study was a collaborative effort, which also included researchers at the National Cancer Institute and the University of California at Davis Department of Public Health Sciences. Their findings revealed firefighters were likely to experience more cancer, and die more frequently from those cancers, than the general U.S. population. The most prominent cancers were digestive (e.g. colorectal), respiratory, and urinary cancers. [6]

TOXINS AND CANCER

Major illnesses from inhaling smoke include:  loss of immunity to respiratory tract infection, airway sensitization (chronic cough), lung damage, sinus trouble, problems with peripheral circulation, heart and neurological/psychological disorders. From the New York Telephone fire in 1975 the most common cancers were in the larynx, liver, skin, throat and brain that were detected through the years 1980 to the present.  The remaining survivors are still developing cancers to this day.  Many 9/11 first responders still suffer with chronic coughing episodes.

Anyone who received a letter from the Department of Health alerting them to the high mercury, arsenic or lead level in a recent blood or urine test knows that this is a wakeup call to further evaluate the problem. However, most of the State Health standards were based on toxicity to the unborn fetus in pregnant mothers.   For some reason, the early blood test abnormalities do not always match the results of the 24 hour urine collection which is supposedly more accurate. Many physicians today accept a high blood mercury level as a sign of health from greater consumption of fish.

 Another unknown is the combination of toxins with trauma and particulate matter at high rise disasters. Many cancers and chronic diseases do not manifest fully until months, years and even decades after the initial body insult as demonstrated by the 1975 NY Telephone Company conflagration and the Cancer Registry for the 911 attack aftermaths still revealing a significant incidence of skin, lung and prostate cancers 15+ years later.  In fact, the most common tumors recorded after 911 are;  Basal Cell Skin Cancer, Squamous Cell Skin Cancer and Malignant Melanoma.  Lung Cancer and Prostate Cancers are 4th and 5th respectively. Other statistical centers have collectively noted the incidence as: Prostate 13.7%  Skin 8.4% Colon 7.1% Bladder 6.9% and testicular 5.5% (lung and stomach have lower incidence to date).  Our body filters toxins by the skin, lungs, kidneys, gastrointestinal tract and liver. This trapped reservoir of irritants may be released over many years increasing the carcinogenic on the colon and rectal tissues.

Since colorectal cancer is mostly silent, how do we find it?  Colonoscopy is recommended for those over 50 but this is an invasive test.  CT colonoscopy is useful to find a tumor however the tissue sampling cannot be performed. Modern diagnostic imaging allows non biopsy analysis of all skin cancers,  most prostate tumors and some colo-rectal  malignancies. Blood flow Doppler measurements predict which tumors are aggressive and which may be watched.  Many cancers are tracked by CT, MRI and PET/CT isotope imaging.  Endorectal 4D sonograms are mostly used in Europe for staging and biopsy even though the resolution of the probe in contact with the bowel wall provides superior imaging. Ultrasound, photo-optical and laser MRI guided focal treatments permit patients to handle the problem with new minimally invasive procedures. 

A 15 minute endoscopy ultrasound probe scan reveals the tumor size and location. The 3D Doppler blood flow offers insight into the aggressive nature and likelihood of metastases.[7]  4D Volumetric imaging shows penetration through the bowel wall and some metastatic lymph nodes which is critical for surgical and radiation treatment planning.  Metastatic spread to distant organs such as the liver, bones and lymph nodes is detected by radiologic imaging. Often a cancer survivor feels a lump in the neck, groin or under the arm and may have their concern addressed by portable sonograms at their home if not available at their physician’s office.  A cancer node and a benign fatty tumor are readily distinguished by general ultrasound units in experienced hands. [8]  If the abnormal lymph node is suspicious, ultrasound guided fine needle aspiration (FNA) will accomplish what was previously a surgical excision, removal and pathologic sectioning. The ultrahigh resolution of lymph node sonography finds areas that the pathologists may miss since they are investigating a large mass of postoperative tissue specimen and may miss the true malignant focus if the sectioning of the nodes is too wide.

COLORECTAL SCREENING:  The low rate of first responders over 50 getting checked for bowel tumors may be increased by a 5 minute skin scan looking for toxic “stars” in the dermal tissues.  The “colon screening genetic markers” have a significant failure rate to date. A future study comparing dermatologic findings with colon and rectal tumors will shed more light on this non invasive clinical option.

ROBERT L. BARD, MD, PC, DABR, FASLMS

Advanced Imaging & Diagnostic Specialist & recipient of the 2020 nationally acclaimed Ellis Island Award for his lifetime achievement in advanced cancer diagnostic imaging. Dr. Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging - www.CancerScan.com) 

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REFERENCES

1. NCI. (2020). Why Is Colorectal Cancer Rising Rapidly among Young Adults? Retrieved from https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-risingyounger-adults.

2. Rahib, L., Wehner, M.R., Matrisian, L.M. et al. (2021). Estimated Projection of US Cancer Incidence and Death to 2040. JAMA Network Open, 4(4). Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778204.

3. CDC. (2016). Findings from a Study of Cancer Among U.S. Fire Fighters. Retrieved from https://www.cdc.gov/niosh/pgms/worknotify/pdfs/ff-cancer-factsheet-final-508.pdf.

4. NCI. (2020). Why Is Colorectal Cancer Rising Rapidly among Young Adults?Retrieved from https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-risingyounger-adults.

5. Rahib, L., Wehner, M.R., Matrisian, L.M. et al. (2021). Estimated Projection of US Cancer Incidence and Death to 2040. JAMA Network Open, 4(4). Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778204.

4. CDC. (2016). Findings from a Study of Cancer Among U.S. Fire Fighters. Retrieved from https://www.cdc.gov/niosh/pgms/worknotify/pdfs/ff-cancer-factsheet-final-508.pdf.

5. US Consumer Product Safety Commission  Fact Sheet No 41:Plastics   GPO889-731 1975

5. Wallace D: Toxic Fires in the Age of Plastics  TH9446.P55W35 1990

6. Bard, Futterer (Eds.) Image Guided Prostate Cancer Treatment   Springer 2014

7. Bard (Ed.)  Image Guided Dermatologic Treatment   Springer 2019

8. Bard (Ed.) Image Guided Covid-19 Lung Treatment   Springer 2021

HANDLING JOB-RELATED TRAUMA IN THE RESCUE SERVICE

In the earliest days of Ground Zero (9/11/2001), we have all watched countless rescue workers on the pile, passionately and pointedly searching for any life in the rubble while trying to stay focused from the devastating images and emotional effects of the disaster around them.  Twenty years later, many of these same responders are sharing the after effects of their experiences both physically and psychologically- some finding great cathartic benefit in sharing, while others still struggle with their memories.

Throughout a firefighter's career, rescue calls mean racing to accidents or disasters- often including traumatic images and sensations. They are usually first on the scene of any life-threatening incident, witnessing and interacting with event-related injuries, deaths or some of the most graphic and violent accidents. According to fire training experts and SAMSHA (Substance Abuse and Mental Health Services Administration), public safety personnel are expected to witness horrific scenes in the line of duty. These professionals respond to tragic events that permeate all senses including sight, sound and smell.[1]   Repeated exposures, coupled with the immense stress of roles in emergency services, can lead to an increased risk for adverse behavioral health outcomes such as distress, worry, disturbed sleep or concentration, alterations in work function, difficulties with interpersonal relationships, increases in substance use, somatization, and depression.  [2]

Active and retired responders comment on the "limited training offered to adequately prepare public safety professionals to process trauma." What training and experience does not provide is the individual's ability to sustain the part of the human condition to reinforce one's internal defenses and ability to heal.  Each traumatic experience (where rescue calls do not end well) contains its own unique elements that can shock or surprise the system.  These traumatic elements have a tendency to carry latent or cumulative effects, which adds to the challenge of treating them as disorders (ie. PTSD, substance abuse, depression etc)

RE-EVALUATING "SUCK IT UP, BUTTERCUP"
Bar none, rescue responders are a unique breed of caregiver, selflessly dedicated to acting on a call to save lives.  Their professional heightened focus to the rescue response can often occur at the cost of THEIR OWN personal safety.  The "toughness" that comes with the job is one that is fostered in part from within, but is also largely enforced by the strong camaraderie and collective support of their  fellow team members. 

But what happens when the rescue worker goes home?

"In the fire service, and also with EMS, we experience a lot of stories, but we don't usually talk about that stuff- it's all just part of the job. And that's where the problem starts", says Lt. Chris Conner of the Bedford (TX) Fire Dept. "It's a lot like being a soldier at war... we (literally) see everything and we just need to get battle-hardened. I can talk about witnessing someone trapped alive inside a burning car, or a baby getting thrown 100 feet out of a drunk drivers' vehicle or amputations in a building collapse- we as humans cannot be expected to just hold all these images in without some kind of backlash or even some permanent damage to the psyche like PTSD - it's just not possible.  Many firefighters got it together while on the job... then others (in their retirement) is when a lot of it collapses and the nightmares begin!"

OTHER TOPICS

- Coping Mechanisms & Endurance Training

- Collapse and Breakdown of Professional Composure

- Aftermath: The Many FLAVORS of Depression

- Diagnostic Protocols for Suicide Prevention

- Does Therapy REALLY Work?

- Medical Innovations in Mental Health Care

- It Takes a Village: Forming a Collaborative A-Team

1) https://www.usfa.fema.gov/blog/cb-030519.html

2) https://www.samhsa.gov/sites/default/files/dtac/dialogue-vol14-is1_final_051718.pdf

VIDEO REVIEW: A RETURN TO ZERO

By “Cousin” Sal Banchitta (RET FDNY)

  

20 years of 9/11 is coming at us fast.  

To many, it really feels like just yesterday.

This video celebrates the dedicated work and creative brilliance of Andrea Booher, world class photographer from FEMA. I was called by the producers to review her catalog of 9/11 work and give my feedback on the selections for this project. Her body of work is extensive and truly remarkable, and selecting a limited few for this presentation was both an honor and a major challenge.  

Seeing the production come together, I find these photos to be priceless gems in our world history.  They hold the task of helping us heal and turn the page from living the tragedy and (many of us even) lost others to illness or mental health.  But to recover and endure is an essential part of continuing with our lives and be empowered. 

The selection of photos after 20 years showed the most tasteful representation of the resilience of the American people and especially of New York City by showing that we have recovered and gone forward.  I personally don't need to see any more images of planes hitting the towers anymore (we have those images burned in our memories enough)- and I personally don't need to see individual pain and suffering. Andrea's images have a cinematic way about them- like a single frame in a feature film.  Of course they record history, but each photo seems to have a way of speaking to us that there is a "next" (or hope) after all this- and that this is not the end. Each image feels like a line in a poem that is part of a larger story that promises a reveal.  By presenting 2001 sandwiched with footage from 2021 (the aftermath) makes complete sense, leading our present day as an uplifting message of strength and spirit.

Concluding the photo showcase was Chief Bobby (Halton)- generously sharing his own experiences about and around 9/11. As a natural leader and communicator, Chief Halton delivered with candor, sincerity and compassion that really brought everything together for anyone personally affected - and whose memories are forever marred by ground zero.  Many in the fire service finds him to be the most relatable voice for the people, and he did not disappoint when speaking about a topic so heavy and emotional as the 9/11 attacks both then and now. 

Contrasting yesterday with today, Andrea’s stunning photographs captured and preserved time, and all the feelings that came with it. Beyond the terrible tragedy, it's important to learn from the past and go forward to the future for the next generations.  It drives us to accept the positives and the negatives in better perspective of what really transpired during those very difficult times and this horrendous attack on our country. Somebody mentioned to me once that the generation of the fire service who operated at that scene were trained for normal fire operating procedures, we were never train for a missile attack on a structure like a high rise building.  How were we supposed to fight a fire or an emergency with an inbound missile hitting a building?  Those planes (make no doubt about it) were missiles. So I think that we can learn from our past, and if we’re smart enough to learn from our past, it makes us stronger as a people.

Having the new freedom tower as the aftermath to all that destruction with its beauty and pride is a powerful uplift for the community. I recall there being a lot of controversy about building another high rise tower-  but I'm glad to have our beautiful symbol of pride and spectacular resilience. 

2021 Firefighters Cancer Awareness- Where are we now?

 

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"GET CHECKED NOW!"- Personal Sustainability in the Fire Service

Driven by the profound voices of firefighters (retired and active), the NY Cancer Resource Alliance and F.A.C.E.S. Foundation launched new community resources to support cancer awareness, prevention and early detection. This year, the two organizations united to break new ground in public education and clinical support, with the help of a few remarkable new friends. 

On a recent interview with oncologist, Dr. Ben Ho Park of Vanderbilt University Medical Center, we discussed occupational hazards in the fire service as well as other high-risk professions.

MODERN FIRES, COMPLEX CONTAMINANTS & LATENCY CANCER PERIODS

As things burn, toxic compounds are formed- and 9/11 was a particularly great reference for this. First responders were heavily exposed to modified chemicals, where materials that safely coexisted in normal conditions are (now) set at high temperatures- forming new compounds that are active and potentially potent carcinogens.  

Occupational cancer claims have been upended due to the lengthy response time for most cancers to develop in the body. From time of exposure (or multiple exposures), it often take years before genetic mutation fully manifest itself.  Cancers never happen overnight, and the DNA damage that leads to cancer actually has to happen very slowly over years.  Cancer isn't just one DNA mistake in a cell; it's actually multiple DNA mistakes in the same cell and again, it takes several years for the mutation to occur, often leading to a decade or more before it manifests into something that we clinically can detect as a tumor. 

RECURRENCE

The short Reader's Digest version about this goes as follows; surgically, we are certainly able to take out all the cancer. We can scan the originating site, but it doesn't mean that there aren't microscopic cells left behind and those are ultimately the cells that will grow back and become metastatic recurrence. And so my job as a medical oncologist is to make decisions based upon past clinical data of who is more likely to have those microscopic cells after surgery or radiation. Depending on the case, we cure more patients by giving them additional systemic therapies like hormone therapies and chemotherapies. What we don't know is whether or not everyone has those microscopic cells or what state of activity they are in. Also, there are different types of cancers; ie. prostate cancer and breast cancer- some are more aggressive than others. So certainly one could probably put together that if you have an aggressive form of prostate cancer under the microscope, and this is again in the prostate gland itself, then the chances or likelihood of having microscopic cells left behind is greater. And that those are ultimately the cancers that will recur faster. 

CANCER PROBABILITY

The risk of cancer in firefighters is said to be significantly greater than in the general population. [1]   Recent data shows that the top cancers from male firefighters are Prostate at 13.7%, Skin at 8.4%, Colon is 7.1%,  Bladder is at 6.9% and Testicular is 5.5%. [2] Conclusive theories dictate that firefighters who were exposed to particular types of smoke (ie. carcinogenic) are contaminated through skin, oral or respiratory cavity.  Once it hits the bloodstream, really anything is fair game in terms of susceptibility and getting exposed to carcinogens. And then it becomes really the question of  "why does it occur in the bladder vs. the colon?" That's a tougher question to answer, but we do know that there are local micro environmental factors that come into play. As an example, when one thinks about the breast cancer susceptibility genes, (BRCA2) those who have inherited this mutation, every single cell in their body has that mutation, but predominantly the cancers that occur, at least in women are going to be breast and ovarian cancers. And that's not to be because those are the organs that are most exposed to estrogens. So there is are kind of interplay between the local environment or micro-environment, and the actual carcinogenic 'insult' to the DNA.

EXPANDING DIAGNOSTIC INNOVATIONS
Tracking, screening and monitoring cancers plays a major role in building the treatment strategy. Technologies like MRI's, Pet-CT scans and advanced ultrasounds are often used on the imaging side, while tissue biopsies are also part of the current gold standard from the lab side. One of the areas of research interests that my colleagues and I have is the use of what's known as LIQUID BIOPSIES- a form of blood test designed to look and see whether a patient has early signs/stages of cancer. This is still something that is in infancy and nobody really has proven that one way is better than the other.  There are a growing number of companies and academic institutions that are starting to really roll this out with the hopes of giving people a simple blood tests that shows that they have a cancer somewhere.  Someday, we could actually catch things very, very early and affect a higher rate of cure. I don't think we're quite there yet for everyone, but I think we're getting closer every day and really through research and help and volunteers like the firefighters we're going to make a big impact in the next 10 years 

ABOUT THE AUTHOR

BEN HO PARK, MD, Ph.D. Professor of Medicine & Director of Precision Oncology in Vanderbilt University Medical Center.   Dr. Park was recently elected to join the medical advisory board for the Male Breast Cancer Coalition and the NY Cancer Resource Alliance. He is often called to present in educational venues about a wide range of critical topics in cancer diagnostics and treatment.  His most recent appointment is as a technical advisor for Occupational Cancers in the Fire Service- a national program co- designed by NYCRA and F.A.C.E.S. Foundation. (also see above video)

References:

1) Source: NFPA: Firefighters and cancer: https://www.nfpa.org/News-and-Research/Resources/Emergency-Responders/Health-and-Wellness/Firefighters-and-cancer

2) FCSN: https://firefightercancersupport.org/resources/faq/

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F.A.C.E.S. SPOTLIGHT: THE VOICES OF FIREFIGHTER'S CANCER AWARENESS

"Cousin" SAL BANCHITTA: is Assoc. Communications Dir. to local FD. After a profound 20+ year career in the NY Fire Department, "Cousin" Sal gave all at the fire service- including his last assignment as one of the first responders in Ground Zero (9/11). He considers the firefighter "the first and last line of defense to protect all the members of the community from any catastrophe". His next personal crusade past fire calls is to share his own experiences and his research on the many cancer cases found "from the job" to drive his brethren to heed NYCRA's cancer prevention message of "Get Checked Now!" Sal continues to volunteer as a speaker in firehouses and FF meetings, contributing his unique presentation style and counseling approach known only as "FROM THE KITCHEN"- a parlance between firefighters. 

ROBERT L. BARD, MD - F.A.C.E.S. Senior Medical Advisor/Cancer Diagnostic Specialist. It is a specialized science and a honed craft to read (and predict) cancer behavior in real time through imaging. Dr. Bard attributes his career in radiology to the US Air Force, having served in military hospitals in Thailand and Laos in the early ‘70’s. His expertise was founded on the critical demands for immediate response and real-time diagnostic implementation of scanning technologies where time and accuracy are of the ultimate essence. His critical eye for the many medical imaging devices to the 'battle hardened' challenges of a military hospital setting is also a main asset as a "cancer detective". Having worked with countless military patients, to first responders (including many from 9/11 rescue units), Dr. Bard's record as a medical leader in cancer diagnostics is an asset to the fight against cancer. 

DANNY NOONAN: A National Safety Advocate and NYCRA Educational Ambassador, Mr. Noonan's career started in Ladder Company 3 on East 13th street where only two years into the fire service, he experienced one of the most historical and devastating fires in the history of NYC Fire Department. He has since been an advocate for the 699 firefighters who responded to the Telephone Company Fire. His countless presentations and published work continues to raise education, awareness and prevention for all emergency responders about occupational toxic exposures and incendiary airborne toxicities and carcinogens. His presentations include valuable references from 9/11 and the 1975 NY Tel Exchange Fire, what many consider the second most deadly and costliest in the long history of the FDNY.

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2001- Andrea Booher overlooks Ground Zero from
rooftop vantage point

Historical Photo Gallery & 9/11 20th Anniversary Retrospective

Since the advent of 9/11, global campaigns drove the "NEVER FORGET" mantra that defined the voice of our post-attack era. This mission of public awareness covered headlines from political, social, educational and news platforms. For this crusade to capture the minds of the global witness, messengers used FILM, VIDEO and PHOTOGRAPHY to spread the thousand-words cemented by history and shared with lightning speed throughout today's digital audiences.

The NY Cancer Resource Alliance, the F.A.C.E.S. Foundation and MOVEMBER hosts the 20th Anniversary of the 9/11 attacks with a special NYCRA-NEWS memorial issue. We proudly feature the powerful and most compelling images of world recognized photographer ANDREA BOOHER - film producer and photojournalist. Ms. Booher has worked as a documentarian for twenty-six years. Based in Colorado, her assignments have taken her to East Africa, Latin America, Micronesia, India, Antarctica, Australia, Myanmar, Somalia, Mexico and Haiti. In the last two decades she has photo-documented every major disaster in the United States, Trust Territories and Sovereign Nations for the Federal Emergency Management Agency (FEMA). Her documentary work resides in several permanent collections, including the National Archives and the Smithsonian. In 2001, she spent 10 weeks working at Ground Zero in the immediate aftermath of the World Trade Center attack. She was one of two photographers working for FEMA with unlimited access. Her work from 9-11 has been published in magazines, newspapers and documentaries worldwide. She was personally profiled on A &E , The History Channel, CNN, Camera Arts, NPR and Photo District News. (Click to see "RETURNING TO ZERO"- our 2021 9/11 Retrospective)

THE 2021 F.A.C.E.S. UNITE PROJECT
Firefighters Against Cancer & Exposures is a national association comprised of active and retired firefighters, cancer advocates, medical professionals, educators and patient advocates united to provide a wide range of supportive resources. These resources are available to any and all first responders in need of assistance. Our members are committed to the continued extension of help to the many who have sacrificed all in the line of duty of the fire service.