In a yearslong trend that experts say is both political and scientific, several states are looking to expand the types of cancer that are covered under existing occupational illness presumption laws for firefighters.

Nearly two dozen states have presumptions in place for firefighters who get cancer, presumably due to exposure to toxins while fighting fires and the historic presence of chemicals in their gear. Most presumptions dictate which cancers are acceptable, such as lymphomas or those of the respiratory tract, and virtually every year lawmakers aim to expand the lists, which vary state to state. This year is no different.

So far, four states are considering adding more cancers to existing presumptions during their current legislative sessions:

• Hawaii’s House of Representatives on Thursday passed H.B. 1889, which would add breast and ovarian cancers to the state’s presumption for firefighters. 
• In Maryland, H.B. 584, passed by the House on March 7, would add thyroid, colon and ovarian to the list of 10 already accepted types of cancer.
• H.B. 2117 in Arizona, sent to committee on March 6, would add “reoccurrence of a previously diagnosed cancer” already on the list of eight cancers.
• H.B. 2817 in Missouri, introduced in February, would amend the state’s firefighter/occupational disease law to define carcinoma as a “condition of cancer affecting the skin or the central nervous, lymphatic, digestive, hematological, urinary, skeletal, oral, breast, testicular, genitourinary, liver, or prostate systems, as well as any condition of cancer that may result from exposure to heat absorption, inhalation, ingestion, or radiation.”

Scott Robinson, Washington-based deputy director of government relations for the International Association of Fire Fighters, said earlier presumptions and disability programs only allowed for lung cancer. As data on cancer diagnoses among firefighters continues to expand, so does interest in adding more types of cancers to presumptions — but politics mixes in with the science, making it a challenge for proponents who see the experiences among firefighters as proof of the need for expanded presumptions, he said.

“There's been a huge push for scientific evidence, demonstrating a clear and consistent link between firefighting and the incidence of cancer,” Mr. Robinson said. “Every year there’s more data now that is coming out that is directly related to firefighting, in the types of cancers that we’re exposed to or that we’re developing.”

To aid policymakers, the federal government maintains a firefighter cancer registry that “collects health and occupational information to better understand the link between workplace exposures and cancer,” according to a spokeswoman with the U.S. Occupational Safety and Health Administration.

“Over time and with broad participation, the data will be used to better understand the types of cancer among firefighters; the prevalence of cancer risk factors and healthy behaviors among firefighters; and the relationship between firefighter cancer and workplace characteristics, exposures and practices.”

Adding cancers to a state’s presumption “often reflects the state of research at the time that the bill is written,” Mr. Robinson said. However, “you have the legislative process and budgetary considerations,” which create challenges for adding cancers to state presumptions, he said.

The success of bills that aim to amend the lists of cancers is mixed, as reported by the National Council on Compensation Insurance, the ratings agency that has long said gathering data on costs for such presumptions is complicated, as most municipalities are self-insured.

Those opposing firefighter presumptions for cancer have cited unknown costs and the fact that cancer is common among the general public. Expansions of presumptions have faced hurdles for the same reasons.

Brian Allen, Salt Lake City-based vice president of government affairs for Enlyte LLC, which provides workers compensation services and tracks legislation, said that while science takes the lead, “a lot of it is politics” with regard to which cancers pass muster and whether there’s a push by opponents to not expand presumptions. 

“If you have three or four firefighters who made a workers comp claim for a particular cancer that wasn't under the presumption, then all of a sudden they’re going to add that to the list because obviously firefighters are getting it now,” he said, adding that cancer’s prevalence among the general population has long been a sticking point.

According to the American Cancer Society, 41.6% of men and 19% of women in the United States will get cancer in their lifetime, and cancer is the second most common cause of death, after heart disease. Meanwhile, the National Institute for Occupational Health and Safety says firefighters have a 9% higher risk of being diagnosed with cancer and a 14% higher risk of dying from cancer than the general U.S. population.

“Policymakers try to make sure that there’s a nexus between the cancer and the work that's being done, and the exposures that they’re subjected to,” he said. “I don’t think they’re just adding (cancers) willy-nilly, but I do think it’s fueled by this desire to take care of first responders.”