I was 25 years old and still a probie when the towers came down on September 11, 2001. I responded that morning with Ladder 129, and I worked the site in the weeks that followed. I’ve spent the 25 years since making sure the people made sick by that day are not forgotten.
Every firefighter wears a breathing apparatus, and built into it is an alarm that goes off if you stop moving. It screams so your brothers can find you. On the pile, we heard those alarms going off underneath us, from men we could not reach. They did not run for hours. They ran for days. I have never stopped hearing them.
Two hundred stories of office building came down on top of us. We did not find the symbols of an office building: no chairs, light bulbs or computer screens. We found nothing. All of it was in the air we were breathing.
On the 25th Anniversary this year, the country remembered the 343 FDNY members who did not come home. But the count did not stop at 343. More than 400 have since died from illnesses linked to that day, and the number keeps climbing.
The World Trade Center Health Program has recorded 10,393 cancer certifications tied to the attacks, more than 28 a day. Since it began, 57,044 members have had a cancer certified as a 9/11-related condition.
These aren’t statistics to me. They are friends and neighbors, parents and brothers and sisters, battling life-threatening illness because they answered the call. I know. I lived it.
In 2007, I was diagnosed with sarcoidosis, an autoimmune disease tied to my exposure at Ground Zero. It attacked my body and swelled me to nearly twice my size. Chest pain, a relentless cough and trouble breathing. I was hospitalized before doctors could tell me what was wrong.
But I was one of the lucky ones. My disease was caught early enough to manage. I fought for years to return to full duty, but I never regained my health, and it cost me the job I wanted my entire life.
An estimated 400,000 people were exposed to toxins from the attacks. Because cancers can take decades to surface, today’s totals are not the final count.
This is not only a 9/11 story. In 2022, the International Agency for Research on Cancer classified occupational exposure as a firefighter as carcinogenic to humans. According to the Firefighter Cancer Support Network (FCSN), occupational cancer accounted for 66 percent of career firefighter line-of-duty deaths from 2002 through 2019. Firefighters face a 9 percent higher cancer risk and unfortunately have 14 percent higher risk of dying from it compared to the general public. The fires go out. The exposure does not.
For more than two decades, FCSN has supported firefighters through diagnosis, treatment and survivorship. That work gives FCSN a firsthand understanding of both the human toll of occupational cancer and why earlier detection matters.
When FCSN began its mission, cancer was not a covered condition under the World Trade Center Health Program. It was added in 2012, after years of pressure from responders and their advocates. I was part of that fight. It took evidence, and it took people willing to tell their stories.
Today, FCSN is leading the National Initiative for Firefighter Cancer Screening Recommendations, the first effort to build screening recommendations for the fire service rather than for the general public. Existing recommendations are keyed to age and to population-average risk. A firefighter’s exposure can begin on his first day on the job. The initiative brings together experts in oncology, epidemiology and occupational medicine alongside fire service leaders, and the recommendations are due in 2027.
Exposure cannot be undone. Detection can be moved earlier. For many firefighters, that is the difference between a treatable diagnosis and a line-of-duty death.
The sacrifice didn’t end on 9/11. This September, as we honor those who gave their lives, we owe something to the ones still carrying it. Get screened. Push your department to make screening routine. And don’t be the guy who won’t see a doctor because he doesn’t want to hear bad news.
Michael O'Connell is a retired FDNY lieutenant who responded to the World Trade Center on Sept. 11, 2001. Diagnosed in 2007 with sarcoidosis tied to his exposure at Ground Zero, he has spent nearly two decades advocating for 9/11 responders and their families, including work to win health coverage for 9/11-related cancers.
