The PACT Act: An essential first step in protecting those who protect us

President Biden was finally able to get it done — for Beau. 

We don’t know definitively that Beau Biden’s cancer was caused by exposure to burn pits during his time in Iraq, but we do know that millions of veterans can now count on getting the treatments they need for chronic illness from exposure to burn pits. 

Burn pits are large areas where military waste is incinerated in the open air. Chemicals, weapons and ammunition, metals, medical and human waste, plastics and rubber are all burned, often with jet fuel as an accelerant, resulting in toxic pollution. A 2020 survey by the advocacy organization Iraq and Afghanistan Veterans of America found that 86 percent of respondents were exposed to these burn pits or other toxins during their service.  

The PACT Act, H.R. 3967 (117), requiring the Department of Veterans Affairs to cover care for toxic exposure related to burn pits during military service. While the importance of this legislation cannot be overstated, it begs the question: What should be done for those here at home who risk their health every day to keep us safe?  

As Elizabeth Beck, a former army reservist who served in Iraq described it during the signing event, “You saw the burn pits. You smelled the burn pits. You felt the burn pits in your body.”  

Her words are not too different than that of the aftermath of a housefire as described by Thomas Magliano, a retired firefighter who was diagnosed with lung cancer after a simple screening — thanks to a unique partnership between RUSH University Medical Center and the Chicago Firefighters Union Local 2. Firefighters, regardless of regional location, have a 60 percent increased risk of developing lung cancer. 

“When you’re looking for hot spots or hidden fires in the fire buildings, you can take your mask off. But that asbestos and insulation and smoke from the plastic is still lingering in the air, so you’re breathing in these toxic fumes — you’re still getting exposed to it.” 

As a thoracic surgeon, I am trained to diagnose and treat lung cancer. A cancer diagnosis is a life-changing event for both patients and their families. Unfortunately, by the time I meet most patients, their cancer is at a later stage, having spread beyond the lung. This alters my role from sharing the joy of cure, to breaking the devastating news that a patient’s disease is more difficult to treat and unlikely to be curable.  

Smoking remains the greatest risk factor for developing lung cancer. We are also learning more about how environmental factors, such as where we live and work, impact the risk of developing lung cancer and other lung diseases. The International Agency for Research on Cancer has identified at least a dozen carcinogens linked to lung cancer that are routinely encountered in various occupations. 

Soldiers. First responders. Selflessly dedicating one’s life to the protection of others, apparently, is a risk factor for lung cancer.  

Lung cancer is the leading cause of cancer-related death worldwide. It kills almost three times as many men as prostate cancer, and almost three times as many women as breast cancer. And while it’s easy to feel powerless in the face of these odds, there is hope. The number of lung cancer deaths are decreasing, and the reason is early detection. Early detection of lung cancer in high-risk patients can reduce the chance of death by up to 20 percent.  

For people who are at higher risk of developing lung cancer, there is an easy screening that can provide peace of mind or save your life. A low dose computed tomography (CT) scan uses X-rays and a smaller dose of radiation to take images of the lungs in an average of 10 minutes. It is often covered by insurance for this high-risk population. Currently, the screening is available for people 50 to 80 years old who are current smokers and those who quit within the previous 15 years. It is estimated that approximately 8 million Americans are at high risk for lung cancer, yet we currently are screening only about 5 percent of those individuals. That means there are more than 7 million people we could be saving. Talk to your primary care doctor, who can let you know if you are a candidate and help you schedule a screening.  

Passage of the PACT Act is an important step in protecting those who protect us. But it should only be the first step. It is time to not only ensure our first responders are cared for should they develop chronic illnesses while on the job — but also that we make it as easy as possible to receive life-saving screenings before things get that far. 

Nicole M. Geissen is Associate Program Director of the Cardiothoracic Residency Program and assistant professor at the Department of Cardiovascular and Thoracic Surgery, Rush Medical College.