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Cancer in Firefighters and Presumptive Disability Coverage

December 7, 2021
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WRITTEN BY Dr. Ramon Martinez III

Executive Summary 

Firefighters are at an elevated risk for developing several occupational diseases, including cancer, due to increased exposure to toxic contaminants while on duty. Estimates from long-term data suggest that U.S. firefighters have an approximate 1 in 8 incidence rate of cancer. Nearly all jurisdictions in America provide some form of benefits to firefighters who develop an occupational-related disease, but differ on which diseases qualify, payment mechanisms, and the funds used to provide these benefits. Missouri law (RSMo § 87.005 & 87.006) and recently passed legislation (SB 45) require that both paid and volunteer firefighters qualify for presumptive disability coverage through retirement/pension funds and municipal benefits pools. 


  • Firefighters are frequently exposed to carcinogenic compounds, including smoke, burning chemicals, and other toxic materials used in construction or protective equipment. The level of exposure to these substances increases the likelihood of cancer development.
  • More than half of states, not including Missouri, cover cancer under workers’ compensation laws. 
    • Workers’ compensation laws in Missouri are not explicit in naming all types of cancers that may qualify firefighters for compensation. Presumptive disabilities are covered under retirement funds.


  • While firefighters experience elevated cancer rates overall, the type of cancer can depend on geography and demographics. More data may be needed to understand specific disease associations.  
  • Delayed disease onset makes both the causes of cancer and the full costs presumptive coverage difficult to determine.
  • Little data exists for presumption costs associated with publicly-employed first responders (compared to privately-employed first responders, for whom more data is available).
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