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The Second Act of a First-Rate Hero

By Sonner Kehrt

Tony Stefani’s cancer diagnosis led to early retirement from the San Francisco Fire Department. Today, he’s leading the charge to keep firefighters safe and healthy.

When firefighters raced to contain the fires that spread across Northern California over the last two years, they had a lot on their mind: how to move safely through the area, whether a structure would collapse around them, and how quickly they could stop the blaze from spreading even further.

Back in San Francisco, Tony Stefani, a retired SFFD firefighter, was thinking about another question. What, exactly, was burning in those fires? And what might it mean for the firefighters who were breathing it in?Stefani is the founder and president of the San Francisco Firefighters Cancer Prevention Foundation. His organization does exactly what it sounds like: It brings attention to the elevated rates of cancer among firefighters, working to minimize the environmental hazards they face and supporting active and retired firefighters who find out they have the disease. Founded in 2006, after Stefani’s own cancer diagnosis, the organization’s work has taken on renewed urgency as California faces repeated record-breaking wildfires.

Firefighters are regularly exposed to toxins — asbestos and other contaminants in older buildings, deadly gases and combustion byproducts, even chemicals used in their own firefighting equipment. This puts them at higher risk for many types of cancers, including respiratory, digestive and urinary tract cancers.

But in 2001, when Stefani found out he had cancer, that risk wasn’t well-known. Stefani was in top shape. He was on the fire department’s track team and had spent a decade as a triathlete. His diagnosis stunned him. He had a rare type of kidney cancer called transitional cell carcinoma. The average age of a kidney cancer diagnosis is 64. Stefani was 49.

“My doctor told me it would be foolish for me to go back to work,” Stefani says. He lost one of his kidneys in treatment, and there was a risk he could develop cancer in the other one. He retired after 28 years in service. Not long after, two other firefighters at his station were diagnosed with the same type of cancer in their bladders.

“More and more firefighters starting coming to me,” says Stefani’s doctor, Marshall Stoller, a professor of urology at UCSF who now serves as a medical adviser to the foundation. Stoller encouraged Stefani to raise awareness of the issue, and several years later, the foundation was born.


— Dr. Marshall Stolle

“There was nothing being done at that time looking into these problems,” Stefani explains. “We didn’t even know if we had elevated rates of cancer compared to the general population.”

The foundation has since funded or collaborated on multiple studies, including a 2010 CDC study, the first large-scale investigation of cancer in firefighters. It examined nearly 30,000 current and prior firefighters and found that firefighters do have higher-than-expected rates of multiple types of cancer. Younger firefighters have more incidents of bladder and prostate cancer. Rates of mesothelioma are two times as high as they are in the general population.

“We knew that the culture of our profession had to start to change,” Stefani says.

The nonprofit, which relies entirely on volunteers, has developed procedures to minimize firefighter exposure to toxins, from encouraging the correct use of breathing equipment to decontamination protocols after a fire. They offer several cancer screening programs and help active and retired firefighters who are diagnosed navigate workers’ compensation and the health care system.

In addition, the organization advocates for closer regulation of potentially carcinogenic substances. Stefani has testified on chemical policy reform around the country and before Congress, arguing that chemicals burning in fires pose unnecessary threats to the firefighters already risking their lives to battle blazes.

It’s an issue that has recently taken on particular significance. Firefighters who have worked to contain the massive conflagrations around the state over the last several years have been breathing in all sorts of toxic chemicals, as cars, electrical equipment and gas stations burned alongside forests. “This isn’t like a wood fire in the 1940s,” Stoller says. “Who knows what they were exposed to?”

In the last two years, the foundation has helped organize and fund studies, conducted in collaboration with researchers at UC Berkeley and UCSF, to test blood and urine samples from fire-fighters involved in these wildfires and to examine the pollutants collected in their breathing masks. Researchers hope the results will inform policies for helping firefighters in future megafires.

“It’s not if the next one happens. It’s when,” cautions Rachel Morello-Frosch, who is leading one of the studies.

The studies — and the organization’s other work — mean that one day, the men and women who risk their lives fighting fires may have one less thing to worry about.

“When these chemical products burn, it’s not good for firefighters. It’s not good for any of us,” says Morello-Frosch. “The foundation kind of put this issue on the map.”

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