MADISON, Wis. - When firefighters report to duty every day, they know they're putting their lives on the line, but besides smoke and flames, there's a silent killer lurking: Cancer.
According to recent studies from the Centers for Disease Control and Prevention, firefighters are more likely than the general population to be diagnosed with or die from cancer.
According to the CDC, digestive, oral, respiratory and urinary cancers are the most common. Firefighters are much more likely to have malignant mesothelioma, a rare cancer caused by asbestos exposure.
Younger firefighters are also coming down with more cases of certain cancers. The CDC points to a more-than-expected rate of bladder and prostate cancers in firefighters under 65.
While firefighters deal with the daily risks, officials from the Madison Fire Department said they are working to mitigate the risk, while advocacy groups are offering support for cancer-stricken firefighters and pushing for legislation to keep track of the incidence of the disease.
Madison firefighter Lt. Terry Ritter is just one of the many firefighters across the country who are dealing with or have dealt with the disease.
The Madison native has served with MFD for 22 years after serving a stint in law enforcement. The career switch came after he realized he had a passion for firefighting.
"I knew that I had a passion for serving in the community, helping people," Ritter, who works at Station 6 on the city's south side, said.
Five years ago, Ritter noticed a lump in his chest while working out at the fire house.
The diagnosis soon came -- a rare form of lymphatic cancer. Doctors told him there was no cure and his life expectancy was only a year at best.
"When I was initially diagnosed, I was told to prepare my family for my death," Ritter said.
The married father of two realized he had a fight in front of him. He sought treatment at UW's Carbone Cancer Center, and he said thanks to the support of doctors there, and his participation in an experimental study, he's still doing what he loves today.
"It's an honor to serve," he said.
Ritter said doctors weren't able to determine if two decades of firefighting contributed to his cancer.
"Rather than looking back at the diagnosis and trying to figure out what went wrong, I took the challenge that was put before me by Dr. Albertini and Dr. Weber to continue to pursue a healthy lifestyle and to continue in my profession and dedicate myself," he said.
Ritter credits his well-being to "living a healthy lifestyle, doing as much as (he) can to identify threats, and (taking) steps to reduce vulnerabilities."
"My favorite meal is a cheeseburger with bacon, a concrete malt and classic Lays potato chips," he said. "They don't let me eat that here, and my wife doesn't let me have it at home either."
Ritter said he understand his job comes with risks of all sorts, whether it's smoke or flames or what's carried with them in the air. Preparation, he said, is key.
"We're continually running into new vulnerabilities, new threats," Ritter said. "Our job is to recognize that there are inherent risks, to be prepared for anything and to problem solve."
Ritter continues to have checkups every few months to monitor his health and said having a positive attitude is key. He expressed gratitude for the support he got from the department, friends, family and his doctors.
"I believe I'm a product of people that are serving others, that have dedicated their lives to helping other people," Ritter said.
Cindy Ell, a retired Maryland firefighter/paramedic, is an advocate for firefighters with cancer as president of the Fire Fighter Cancer Foundation. Ell survived cancer herself and is now trying to raise awareness on the issue.
The reason cancer rates have become so high for firefighters could lie in how modern fires burn.
"The words 'toxic soup' are being used frequently now to encapsulate, if you will, or capture the idea of what our fires have become," Ell said. "We're now having to treat every fire as a hazardous materials incident."
"Fires just don't burn the same as they did 20 or 30 years ago," Madison Fire Department Division Chief Art Price said. "The housing industry, the clothing industry, the furniture industry have all changed gears and the type of products they use to produce their end products are all synthetics and plastics."
Price, who is in charge of health and wellness for the department, said those products are releasing a previously unseen mixture of chemicals in the air.
"Every time we go into a fire now, we are going to be exposed to more toxic chemicals, because the materials that are burning aren't natural fabrics or even natural wood," Price said. "It's more plastics and synthetics."
Ell said most firefighting equipment does not adequately protect against exposure.
"Firefighting equipment was not designed to protect from these carcinogens. It was designed to protect from the heat of these fires," Ell said.
Even though firefighting is an inherently dangerous job, with the chance of exposure to hazardous chemicals and conditions much higher than in other careers, Price said the department has looked into ways to reduce the risk.
"We can't totally reduce our exposure, because of what we do, but we can educate ourselves on how to best protect ourselves and how to best limit the time frame that we're exposed," Price said.
Price said the department has adjusted its training and procedures to reduce exposure to toxic chemicals. He said the department has also invested in industrial-strength washing machines in four stations around the city to deep clean gear of potential contaminants.
MFD has also installed vents in stations to reduce exposure to diesel fumes emitted by fire engines.
Price said the department is in the early stages of looking into infrared saunas to help firefighters sweat out toxins after returning to their stations.
Price said MFD hasn't had any significant "cancer clusters" -- or reports of cancer linked to numerous firefighters in one area in a specific period of time, like what happened to New York City-area first responders on September 11.
"We have had some incidences of some of our members that have contracted cancer that are on the job, but our numbers aren't huge at this point."
Price said the aftermath of Sept. 11 led MFD, along with fire departments across the country, to take another look at its equipment and procedures.
"It made us take a step back and really try to reexamine what we do and how we do it," Price said.
Meanwhile, Ell's group is advocating for federal legislation designed to keep track of the incidence of firefighter cancer nationwide.
"We're seeking to establish a registry basically that would be tracking cancers across the board, for firefighters regardless of whether they're paid or volunteer," Ell said.
The group has shown support for the bipartisan Firefighter Cancer Registry Act of 2017, which would create a first-ever national registry.
Wisconsin has what's called a "presumptive disability law" on the books that covers firefighters diagnosed with cancer. It presumes that diagnosed cancers meeting the law's criteria are presumed to be duty-related.
According to the website of the International Asssociaiton of Firefighters union, a presumptive disability law shifts the burden of proof from the employee to the employer to "demonstrate that the condition was not in fact associated with the occupation but with another cause."
Visit the IAFF's website to read the text of Wisconsin's presumptive disability law.