The fire service requires thirteen things to prevent cancer. Not one has been measured in a firefighter's body.

Of the thirteen practices the fire service now requires to reduce our cancer exposure, not one has a published measurement of what it removes from a firefighter's body. Three have ever been tested that way. All three came back showing no change.

That is not an argument for doing less. It is an argument that we have been measuring the wrong thing, and that nobody told us.

First, what the thirteen actually are

There is no single law that says "do these things." There are two documents, and between them they are what almost every North American department now trains to.

The first is a checklist. In 2018 two fire-service bodies, the International Association of Fire Chiefs' Volunteer and Combination Officers Section and the National Volunteer Fire Council, published a short report setting out eleven actions a firefighter or a department can take to cut cancer risk. They called it the Lavender Ribbon Report, and updated it in 2021. If you have seen a poster in a fire hall listing things to do after a fire, this is almost certainly where it came from. Industry — guidance from fire-service associations, not a regulation.

The practices it covers, in plain terms:

• Wear full PPE through the whole incident, including SCBA during salvage and overhaul.
• Start gross decon of your gear on scene, while still on air, with soap, water and a brush.
• Bag the dirty gear and keep it out of the cab, in an exterior compartment or a tote.
• Wipe your exposed skin on scene, and carry wipes on every apparatus.
• Shower as soon as you can after exposure.
• Have a second hood, so a dirty one can be washed while a clean one is in service.
• Change and wash your station wear after exposure.
• Clean your PPE, tools, equipment and the apparatus itself on a routine basis.
• Keep contaminated gear out of living and sleeping quarters.
• Use sunscreen.
• Get an annual physical.

The second is a standard, and it is newer. NFPA 1850 took effect on 9 September 2025 and made two things obligations rather than advice: on-scene Preliminary Exposure Reduction, which is essentially the gross-decon step above given a formal name, and a minimum of two advanced cleanings of your gear per year. Regulatory — NFPA is a standards body.

Eleven plus two is thirteen. That is the list this page went looking for numbers behind.

There are two questions, and we only answer the first one

When a department reports that decon worked, it means someone wiped a jacket and measured what came off. That is a real measurement and it is worth doing.

The other question is whether less of the contamination ended up inside the firefighter. You answer that with urine, blood or breath, not a wipe.

The whole prevention programme assumes the first thing causes the second. It is a reasonable assumption. It has been tested three times, and it did not hold.

The clearest test came from a randomised trial of 88 firefighters at live-fire training. Four decontamination methods were compared against a control group who did no skin decon at all. Detergent and water was the only method that significantly reduced PAH on the skin, from 0.72 ng/cm2 preintervention vs. 0.38 ng/cm2 postintervention. Then the authors looked at what was in the firefighters' urine, and found that the change in PAH metabolites did not differ between any of the methods and the control group. Peer-reviewed — Keir et al. 2022, J Occup Environ Hyg, DOI 10.1080/15459624.2022.2150768.

Their own conclusion is worth reading slowly: despite on-site attempts to remove PAHs from firefighters' skin, the examined interventions did not reduce the internal dose of PAHs.

The ledger

Thirteen requirements, sorted by what is actually known about each one. The counts add to thirteen so nothing is hidden in a rounding.

The one thing that worked was all of it at once

There is a positive result, and it matters more than anything else here.

A set of fireground interventions was run together: SCBA use by engineers, entry team wash-down, isolating contaminated equipment, then showering and washing gear back at the station. Measured in urine after structural fires, that bundle reduced mean total urinary postfire PAH-OHs in engineers (-40.4%, 95%CI -63.9%, -2.3%) and firefighters (-36.2%, 95%CI -56.7%, -6.0%). Captains showed no significant reduction, which fits: the effect tracked who was closest to the fire. Peer-reviewed — Burgess et al. 2020, J Occup Environ Med, PMC8647371.

So the honest instruction to a crew is not "decon does nothing." It is closer to this: do all of it, together, or you have no evidence you did anything. The practices have been tested as a system exactly once, and as a system they worked. Individually, not one of them has been shown to.

Two things that cost nothing beat things departments pay for

Both of these fell out of the same search, and neither is in the guidance.

How you take the hood off. Particulate-blocking hoods do reduce soot reaching the neck. But when hood design and hood removal technique were compared in the same study, modifying the process for hood removal resulted in a larger reduction in neck skin contamination than design modification, with no penalty in skin temperature, core temperature or heart rate. Overhead removal beat buying a better hood. Peer-reviewed — Kesler et al. 2021, Ergonomics.

How much detergent goes in. This is the single most useful number in the ledger, and it is about the dose of soap:

In bench-scale washing of contaminated turnout fabric, a 12-hour presoak at a 90:10 water-to-detergent ratio removed 97% of the LMW PAHs and 78% of the HMW PAHs, compared to only an 11% removal of the HMW PAHs with a 99:1 ratio. Peer-reviewed — Hossain et al. 2024, Toxics.

The same authors then found that direct washing with a 90:10 ratio achieved comparable efficacy to that of presoaking with the same water-to-detergent ratio. The operative variable is how much detergent, not how long it soaks. An independent run by the same group a year earlier found that at manufacturer-recommended concentrations, only 40% of HMW PAHs were removed. Peer-reviewed — Hossain et al. 2023, Frontiers in Materials.

Worth saying plainly: this is fabric swatches on a bench, not whole garments in a station extractor. It needs confirming at full scale. It is still the closest thing to a free improvement in the whole record.

The uncomfortable one: sealing the gear away

Best practice number eight says to bag and isolate off-gassing gear, away from living and sleeping quarters. I have followed it for years and I would still keep gear out of a bunkroom.

In 2026, researchers sampled air in eleven North Carolina fire stations plus one gear cleaning and supply station, in the day room and in the gear storage area, for 14 PFAS and 120 other semi-volatile compounds. Total SVOC levels, and particularly PFAS, were significantly higher in closed rooms with turnout gear relative to storage areas open to the apparatus bay or the day room. The single highest reading was 8:2 FTOH at 1067 ng m-3, and the authors estimate that some turnout gear storage areas may pose a health risk for PFOA through inhalation of that compound and its conversion in blood. Peer-reviewed — Stapleton et al. 2026, Environ Sci: Processes & Impacts.

Read it carefully, because it is easy to get backwards. It does not say stop isolating gear. It says a sealed room with no ventilation concentrates what comes off the gear, and the authors frame the answer as station design and ventilation. The instruction that survives is ventilated isolation, not sealed isolation.

It also connects to something else in the record. Off-gassing from gear decreased 17-36 min later regardless of whether field decontamination was performed Peer-reviewed — Fent et al. 2017, J Occup Environ Hyg, DOI 10.1080/15459624.2017.1334904. And cleaning does not reach the reservoir: semi-volatile PAHs deep in the fibres of bulky gear are not effectively reduced by either on-scene decon or machine laundering, so the gear keeps emitting afterwards. Peer-reviewed — Wilkinson et al. 2023, IJERPH.

Put those together and the sealed-room result stops being surprising. Decon never stopped the off-gassing, cleaning never emptied the reservoir, and then we put the gear in a cupboard with no air moving through it.

Where this argument is weak

This piece has just spent two thousand words on an absence, and an absence is the easiest thing in research to get wrong. So here is the case against it.

"No published effect size" means none that I found. It is a claim about a literature search, not proof that nobody has ever measured it. The count of zero is the honest result of looking; it is not a mathematical zero.

I read abstracts, not full texts. Every number on this page was copied verbatim from the source's own abstract and checked against the claim it supports. That catches misquotation. It does not catch a result reported differently in the body of the paper, and a full-text pass could move an item from one row of that table to another.

Seventeen of the twenty-two studies below do not yet carry a verified identifier. That is stated in the references and it is the reason this is edition one rather than a finished document.

And this is a synthesis, not a measurement. Anyone with a literature budget could assemble it. The thing that would make it genuinely mine is data nobody else has, and I do not have that yet. What the ledger did was tell me exactly where to point: nobody has ever sampled a fire station bunkroom for these compounds. The published station work covers lockers, bays and day rooms. The place we sleep is unstudied, and I can walk into one tomorrow.

Somebody got to the neighbouring question first, and it would be dishonest not to say so. Horn and colleagues reviewed fire service contamination control against the NIOSH Hierarchy of Controls in 2022, and identified knowledge gaps that remain. Peer-reviewed — Horn et al. 2022, J Occup Environ Hyg, PMC9928012. That review organises the controls by type. What it does not do, and what this ledger tries to do, is attach an effect size to each required practice and separate what came off the surface from what stayed out of the body.

What this cost me

Two of the findings are about practices I perform on shift.

I have wiped my face and neck after fires for years believing it was lowering what I absorbed. The trial says the wipe removes soot from skin and that the firefighters who did it had the same metabolites in their urine as the ones who did nothing. I am going to keep doing it, because it is free, because removing a carcinogen from your skin is not nothing, and because a study finding no effect on one biomarker in one trial is not proof of no benefit. But I cannot tell another firefighter it lowers their dose, because nobody has shown that.

And I have bagged gear into a closed space to keep it away from where people sleep, which is exactly the configuration that measured worst.

What I would do on Monday

Nothing here justifies doing less. Three things are worth changing, and all three are free.

1. Run the practices as a bundle and treat them as one procedure. That is the only configuration with evidence behind it.
2. Change how the hood comes off before spending money on a different hood.
3. Put more detergent in the wash than the bottle says, and check what your extractor is actually dosing.

And one to raise with whoever runs your station: is the gear room ventilated, or just closed? On the current evidence that is the difference that matters, and almost nobody is measuring it.

What this does not establish

• That decontamination is pointless. Surface removal is real and repeatedly measured. Peer-reviewed
• That any practice on the list causes harm. One study measured higher air concentrations in sealed gear rooms; that is a measurement of a room, not a health outcome in a person. Inferred
• That the interventions do not lower internal dose. Three tested methods did not, in the trials that looked. Absence of a measured effect is not proof of absence. Speculation
• That following this list will or will not change any individual firefighter's cancer risk. No study on this page measured cancer. They measured chemicals on cloth, on skin, and in urine. Speculation

The occupation is a confirmed hazard. In 2022 the International Agency for Research on Cancer classified occupational exposure as a firefighter as Group 1, carcinogenic to humans. What is not established is which of the things we do about it actually works, and that is a different problem from the hazard itself.

Why this exists

Every organisation with the resources to assemble this table sells something that appears in it. Wipes, hoods, lockers, extractors, cleaning contracts, screening programmes. Nobody whose revenue depends on an intervention can publish the sentence "this did not lower internal dose."

Embr takes no affiliate revenue, no sponsorship and no manufacturer money, which is the only reason this page can exist in this form. That is the whole business model and it is worth stating once.

Edition one is a map of what has never been measured. The next edition should contain something measured.

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The studies

Every quote on this page is copied verbatim from the source abstract and pinned to the claim it supports in our claim-evidence ledger. Every citation below carries a DOI, PMID or PMC ID. Eleven further studies informed the table above and are held for edition 2 pending identifier resolution.

1. Keir, J. L. A.; et al. "Effectiveness of dermal cleaning interventions for reducing firefighters' exposures to PAHs and genotoxins." Journal of Occupational and Environmental Hygiene 2022. DOI: 10.1080/15459624.2022.2150768. Peer-reviewed
2. Fent, K. W.; et al. "Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures." Journal of Occupational and Environmental Hygiene 2017. DOI: 10.1080/15459624.2017.1334904. Peer-reviewed
3. Burgess, J. L.; et al. "Evaluation of Interventions to Reduce Firefighter Exposures." Journal of Occupational and Environmental Medicine 2020. PMC8647371. Peer-reviewed
4. Kesler, R. M.; Mayer, A.; Fent, K. W.; Chen, I.-C.; Deaton, A. S.; Ormond, R. B.; Smith, D. L.; Wilkinson, A.; Kerber, S.; Horn, G. P. "Effects of firefighting hood design, laundering and doffing on smoke protection, heat stress and wearability." Ergonomics 2021, 64(6), 755–767. DOI: 10.1080/00140139.2020.1867241. Peer-reviewed
5. Hossain, M. T.; Ormond, R. B. "Assessing the Impact of Pre-Soaking to Enhance Laundering Efficacy of Firefighter Turnout Gear." Toxics 2024, 12(8), 544. DOI: 10.3390/toxics12080544. Peer-reviewed
6. Hossain, M. T.; et al. "Evaluating the performance of surfactant and charcoal-based cleaning products to effectively remove PAHs from firefighter gear." Frontiers in Materials 2023. PMID: 38073671. Peer-reviewed
7. Stapleton, H.; Herkert, N. J.; Hay, D.; Hoffman, K.; Ormond, B. R. "Volatile per- and polyfluoroalkyl substances (PFAS) and other semi-volatile organic chemicals in indoor air of fire stations: the influence of gear storage conditions." Environmental Science: Processes & Impacts 2026. DOI: 10.1039/D6EM00069J. Peer-reviewed
8. Wilkinson, A. F.; Fent, K. W.; Mayer, A. C.; Chen, I.-C.; Kesler, R. M.; Kerber, S.; Smith, D. L.; Horn, G. P. "Use of Preliminary Exposure Reduction Practices or Laundering to Mitigate Polycyclic Aromatic Hydrocarbon Contamination on Firefighter Personal Protective Equipment Ensembles." International Journal of Environmental Research and Public Health 2023, 20, 2108. DOI: 10.3390/ijerph20032108. Peer-reviewed
9. Horn, G. P.; et al. "Hierarchy of contamination control in the fire service: review of exposure control options to reduce cancer risk." Journal of Occupational and Environmental Hygiene 2022. PMC9928012. Peer-reviewed

This article is part of Embr's research series. It is not medical advice and does not promise health outcomes. It is not a recommendation to stop any practice your department requires. Our methodology and editorial standards are published openly. If you find a factual error, tell us.