Now, just weeks after the Labor Department added coverage for those illnesses, firefighters worry the gains may be in jeopardy after the Trump administration deleted information about the expansion of coverage for cancers that mostly affect women and transgender firefighters from a federal webpage and ducked questions about whether it will uphold the policy change made in the waning days of the Biden administration.

“It’s really important to continue to focus on ensuring that those who devote their lives to protecting the public and communities continue to receive coverage through the special claims unit,” said Pete Dutchick, a federal firefighter and volunteer with the advocacy group Grassroots Wildland Firefighters.

The Labor Department’s special claims unit, , processes all federal firefighter claims and provides a streamlined path for those with covered conditions. Wildland firefighters and advocacy groups representing them celebrated that year when federal officials moved to expedite workers’ compensation coverage of cancers tied to their jobs. It was recognition that the dangers of battling wildfires extend long after a blaze is extinguished.

The list of cancers federal officials tagged for streamlined claims processes through the Labor Department’s Office of Workers’ Compensation Programs included esophageal, colorectal, prostate, testicular, kidney, bladder, brain, lung, thyroid, multiple myeloma, non-Hodgkin’s lymphoma, leukemia, mesothelioma, and melanoma.

But that initial jubilation soured when it became clear that breast, ovarian, cervical, and uterine cancers were excluded, creating a coverage gap for more than 2,700 people, or about 16% of the more than 17,000 federal wildland firefighters working for the Forest Service and the Interior Department. These are firefighters who are dispatched to federal lands, like in national forests and national parks, and sometimes , as they did when fires swept into Los Angeles in January.

“At first glance, we were ecstatic,” Dutchick said. “And then we’re like, ‘Well, where are the female cancers?’”

Dutchick, who has an 8-year-old daughter, was upset. “I certainly want her to have equal protections when it comes to health if she chooses to get into a field of public service,” he said.

Then this year, as the Biden administration wound toward a close, federal officials addressed the exclusion, adding the cancers to the list in a last-minute change before Donald Trump took office.

“This policy change acknowledges the unique occupational hazards faced by women firefighters and ensures they receive the care and support they deserve,” Christopher Godfrey, the now-former director of the workers’ compensation office, said in a Jan. 6 statement on the Labor Department’s website.

In a statement to Â鶹ŮÓÅ Health News four days later, Godfrey said the policy change resulted in immediate action for firefighters with new claims.

But in the early days of the Trump administration, the January press release announcing the cancer coverage expansion was deleted from the Labor Department website. When asked whether claims were still being processed for the four recently added cancers, a spokesperson for the workers’ compensation office, Frances Alonzo, told Â鶹ŮÓÅ Health News, “We do not have any additional updates regarding your inquiry.”

Formalizing the policy change through rulemaking will take months and support from Congress.

Kaleena Lynde is among a generation of women firefighters who developed cancer before streamlined coverage for workers’ compensation claims existed. In 2006, Lynde, then 22, was diagnosed with small cell ovarian cancer during her third fire season on the Shasta Lake Hotshots, an elite crew of firefighters in Northern California. Doctors removed a 5.4-pound tumor almost immediately that year. She’s now cancer-free, but only after multiple surgeries, chemotherapy, and an additional cervical cancer diagnosis three years later. Lynde has since gone on to work various jobs for the Forest Service, including 16 years at Eldorado National Forest doing fire investigation, fire prevention, and dispatch center jobs. She now coordinates wildfire apprenticeships for the agency’s Pacific Southwest region.

A friend recently sent her a link to the , a database tracking the prevalence of diseases among all firefighters, both structural and wildland. It made Lynde wonder — could her cancers be connected to her work on the fire line?

“I just thought I had bad luck,” Lynde said.

Seeking to fix the omission, more than 15 wildland firefighter advocacy groups, representing Hotshot crews, smokejumpers, and others, signed a September letter to Julie Su, the acting labor secretary at the time. They pointed out that other countries, , already included presumptive coverage for cervical, ovarian, uterine, and breast cancers.

The Labor Department implemented that eased the requirements for covering wildland firefighters’ cancer-related workers’ compensation claims in April 2022 through a Federal Employees’ Compensation Act bulletin. The rules were codified in December 2022 when President Joe Biden signed the National Defense Authorization Act.

To qualify, firefighters must have worked for at least five years and be diagnosed within 10 years of their last exposure. Those with unlisted cancers could still file claims through a special unit but wouldn’t receive the same streamlined adjudication for compensation. By September 2024, the workers’ compensation office had received 91 claims for qualifying cancers and heart and lung conditions. Of those, 89 were adjudicated through the special claims process and 84, or 94%, were accepted. Godfrey said that prior to the legislation, only 29% of occupational disease claims for firefighters were accepted.

Rachel Granberg, a wildland firefighter in Washington state, said streamlined processing and reimbursements are important. “It really gives people more bandwidth to worry about how they’re going to manage their life after a cancer diagnosis, rather than just fighting for basic health care.”

Too often firefighters end up crowdsourcing for financial support after cancer diagnoses, she said.

George Broyles, retired firefighter and Forest Service researcher, said that health risks are too often seen as part of the job. “Hazard pay is not going to stop cancer,” he said. Broyles wants federal firefighting agencies to be honest about cancer risks when hiring young workers and then educate them on ways to protect themselves.

The recent policy change meant claims for federal wildland firefighters with ovarian, breast, or uterine cancer were immediately directed to the special claims unit and expedited processing.

The Labor Department’s decision to change course and expand presumptive coverage to female reproductive cancers was sudden. In December, the agency released a statement to Â鶹ŮÓÅ Health News saying such a change was unwarranted.

Three weeks later — without pointing to any new published research — the agency changed course, citing additional consultation with the National Institute for Occupational Safety and Health and with Steven Moffatt, a doctor who specializes in firefighter illnesses. The agency conducts periodic reviews to consider adding new conditions to its coverage.

The Labor Department’s initial exclusion of female reproductive cancers illuminated the repercussions of research on wildland firefighter health in which women are understudied. that only three out of 20 studies evaluated women firefighters’ cancer risk.

But research has confirmed for years that firefighters are exposed to toxic dangers. A Florida firefighters for almost 20 years in the 1980s and 1990s found that firefighting increases the overall cancer risk in female firefighters. In 2022, the International Agency for Research on Cancer as a cancer-causing occupation.

Recent research contributed to the agency’s inclusion of female reproductive cancers, Godfrey said. In 2023, a link between perfluorononanoic acid, a type of PFAS, and uterine cancer. PFAS, which stands for per- and polyfluoroalkyl substances, are a category of chemicals that in the protective gear worn by wildland firefighters. has also linked PFAS exposure to an increase in melanoma. in September identified 12 chemicals that firefighters are exposed to on the job linked to breast cancer.

But now, it’s unclear whether the Trump administration will roll back the new coverage, leaving some federal firefighters unsure whether exposures on the job will leave them scrambling for care.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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They include seniors living in long-term care facilities, many of whom are considered an for smoke exposure because of respiratory or cardiac diseases.

“An astonishing amount of smoke gets inside these facilities,” said Luke Montrose, an environmental toxicologist and researcher at Colorado State University. Data from monitors Montrose installed in four Idaho long-term care facilities in 2020 showed that large amounts of smoke pollution recorded outside during wildfire season seeped into the facilities. One building let in 50% of the particulate matter outside; another, 100%. In some cases, Montrose said, “it was no better to be inside than to be outside during those smoke events.”

That’s why Montrose has spent the past few years installing more monitors in care facilities across Idaho and Montana. The study is expanding into Colorado this summer.

Understanding and addressing how wildfire smoke affects indoor air quality could help better treat the roughly 1.4 million seniors who live in more than 15,500 Medicare- and Medicaid-certified nationwide and nearly a million more who live in assisted living facilities.

“It may be a game-changer for quality of care,” said Robert Vande Merwe, executive director of the Idaho Health Care Association. Vande Merwe helped persuade facilities to join Montrose’s study.

Although residents of the western U.S. have lived with smoky summers for decades, the fallout from wildfires is becoming a nationwide issue. Smoke from blazes in barreled into the densely populated Northeast and Midwest last June, making the skies above Toronto, New York, Chicago, and much of the Atlantic Coast glow an . More than 120 million people were . As wildfires increase in size, intensity, and duration, fueled by a combination of climate change and , the smoke they generate will likely affect more people.

“We’re going to see more and more smoke events that reach further across the U.S. and across the world,” said Savannah D’Evelyn, a postdoctoral scholar at the University of Washington who studies wildfire smoke and its effects on health. She was not involved in Montrose’s study.

Air pollution from — a brew of pollutants, water vapor, and fine debris — is a growing public health problem. known as PM 2.5 are small enough to embed deep into people’s lungs and, sometimes, infiltrate their bloodstream. Research has shown and respiratory inflammation or jeopardize lung function, and the particles . They are especially dangerous for children and people with preexisting heart or lung conditions — including seniors, the focus of Montrose’s work.

“I think honing in on this particular community that is really quite impacted by smoke exposure on the health side of things is really great,” D’Evelyn said. “It’s a gap that needs to be addressed.”

For years, public health officials have told people to go inside on bad air quality days, even though, without testing and filtration, indoor air quality often isn’t much better than what’s outside. Although skilled nursing facilities follow to participate in the Medicaid and Medicare programs — from building safety features, like fire sprinklers, to residents’ rights — indoor air quality isn’t addressed.

“There really aren’t any regulatory standards for indoor air quality, broadly, in any country that I’m aware of,” said Katherine Pruitt, national senior director for policy at the American Lung Association.

Without the few indoor air quality monitors in the study, long-term care facility managers or operators might check their local air quality index, or AQI, on their smartphone’s weather app or by watching the news. But air quality monitors don’t always provide accurate information about the air outside, let alone inside a building. Rural areas are particularly underserved by air quality monitors. According to Montrose, 25% to 30% of skilled nursing facilities in the Mountain West are more than 30 miles from a regulatory-grade monitor. Indoor air quality monitoring is rare outside of studies like Montrose’s.

That’s why Montrose is on a quest to get more air quality monitors placed inside facilities. In 2019, he contacted more than 80 Boise-area nursing and assisted living facilities to gauge interest and concern about wildfire smoke. In 2020, he collected data from indoor and outdoor air quality monitors at four nursing homes — two in the Boise area, others in northern and eastern Idaho. The particulate air pollution inside one facility nearly 17 times what’s considered healthy.

In 2021, data collected from six facilities from July to October — four in Idaho and two in the Missoula, Montana, area — also showed that in some buildings indoor and outdoor air quality were almost identical on smoky days. Montrose repeated the monitoring at four other southern Idaho facilities last summer. The monitors fed real-time data to a dashboard that people running the nursing homes could see and respond to.

Protecting seniors from wildfire smoke is an important piece of wildfire preparedness, yet Montrose acknowledged that conducting research in nursing homes and care facilities has challenges. Unique ethical considerations arise with dementia or Alzheimer’s patients, who can’t give informed consent. Staff turnover makes it hard for researchers like Montrose to establish relationships with facility operators, and asking overburdened nurses or employees to do extra work, like understand and check air quality monitors, can be a nonstarter. Still, Montrose said, people living in long-term care facilities are particularly vulnerable. “If we can protect them, there’s great benefit to our communities,” he said.

Some facilities in Idaho have made changes because of the research. Those include a pre-fire season facility checklist to make sure filtering systems are in good shape and that doors and windows are properly sealed. They also share the area’s AQI as part of their daily morning safety meetings.

Mark Troen, regional maintenance director for 10 Edgewood Healthcare facilities in the Boise area, four of which had monitors last summer, laid out a litany of things he does when the indoor air quality rises past healthy levels: changing air filters to a higher level that traps more particulates, turning off outdoor air intake, and alerting staff to keep doors and windows closed. “Anything I can do to keep the residents safe, I’m all for,” Troen said.

Clinical staff members also have identified which residents have respiratory problems or are immunocompromised. In an intense smoke event, those people may get portable air filtration in their rooms for extra protection.

Troen plans to install air quality monitors from his own budget once the study’s monitors need to be replaced due to age. “To actually see in real time what your indoor air quality is is huge,” he said. “It helps us mitigate some of those problems, rather than waiting until it’s bad.”

Anyone can take steps to improve the air they’re breathing during wildfire season. “It’s pretty easy to clean indoor air,” D’Evelyn said. HEPA air filters are the gold standard but can cost upward of $100; creating a box fan filter is a cheaper alternative. According to D’Evelyn, making even one room in a building a “clean air space” can make a difference during a wildfire.

The American Lung Association’s Pruitt said starting policy conversations about regulating indoor air quality faces many barriers, including perceptions of federal overreach. In the absence of federal regulations, Pruitt believes, the most effective actions would likely come from state or local building codes and ventilation standards. “Policymakers should be looking at the steps that need to be taken to protect people from exposure to hazardous levels of smoke or other outdoor pollutants,” she said.

Montrose is recruiting more nursing homes to install air quality monitors this summer, including additional facilities in Idaho, Colorado, and Montana. Vande Merwe, of the Idaho Health Care Association, said other places in the region — like his hometown, Salt Lake City, which is situated where smoke and other pollutants accumulate — should take note. Breathing in the best possible air could make a big difference for residents’ health and quality of life as they age, he said.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).