Lately I have been thinking about a story by Richard Kalish that I first heard early in my college years at Iowa State. In the tale, a man journeyed to Nepal to consult a famous guru. This man was pursuing the study of medicine and the issues of death and dying. He felt his questions could be answered only by the highest of spiritual leaders of the one religion which seems to be held in the highest regard on the issues of death and dying.

After an arduous and exhausting climb for an audience with the guru — and to the point of exhaustion from the altitude — he was given an opportunity to ask a question. "Your holiness, what is it the dying person feels when no one will speak with him nor permit him to speak about his dying and what it is like to die," he asked.

The guru answered after several minutes: "It is the horse on the dining room table." Shortly after that comment, the man fell asleep. When he awoke, he found that the guru was gone. The man left with the idea he would understand the comment at some point.

Several years later, the man and his wife attended a dinner party. The guests assembled in a part of the house away from the dining room. There was lively conversation with drinks and snacks in the den. When dinner was ready, the guests moved single file into the dining room for buffet service. A silence followed immediately. When the man and his wife entered, they were shocked by the horse that had been placed in the center of the table. The man looked back to see his hosts had a similar look of shock and amazement. The horse dominated the atmosphere.

People sat next to their place cards and barely conversed. No one spoke of the horse. Someone would start a conversation about taxes or politics, but it couldn't be sustained in the overwhelming presence of the horse. No one asked from where this horse had come, why was it there or who brought it. But as uncomfortable as the horse made everyone, no one removed it. It was as if the horse had complete control over everyone and everything. It was a miserable dining experience. After dinner, everyone expressed their gratitude and left immediately.

The man promptly returned to Nepal for another audience with the guru. This time, they engaged in a lengthy conversation.

I share this story because I see parallels in the fire service. I share it because I am outraged by others' ignorance of the fire service's horse.

Like the horse on the dining room table, the fire service often doesn't discuss cancer — though the occurrences of it stare us in the face daily. It seems like you hear of a new case every month, yet we don't acknowledge its presence. It is time to change that.

There seems to be an alarming increase in the cancer rates for firefighters. In February, I saw my previous department struggle with the diagnosis and soon-after death of one of the most humble and dedicated firefighters I have ever known, from an aggressive melanoma that more than one cancer study has correlated with firefighting. The fire service tracks and records line-of-duty deaths, but cancer deaths aren't examined in the detail we need.

Toxic smoke and combustion products, coupled with the stresses of the job and toll the alarm response takes on the body, give cancer a foothold. Some studies show certain cancer rates to be 150% to 300% higher in firefighters than in the general population. Some states have presumptive legislation that addresses cancer-related firefighter illness or death. But these benefits appear to be under attack. The National League of Cities has misinterpreted a recent study by TriData on firefighters and cancer. It is important to read the entire study and not just the press release from the NLC, which distorts the information.

Cancer has been the horse on the station table for years, and the fire service has yet to engage in a serious effort to acknowledge it, combat it and take the risk seriously.

The real and immediate need is threefold. First, we need to begin gathering statistics on cancer occurrences in the fire service. Many fire departments experience a death and it goes unreported as an LODD. Well-documented exposure reports often don't connect a cancer case to a repeated or single event where a firefighter was exposed to a known carcinogen. This prevents science from proving that firefighters are at risk like no other group of public-safety professionals. These numbers make it paramount for the NFPA to adjust fire department physicals and ensure the screening tools are looking for the most prevalent killers. We must back up the presumptive legislation with real numbers.

Second, there needs to be more funding from the National Institutes of Health to look at exposures to products of combustion, effects of stress and lifestyles of firefighters. Most of the cancer studies in the last 10 years have been funded by drug companies that were looking for the effects of a specific treatment. In the 1980s, many of the studies used more epidemiological approaches. In 1988, Michael Bates at the University of California-Berkeley produced a study of 3,659 firefighters taken from a cancer registry database. This should be mandatory reading for anyone engaged in this argument.