State leaders are now taking steps to help protect them, including a bill recently signed by Gov. Charlie Baker that designates cancer as a work-related injury for state and local firefighters.
The designation gives firefighters diagnosed with cancer better medical coverage, paid leave and more access to disability benefits.
"Cancer is a very real hazard of the job, and we want to make sure we’re doing what we need to do to help those who serve,” Baker said at the bill's signing.
Richard MacKinnon, president of the Professional Firefighters Association of Massachusetts, said firefighters with a cancer diagnosis are often forced to use sick and personal days for treatments. Most communities don't pay for coverage of cancer-related illnesses, either.
"We've had firefighters who had to use all of their sick time to get treatments," he said. "Some have even lost insurance coverage because they aren't working.”
Since 2016, nearly 300 active firefighters in Massachusetts have been diagnosed with cancer, according to the union, and at least 29 have died from the disease.
Nationally cancer is a leading cause of death for firefighters, accounting for about 3 in 5 deaths in the line of duty, according to recent studies.
The new law also includes coverage for breast and reproductive cancers, MacKinnon said.
He noted that firefighters are exposed to burning plastics, chemicals and toxins -- including flame retardant chemicals used to treat furniture -- each time they respond to a burning structure or vehicle. The materials emit carcinogenic fumes, such as benzene and hydrocarbons, that can be absorbed through skin.
Rep. Paul Tucker, D-Salem, a member of the Legislature's Public Safety Committee, said cancer diagnoses are more likely among firefighters than others.
"The numbers speak for themselves," he said. "These guys are putting themselves in harm's way so anything we can do to help them, we need to do."
A 2015 study by the National Institute for Occupational Safety and Health found firefighters are 9 percent more likely than the general population to develop cancer, and 14 percent more likely to die from it.
The International Association of Firefighters reports 61 percent of line-of-duty deaths from 2002 to 2016 were cancer-related.
Decades ago firefighters were most often diagnosed with asbestos-related cancers, but now the cancers are more typically leukemia, lymphoma or myeloma, according to the U.S. Centers for Disease Control and Prevention. Among the most aggressive cancers are oral, digestive, respiratory and urinary.
Cancer-causing agents can be absorbed through the skin, the CDC notes, and studies have shown that more toxins are absorbed as skin gets hotter.
State lawmakers were considering a ban on flame-retardant children's products and household furniture, but the bill stalled before its formal session ended.
At least 13 states -- including California, Maine, New York and Vermont -- ban flame-retardant products, while a dozen others are considering similar restrictions, according to the National Conference of State Legislatures.
But the industry is resisting and suing to block laws that seek to keep flame retardants off the market or require labeling of new products.
Federal policymakers, in the meantime, are trying to get a handle on the problem by creating a cancer registry.
In June, President Donald Trump signed a law directing the Centers for Disease Control to collect data on the occurrence of cancer among firefighters, potentially leading to better prevention and safety protocols.
Under the law, firefighters will voluntarily enter health information into a database that hopes to better determine their cancer risk.
Besides requiring cancer coverage, Massachusetts lawmakers have also earmarked funds for equipment to minimize firefighters' exposure to carcinogens.
An amendment to the fiscal 2019 budget, sponsored by Rep. Linda Campbell, D-Methuen and others, calls for $420,000 to purchase so-called "extractors" -- commercial-grade washing machines that allow firefighters to wash chemicals and toxins off their gear after a shift.
Cash-strapped fire departments can't afford to buy the equipment -- which can cost $9,800 or more -- or a second set of gear for firefighters, she said.
"The goal is to eventually get one of these extractors in every fire station," Campbell said. "It's something that can be done, right now, to help them."
Christian Wade covers the Massachusetts Statehouse for the North of Boston Media Group's newspapers and websites. Reach him at cwade@cnhi.com.
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