In 2019, Lieutenant Tracy Post discovered a small dimple on her breast during a routine breast self-exam. There was no pain. Not even a lump. Just a strange little indentation. At first she thought maybe she’d slept on it wrong, or her bra had dug in and left a mark.
Only the dimple didn’t go away.
Tracy was just 44 — younger than the standard recommended age for mammograms at the time. The possibility of it being a sign of breast cancer never crossed her mind. But after a couple of months with no changes to the dimple, she decided to see her doctor.
What resulted from that visit not only changed her life but is now also bringing in healthcare reforms for female firefighters in Colorado — and hopefully beyond the state’s borders.
Finding her calling
It was after 9/11 when Post started feeling a void in her life and wanted a career that would provide fulfillment through serving others. She considered joining the Armed Forces, but as a 30-year-old mom to a newborn baby at that time, she realized it just wasn’t feasible.
In 2004, a friend heard that the Westminster Fire Department in Colorado was looking for a secretary. Post applied and got the job. Over the next several years, Post worked in the administrative office while training, testing, volunteering and serving part-time as a firefighter. She finally joined the force as a full-time firefighter and EMT in 2013.
“I had to test like everybody else, and testing can be a long process,” Post recounted. “So once I decided that was what I wanted to do, it still took me about seven years to actually be successful at it.”
Being a firefighter opened Post’s eyes to the real meaning of public service and gave her the fulfillment of having a positive impact on her community. But six years into her career as a firefighter, she was diagnosed with breast cancer.
During her initial consultation, Post learned that the dimple she discovered on her right breast was caused by tethering, which occurs when a breast cancer tumor pulls the tissue into itself as it grows. By the time Post saw a doctor, the tumor had already grown to five centimeters, or the size of a small lime.
Her doctors also found pre-cancer in her left breast, so she and her medical team determined the best course of action was a bilateral mastectomy and reconstruction, along with chemotherapy. Because her illness was hormone related, she also required monthly treatments to keep her in medical menopause to prevent her hormones from feeding her cancer.
The grim reality for women in the fire department
According to the Centers for Disease Control (CDC), cancer is the leading cause of death among firefighters. However, despite ongoing studies, the link between firefighting and cancer has remained difficult to prove because every firefighter is unique in terms of genetics, years on the job, exposures during fires and lifestyle choices.
But one fact stays the same. The U.S. Fire Administration states that the International Agency for Research on Cancer (IARC) has recently classified firefighting under “Group 1: Carcinogenic to humans”. Being the highest hazard category, it means there is significant evidence proving that some forms of cancer are an occupational hazard for firefighters.
In 2007, the state of Colorado enacted presumptive cancer laws that placed treatment for several types of cancers in firefighters under workers’ compensation. Presumptive laws are designed to help firefighters get paid their normal salary or retirement benefits while they stay home and focus on their health. However, worker’s compensation companies were fighting cancer claims, forcing firefighters to spend hours in court justifying that their cancer resulted from their job.
To remedy this issue, the Colorado Firefighter Heart and Cancer Benefits Trust was created to provide financial assistance to firefighters whose condition met the trust’s qualifications for an occupational cancer. At that time, the trust covered five types of cancer, including brain, digestive, genitourinary, hematological and skin cancer. Breast cancer, along with other female cancers, was not covered because most research on these illnesses did not include women.
According to a 2020 study by the National Fire Protection Association, only 9% of all U.S. firefighters — both career and volunteer — are women. While 9% doesn’t sound like a lot, it still equates to over 89,000 of women. On top of that, more and more of these courageous women are developing breast cancer.
“I know as a population, we weren’t intentionally left out of studies,” Post said. “We just weren’t considered. Still, it’s hard when I think about why nobody considered me. I’m a member of this organization and this team and this populace. Why did nobody bother to think about female cancers at the same time?”
In 2019, Post filed a claim and presented her case to the trust in an effort to get her breast cancer treatment covered. Because her case was not one of the five approved types of occupational cancers, the claim was quickly denied.
However, the board extended her the opportunity to appeal. She then created a presentation arguing that since male reproductive system cancers were covered, the same should be done for female reproductive system cancers. The trust denied the appeal, arguing that breast cancer was separate from reproductive cancers.
After the failed appeal, nothing else could be done to help Post financially. She either had to file for disability— which pays less and takes a while to get approved — or she had to keep working through her cancer treatment. Post didn’t have the benefit of just staying home and focusing on getting better.
Post’s department supported her battle with cancer by allowing her to change her duties so she could work from home, which worked out in the wake of the COVID-19 pandemic. Still, she had to pay thousands of dollars out of pocket for care. She also ended up using most of her sick and personal days before she was finally able to return to work 10 months later.
Not backing down
Although Post lost her case to have her cancer covered, the trust invited her to return with more proof of the link between firefighting and breast cancer. The goal was to get it potentially covered in the future.
“It’s not that the trust didn’t want to cover breast cancer,” Post said. “It was more that their hands were tied by the semantics of what they could and could not do. They needed more evidence. I was very fortunate that they wanted to keep the conversation going.”
In her experience with the fire department, Post had come to know of two other female firefighters who had gotten diagnosed with breast cancer. One survived and is now enjoying retirement. The other was not so fortunate. So despite knowing that her claims would not be accepted, she continued to fight for other women.
“I’m not going to lie, it sucked really bad when they denied my appeal and my opportunity to get any benefit from the trust was over,” Post said. “But I had to keep fighting because it was the right thing to do. When it stopped being about me specifically and started being about the population of women in the fire service as a whole, that made it easier for me to fight.”
In the course of her research, Post came across a tiny blurb in the references section of a medical study on occupational cancer contributors.
The magic word? “Dioxins.”
Dioxins, which are considered to be one of the “dirty dozen” chemicals, are in just about everything that burns — whether organic or man-made. Finding that one detail helped her uncover more definitive information from the World Health Organization (WHO) and the Environmental Protection Agency (EPA).
According to the EPA, dioxins take a long time to break down once they are in the environment. They are also “highly toxic and can cause cancer, reproductive and developmental problems, damage to the immune system, and can interfere with hormones.”
Post grazed another key piece of evidence from a study conducted by the San Francisco Fire Department, which revealed that 15% of their female firefighters have had breast cancer in their lifetime. The study made references to “light at night,” an issue that’s gaining momentum in cancer research.
“When we sleep, we produce melatonin, which regulates our estrogen production,” Post explained.
During Post’s time as a firefighter, over 25% of all her calls occurred at night during sleeping hours, disrupting her circadian rhythm. This produced unregulated estrogen, which can lead to cell mutation specifically in breast tissue and can lead to malignancy.
Both dioxins and light-at-night can also affect hormones. Post’s tumor was estrogen positive. She also was tested for the BRCA genes, which determined she did not have a genetic predisposition towards breast cancer.
With this information in hand, Post returned to the trust board, who then agreed with her findings.
On January 1, 2021, the Colorado Firefighter Heart and Cancer Benefits Trust officially added breast cancer under their list of occupational illnesses.
The fight goes on
While the trust has taken a big step to cover breast cancer, there is still a lot of work to be done, especially because the laws that control what worker’s compensation must cover have not followed suit.
In Colorado for example, thyroid cancer has been added as a presumptive firefighting cancer, but breast cancer still has not.
Some other states do cover breast cancer as a presumptive cancer, but even those often have limitations — like not having a genetic disposition (BCRA gene) or being diagnosed before a specific age.
“They don’t put those limitations on testicular or prostate cancer,” Post stressed.
Because of Post’s tireless efforts in raising awareness on the prevalence of breast cancer among female firefighters, she received numerous thank you’s from women across Colorado. As of now, the trust’s website reports that they have covered the breast cancer treatment of one female firefighter so far. With time, more and more women should start to benefit from this initiative.
Post’s fight has sparked a great change for firefighters in her state and she hopes other states will follow.
“The best way I know to ensure that happens is to keep the conversation going — like with this article — so that the issue remains in the forefront,” Post concluded.
