Four key points
- IARC Group 1. Since June 2022, occupational exposure as a firefighter has been classified as "carcinogenic to humans".
- Two established cancers. Mesothelioma and bladder cancer; five other cancers with limited evidence.
- Broader recognition. Since the decree of 26 December 2025, firefighting has been included in occupational disease tables no. 16 bis and no. 30.
- Record it to prove it. Without a dated, individual exposure record, the link between a disease and call-outs from years ago remains very difficult to establish.
What fire smoke contains
Fire smoke is a mixture of gases, vapours and particles whose composition depends on what is burning: furniture, plastics, insulation, fuels, batteries, vegetation. It contains hundreds of compounds, several of which are carcinogenic, mutagenic or toxic to reproduction (CMR).
The main families of CMR agents
Incomplete combustion of any organic material: soot.
Plastics, fuels, wood, foams.
Combustion of chlorinated materials such as PVC.
Treated wood, paints, electrical equipment, batteries.
Buildings constructed before 1997.
Some foam concentrates and textiles; classified as carcinogenic (Group 1) by IARC since 2023.
In addition, there are acutely toxic gases such as carbon monoxide and hydrogen cyanide, which pose a risk of immediate poisoning rather than a carcinogenic risk.
Three routes of exposure
Breathing apparatus (BA) removed too early, overhaul, vegetation fires where BA is generally not worn, fire kit that continues to off-gas.
Soot settles on the neck, jaw and wrists. Absorption increases with heat and sweating.
Hands, water bottles or food consumed without prior cleaning.
Exposure therefore does not stop when the fire is out. Overhaul, the ride back in the appliance wearing contaminated kit, and storing personal protective equipment (PPE, EPI in French) at the station or at home all prolong contact with pollutants. This is what the PPE module for tracking fire kit addresses.
Wildfires and vegetation fires: a distinct exposure
The French Agency for Food, Environmental and Occupational Health & Safety (ANSES) has published an expert report on pollution from vegetation fires and its health effects, including on emergency responders[a].
- A mixture of pollutants: fine particles (PM2.5 and PM10), carbon monoxide, nitrogen oxides, volatile organic compounds and polycyclic aromatic hydrocarbons (PAHs). Their composition varies with the vegetation, the combustion conditions and air humidity.
- Carcinogenic particles: the International Agency for Research on Cancer (IARC) classifies outdoor air pollution and the particulate matter it contains as carcinogenic to humans (Group 1, 2013)[b].
- Everyone under the plume: according to ANSES, exposure does not only concern crews in contact with the fire, but also appliance drivers, the chain of command and medical personnel present in the smoke fallout area.
- Inadequate protection: ANSES reports that an assessment by the CEREN laboratory concluded that the hoods available for wildfires filter neither fine particles nor the chemical compounds in the smoke.
Wildland firefighting work is included in the occupational disease tables amended by the decree of 26 December 2025: recording vegetation fires matters as much as recording urban fires.
PFAS: foam concentrates and fire kit
PFAS, known as "forever chemicals", are highly persistent fluorinated compounds. Travail et Sécurité, the magazine of the French National Research and Safety Institute (INRS), identifies two sources of exposure for firefighters: firefighting foams and waterproofed, flame-retardant equipment, including turnout gear[c].
Perfluorooctanoic acid, classified as carcinogenic to humans[d].
Perfluorooctane sulfonate, classified as possibly carcinogenic to humans[d].
For traceability purposes, the use of fluorinated foams during a call-out should be noted in the exposure record, just like smoke.
Cancers recognised in firefighters
The IARC classification (2022)
In June 2022, a working group of the International Agency for Research on Cancer (IARC), the specialised cancer agency of the WHO, classified occupational exposure as a firefighter in Group 1, "carcinogenic to humans" (Monograph 132). This is the highest level of evidence; previously, the occupation was classified as "possibly carcinogenic" (Group 2B).
- Sufficient evidence: mesothelioma, bladder cancer.
- Limited evidence: cancer of the colon, prostate and testis, melanoma, non-Hodgkin lymphoma.
Cancer by cancer: what IARC and the tables say
| Cancer | IARC (2022) | Occupational disease table |
|---|---|---|
| Mesothelioma | Sufficient evidence | No. 30 (asbestos) |
| Bladder | Sufficient evidence | No. 16 bis (tumours of the urinary epithelium) |
| Colon | Limited evidence | Case-by-case examination |
| Prostate | Limited evidence | Case-by-case examination |
| Testis | Limited evidence | Case-by-case examination |
| Melanoma | Limited evidence | Case-by-case examination |
| Non-Hodgkin lymphoma | Limited evidence | Case-by-case examination |
| Lung (bronchopulmonary) | Not cited by IARC for the occupation | No. 16 bis (primary bronchopulmonary cancer) |
| Skin (carcinomas) | Not cited by IARC for the occupation | No. 16 bis (primary skin epitheliomas) |
Sources: IARC, Monograph 132[e]; INRS, table no. 16 bis[f]; Decree no. 2025-1349 (décret n° 2025-1349). Other cancers are not among those retained by IARC in 2022. "Case-by-case examination": outside the tables, recognition goes through the regional committee for the recognition of occupational diseases (comité régional de reconnaissance des maladies professionnelles; article L. 461-1 of the French Social Security Code, code de la sécurité sociale), which requires the exposures to be documented.
Recognition as an occupational disease in France
Decree no. 2025-1349 of 26 December 2025 (décret n° 2025-1349), published in the Journal officiel (French official gazette) on 29 December 2025, amended two occupational disease tables of the French Social Security Code to include firefighting work: fighting urban, rural and wildland fires, training involving the same risks, overhaul, rescue after building collapse and equipment cleaning.
- Table no. 16 bis (tableau n° 16 bis: tars, oils, pitches and combustion soot): skin cancers, bronchopulmonary cancers and tumours of the urinary epithelium, including the bladder.
- Table no. 30 (tableau n° 30: asbestos dust): notably mesothelioma.
Inclusion in a table creates a presumption of occupational origin when the conditions of the table are met. It must still be possible to show that the firefighter actually carried out this work, and for how long: this is what traceability is all about.
Volunteer firefighters
As at 31 December 2024, France had 256,400 firefighters, of whom 198,900 were volunteers, i.e. 78% of the workforce[h]. They fight the same fires and breathe the same smoke as career firefighters. To reconstruct their exposures years later, an individual record that follows them throughout their service is their best safeguard.
What the law says about monitoring CMR exposures
- 1985FoundationIn force
The Labour Code applies to French fire and rescue services (SDIS)
The CMR risk prevention rules (articles R. 4412-59 et seq. of the French Labour Code, Code du travail) apply to local authorities and their public bodies, including the SDIS, under Decree no. 85-603 of 10 June 1985 (décret n° 85-603): assess exposures, reduce them to the lowest possible level, inform staff.
- April 2024Decree no. 2024-307In force since 5 July 2024
A list of exposed workers, kept for 40 years
Transposition of the European directive on carcinogenic, mutagenic and reprotoxic agents. The employer keeps an up-to-date list of workers likely to be exposed, with the agents concerned and, where known, the nature, duration and degree of exposure. The occupational health service keeps it for at least forty years.
- January 2025DGSCGCIssued
National templates for firefighters
The French Directorate General for Civil Protection and Crisis Management (DGSCGC) issues templates for an annual summary and a certificate of activities, to record call-outs involving exposure to risk factors.
- March 2025Private member's billAdopted by the Senate · sent to the National Assembly
A mandatory exposure record
Each SDIS would have to draw up an exposure record, following a national template, for every firefighter, career or volunteer, exposed to CMR agents in the course of their duties.
- December 2025Decree no. 2025-1349In force since 29 December 2025
The occupational disease tables are updated
Firefighting work is included in tables no. 16 bis (combustion soot) and no. 30 (asbestos).
The finding: traceability is still very uneven
Occupational disease claims by firefighters registered by the CNRACL (the national pension fund for local government employees) in 2023, i.e. 0.55% of all claims. In 2024, the Senate fact-finding mission noted that an exposure record was not systematically completed and that only some départements recorded exposures.
Decontamination: the practices that reduce exposure
The DGSCGC operational doctrine guide "Prevention of risks related to smoke toxicity" (Prévention des risques liés à la toxicité des fumées, 2018, updated in 2020) organises prevention before, during and after the call-out. Each SDIS translates it into its own protocols. The common principles:
- Keep BA on until leaving the area, including during overhaul where possible.
- Limit the number of personnel exposed and the time spent in smoke.
- Undress in a dedicated area, preferably in the open air.
- Bag contaminated PPE and transport it outside the cab.
- Clean face, neck and hands with suitable wipes.
- Shower as soon as possible and change clothes.
- Wash PPE before any reuse, without taking it home.
- Do not drink or eat before washing your hands.
Recording these practices serves two purposes: checking that they are actually applied, and documenting each firefighter's residual exposure when they have not been.
Medical surveillance, over decades
Cancers linked to fire smoke often appear several decades after exposure, sometimes long after the end of service. The SSSM provides medical surveillance for firefighters; for it to be appropriate, it needs to know who was exposed, to what and how many times.
- Tailor surveillance: identify the most exposed firefighters and adapt examinations.
- Prove exposure: provide, years later, the evidence needed for a recognition claim.
- Improve prevention: identify the types of fire, roles and practices that cause the most exposure.
- Cover volunteers: volunteer firefighters, who make up the vast majority of the workforce, are affected just as much as career firefighters.
The record is made the same evening, with no re-keying
The crew / incident commander (CA / COS) fills in the contamination report for their crew at the end of the call-out. Command sees what is missing, the SSSM checks and completes it, and each firefighter keeps the history of their exposures.
Frequently asked questions
Do wildfires also expose firefighters to carcinogens?
Yes. According to ANSES, vegetation fire smoke contains fine particles, carbon monoxide, nitrogen oxides, volatile organic compounds and PAHs; IARC classifies particulate matter from outdoor air pollution as carcinogenic to humans (Group 1). Wildland firefighting work is included in the occupational disease tables amended in December 2025.
Does fire kit contain PFAS?
According to the INRS magazine Travail et Sécurité, firefighting foams and waterproofed, flame-retardant equipment, including turnout gear, are sources of PFAS exposure. IARC classified PFOA as carcinogenic to humans (Group 1) in 2023.
Are volunteer firefighters affected?
Yes, just as much as career firefighters. At the end of 2024 they made up 78% of firefighters in France (198,900 out of 256,400, according to the DGSCGC). An individual exposure record makes it possible to reconstruct their exposures years later.
Is firefighting recognised as carcinogenic?
Yes. Since June 2022, IARC has classified occupational exposure as a firefighter in Group 1, "carcinogenic to humans", with sufficient evidence for mesothelioma and bladder cancer.
Which cancers can be recognised as occupational diseases?
Since Decree no. 2025-1349 of 26 December 2025 (décret n° 2025-1349), firefighting work is included in table no. 16 bis (soot-related skin, bronchopulmonary and urinary tract cancers) and table no. 30 (asbestos, including mesothelioma). Other cancers can be examined on a case-by-case basis.
What is an exposure record?
It is an individual document stating which hazardous agents a firefighter was exposed to, during which call-out, for how long and with what protection. It is used for medical surveillance and, later, for any claim for recognition of an occupational disease.
Are volunteer firefighters affected?
Yes. They are exposed to the same smoke as career firefighters. The private member's bill adopted by the Senate in March 2025 expressly includes them in the exposure record requirement, and the December 2025 decree covers career and volunteer firefighters alike.
How long must exposure data be kept?
For CMR agents, Decree no. 2024-307 (décret n° 2024-307) requires the occupational health service to keep the data for at least forty years. As this is health data, its hosting must comply with the GDPR (General Data Protection Regulation, RGPD in French) and the rules applicable to health data.
Who fills in the record after a call-out?
It depends on how each SDIS is organised. In Carnet Expo CMR, the crew commander (CA) or incident commander (COS) fills it in for themselves and their crew: they know the roles held, BA use and the decontamination conditions. The SSSM then checks it and can correct it.
Are vegetation fires less of an exposure?
Not necessarily. Concentrations are often lower than in structure fires, but deployments are long and BA is generally not worn. Cumulative exposure can therefore be significant.
Sources
- IARC, Monographs volume 132: occupational exposure as a firefighter (in French)
- French Senate, information report no. 641 (2023-2024): cancers attributable to firefighting (rapport d'information n° 641, in French)
- French Senate, report no. 436 (2024-2025) on the private member's bill on monitoring firefighters' exposure to CMR agents (rapport n° 436, in French)
- French Senate, "la loi en clair": progress of the private member's bill (in French)
- DGSCGC, operational doctrine guide "Prevention of risks related to smoke toxicity" (Prévention des risques liés à la toxicité des fumées, in French)
- Decree no. 2024-307 of 4 April 2024 (décret n° 2024-307): traceability of exposure to CMR agents (Légifrance, in French)
- Decree no. 2025-1349 of 26 December 2025 (décret n° 2025-1349): occupational disease tables no. 16 bis and no. 30 (Légifrance, in French)
- [e] IARC, Monograph 132: cancers with sufficient evidence (mesothelioma, bladder) and limited evidence (colon, prostate, testis, melanoma, non-Hodgkin lymphoma)
- [g] Demers et al., "Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification", Safety and Health at Work, 2023 (rate ratios of 1.58 for mesothelioma and 1.16 for bladder cancer)
- [a] ANSES, expert report "Pollution from vegetation fires and effects on human health" (Pollution liée aux incendies de végétation et effets sur la santé humaine, request 2023-SA-0154, in French)
- [b] IARC, press release no. 221 (17 October 2013): outdoor air pollution and particulate matter classified as carcinogenic to humans (Group 1)
- [c] INRS, Travail et Sécurité no. 861: "PFAS: firefighters sound the alarm" (PFAS : les pompiers sonnent l'alerte, in French)
- [d] IARC, Monograph 135: PFOA (Group 1) and PFOS (Group 2B), 2023
- [f] INRS, general scheme table no. 16 bis (tableau n° 16 bis du régime général): primary skin epitheliomas, primary bronchopulmonary cancer, tumours of the urinary epithelium (in French)
- [h] DGSCGC, fire and rescue service statistics, 2024 edition (in French)
This guide is a general information summary written by VB Safety. It constitutes neither medical advice nor legal advice. The texts cited may change: refer to the official sources and to your SSSM.