The International Association of Firefighters estimates that roughly 60 percent of career firefighters will die from cancer. Firefighters are two to three times more likely to be diagnosed with cancer than the general public. By age 60, twice as many firefighters die from cancer than heart attacks, the biggest killer among most Americans.

Volunteer firefighters in Douglas County know all about the risks.

"It hits home," said Alexandria Fire Chief Jeff Karrow. "In the last two and a half years, we've buried five firefighters who died from cancer, not only from our department but from Brandon, Forada, Kensington and Miltona."

Six out of the last seven firefighters who retired from the Alexandria Fire Department died after battling some type of cancer, Karrow added.

The threat is not a secret. It's impacting fire departments across the country.

"The Boston Fire Department has a wall filled with the names of all those who died from cancer," Karrow said. "Studies in Miami and Dade County show that 35 percent of their firefighters will get cancer and die. Three firefighters sitting around the table — they know one firefighter will develop cancer. Those are pretty staggering numbers."

When firefighters took their oath decades ago, they knew they'd be sacrificing time away from family, church and work, said Karrow, who has been with the Alexandria Fire Department for 24 years and spent another five years with Forada.

They also knew there would be times when they'd be putting their lives on the line to save others. But up until a few years ago, the fire industry didn't realize that cancer was also in the mix.

These days, battling the fumes, toxins and carcinogens from a fire have become just as important as knocking down the flames. Materials that catch fire aren't just made out of wood, glass and metal. There are electronic devices like laptops and TVs, and deadly chemical compounds hidden in plastics and petroleum products.

"The 'smoke eater days' of going into a fire without an air pack are gone," Karrow said. "You can't just be an ostrich and bury your head in the sand. You have to be as proactive as you can."

Technology is helping. When responding to grass fires, firefighters will now be wearing a protective covering called a "hot shield" around their face that filters out 95 percent of the hazardous particulates, said Karrow.

Other precautions can be found throughout Alexandria's fire station. The department has two powerful extractors — which look like washing machines — that remove soot, hydrocarbons and other toxins from firefighting gear using special cleaning fluids.

At $7,000 each, the extractors aren't cheap but the precautions are well worth it, Karrow said.

Getting the firefighters to use the machines, thoroughly clean their gear and take other safety measures are part of a new educational effort and culture change, the chief said.

"We've been changing the culture," Karrow said. "There are a lot of little things we're trying to do."

Little things like putting up a chart listing 10 actions firefighters can take to protect themselves from cancer, such as changing clothes and showering immediately after a fire, using baby wipes to remove soot, and not taking contaminated clothes back to their home or vehicle.

Little things like displaying cartoon-like drawings that deliver powerful messages of the cancer risks firefighters face. One drawing shows a two-headed monster — dubbed Hydrogen-Cyanide and Carbon-Monoxide — looking evilly at an unmasked firefighter while saying, "He's not wearing his SCBA (self contained breathing apparatus) ... Let's play!"

Little things like teaching firefighters to keep wearing their air packs and masks even while they're doing routine mop-up work after a fire. "Those materials can still be off-gassing and the soot and smoke can collect," Karrow said. "And the areas where they sweat the most can suck up all those particulates into the neck, stomach, groin or colon. You can never eliminate the risk but small steps can be taken."

And there are bigger efforts, too — like new Nomex hoods that offer advanced heat and flame protection. Each firefighter has two of them, including a pink one for breast cancer awareness in October.

The department is also taking a big step forward in fighting cancer by using an $85,000 grant to purchase new turnout gear for all 31 firefighters. "The new gear will be better at filtering out soot and particulates," Karrow said.

Despite the cancer risks, it hasn't hurt recruitment efforts at the Alexandria Fire Department. The department signed up three new firefighters last September and there are 15 people on the waiting list.

But that's not the case in some areas where fire departments are struggling to maintain their ranks.

"Right now, we are an anomaly," Karrow said. "Statewide, departments have lost 5 percent of their volunteers in the past 10 years. ... We're on an island. We're very blessed."

The issue of protecting firefighters from cancer prompted U.S. Sen. Amy Klobuchar, D-Minnesota, to introduce legislation to establish a national cancer registry that would track the relationship between firefighters' exposure to fumes, toxins and cancer.

In an editorial justifying the effort, Klobuchar noted that statistics and stories have been highlighting the risks firefighters face but the studies are independent and varied. "We don't know the true scope of the problem because we don't effectively record cancer diagnosis among firefighters," Klobuchar said.

The data collected would shed light on the environmental risks firefighters face and spread awareness about prevention techniques, she said. Both career firefighters and volunteer firefighters would participate in the registry. "That's especially important in Minnesota where the vast majority — 18,000 of 20,000 firefighters — are volunteers."

Klobuchar said she'd also push for funding to help more fire departments purchase extractors for their fire stations. A report found that 26 percent of Minnesota's departments do not have an extractor.

"In taking their oath, firefighters accept an immense responsibility — to put service before self," Klobuchar said. "No matter the hour or risk, firefighters answer the call to keep us safe. The very least we can do is pass commonsense legislation to protect their health."