Presumptive disease employment laws facilitate access to health care and compensation for employees who work in hazardous conditions. The scope of these laws is to remove the employee’s responsibility of demonstrating that their condition(s) are caused by their work, thus providing rapid access to resources. On a federal level, the Federal Employees’ Compensation Act (FECA) provides firefighters with these benefits in the event of a disease. In 2025, this Act was expanded to include women’s specific cancers, clarifying conditions for compensation and improving access to care.

However, state-level legislation often lags behind in aligning with federal regulations, as municipalities often seek to preserve their right to dispute such claims. The cost of compensation for a single injured or sick firefighter can reach millions, prompting policymakers to delay implementing these laws in an effort to limit financial responsibility. Nevertheless, these tactics to preserve municipal funds can have rippling effects, whereby firefighters are less likely to pursue this profession, despite other potential benefits.

In the United States, women comprise 9% of the entire firefighting force, totaling more than 90,000 female firefighters. Around 72,400 of these people work voluntarily, a professional firefighting category that is also excluded from presumptive coverage. Moreover, as the number of women firefighters increased in the past decade, the number of volunteers and professional career firefighters decreased by 25% over the past four decades, while population levels increased by 40% during this time. In this context, presumptive coverage becomes a vital tool in securing the nation’s future and current workforce.

Arizona’s presumptive coverage for women firefighters

While FECA now recognizes ovarian, breast, uterine and cervical cancers as presumed to derive from toxic exposure, Arizona’s Revised Statutes § 23-901.09 of Title 23 labor law only recognizes breast and ovarian cancer. Moreover, this provision has a clear specification of who these presumptions apply to, as it defines firefighters as those in full-time employment, i.e., career firefighters. In practice, this legislation leaves without coverage women firefighters who are employed in this profession but suffer from uterine or cervical cancer. As required by this statute, these firefighters still need to undergo a process to demonstrate that their condition is caused by employment. Furthermore, this legislation does not cover volunteer firefighters, although most women in this profession work on a volunteer basis.

Of 238 fire departments in Arizona, only 30% are career-based departments, while the rest operate entirely with volunteer firefighters or use a mix of career and volunteer firefighters. In 2003, a total of 116 women worked as firefighters across Arizona. Today, despite limited reporting by fire departments on gender-specific statistics, this number is likely much higher. With an impressive 70% of all fire departments based on volunteer work, and a considerable number of women firefighters, Arizona leaves much of its female firefighting force without adequate protections, despite compelling evidence of cancer in women linked with this profession.

Toxic exposure and cancer in firefighters

A wide-scale cohort is currently under development to analyze cancer risk in women firefighters. However, existing research shows that women firefighters have an increased risk of reproductive organ cancers, which also manifest almost a decade sooner when compared to the average population. A primary source of toxic contamination with cancer-causing chemicals for this professional group is firefighting gear. Protective equipment contains high levels of PFAS, also known as “forever chemicals,” which are added to textiles to provide heat and water protection. Notably, under hot and humid conditions, this gear releases significant amounts of PFAS, which are then absorbed through the skin and directly enter the bloodstream. With repeated exposure, PFAS continues to accumulate in the body as these substances cannot be broken down by natural processes.

In this context, studies measuring PFAS content in the blood of volunteers and career firefighters report staggering levels of these chemicals. Volunteer firefighters appear to be particularly at risk, as departments funded through local budgets often struggle to replace or upgrade protective gear on a regular basis. Research on PFAS release from outdated equipment demonstrates that wear and tear of turnout gear significantly increases the amount of PFAS leaked out and possibly absorbed through the skin.

Considering these aspects, Arizona must update its presumptive coverage laws to include all reproductive cancers and extend these protections to volunteer firefighters. By aligning with federal standards and recognizing the unique risks faced by women in the profession, Arizona can ensure that all firefighters, regardless of employment status, have access to timely health care and compensation. This legislative reform is essential not only for the well-being of women firefighters but also for the future of Arizona’s firefighting workforce, providing reassurance and support for those who risk their lives every day.

Jordan Cade is an experienced attorney at Environmental Litigation Group, P.C., where he offers case evaluations and legal representation to individuals impacted by environmental and occupational toxic exposure.