Risk factors like hereditary predisposition, tobacco usage or exposure to carcinogens in the environment, can increase one’s likelihood of developing cancer. And then there are occupational hazards.
For example, along with the myriad dangers faced by firefighters, the job can entail a significant risk of exposure to carcinogens. This leads to a level of “certain uncertainty” that compromises firefighters’ agency, making it difficult for them to make choices about their health. They know they may encounter carcinogens while fighting a fire, but they do not know which ones, when they might be exposed, and for how long. The carcinogens range from byproducts of combustion, such as formaldehyde and benzene, to toxic materials like asbestos in older buildings. This dilemma has led to the development of presumptive cancer laws for firefighters to help provide some level of control and protection to those who develop cancer related to fighting fires.
A legal presumption is “a rule of law that permits a court or exclusive adjudicative body to assume a fact is true until contrary evidence proves otherwise”. In the case of firefighters diagnosed with cancer, this means that to receive worker’s compensation for on-the-job harm, a firefighter’s employer must prove that the employee’s illness was not caused by their employment. (In a typical worker’s compensation case, the employee has the burden of proof.) This assures firefighters that even though they may encounter numerous unknown substances in their work day, any financial hardship related to the exposure will be mitigated.
Twenty-three states currently have presumption laws for duty-related exposure. Specifics of the laws vary by state, however, there are some commonalities in terms of coverage and eligibility. For coverage, most cover all treatments related to duty-related cancers like that of the throat or lungs. They also cover death benefits for the family if the patient dies due to their cancer. Eligibility for this coverage includes length of service requirements, having a physical before joining the department, and refraining from using tobacco products.
These bills have helped to ease burdens for firefighters and their families. Like genetic testing, cancer screening and patient navigation, cancer presumption laws use current understandings of cancer to help patients make more informed health care decisions and minimize the “certain uncertainty” faced by those with increased risk of cancer.