Thyroid Cancer Risk in WTC Responders

Details

• Personal Author:
  Benn E ; Donovan M ; Genden E ; Liu B ; Riggins G ; Taioli E
• Description:
  A statistically significant excess of thyroid cancer has been identified among World Trade Center (WTC) rescue and recovery workers included in the WTC Health Program (WTCHP) at Mount Sinai in New York. Similar results have also been reported in two other cohorts, the WTC-exposed firefighters and the NYC Department of Health exposed residents. Heightened diagnosis due to increased medical surveillance is a possible explanation for greater than expected numbers of thyroid cancer diagnoses. The objectives of this project were to elucidate the reasons for the increased incidence of thyroid cancer among WTCHP participants, and to explore the behavior of these cancers. This project investigated whether thyroid cancers among WTCHP participants differ from a clinical, epidemiologic and molecular viewpoint from thyroid cancers in WTC-unrelated patients, with the following specific aims: 1) analyze if thyroid cancer over-diagnosis occurred among WTCHP responders because of increased surveillance and 2) test if over-diagnosis of malignant thyroid cancer occurred among WTCHP responders For aim 1, thyroid cancer WTC patients were compared with 949 non-WTC thyroid cancer cases identified within the Mount Sinai cancer registry. No significant difference in tumor size (p= 0.405) and age at diagnosis (p=0.225) was found between the two groups, suggesting that surveillance bias does not adequately explain the excess thyroid cancer risk alone. For aim 2, 30 patients with available thyroid tumor tissue samples were matched with 30 non-WTC thyroid cancer patients on age, sex, and histology and were evaluated using established cancer-detection four-biomarker panel of malignancy to determine the false positive rate for malignancy. All samples tested were confirmed to be malignant, suggesting that overdiagnosis by virtue of misdiagnosis of a benign tumor as malignant does not explain the increased incidence of thyroid cancer observed in WTC responders. Rather, there may be an increased incidence of thyroid cancers by virtue of WTC disaster exposure and thus increased screening may be justified in this population. Our results suggest that screening of WTC responders, at least in the case of thyroid cancer, may be beneficial as it might be that the yearly screening visits by the WTCHP are identifying true cases of thyroid cancer earlier, increasing the possibility of a favorable prognosis. Furthermore, future studies should investigate a causal link between thyroid cancer in WTC responders and exposure to potentially thyroid carcinogenic agents at Ground Zero as well as the potential of more aggressive thyroid cancer in the WTC dust exposed population. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Emergency Responders Epidemiology Firefighters Health Care Facilities Workforce And Services Neoplasms Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Cancer Rates Cohort Studies Disaster Response Emergency Responders Fire Fighters Medical Monitoring Medical Screening Thyroid Gland Disorders World Trade Center WTC
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  Maryland ; New York ; OSHA Region 2 ; OSHA Region 3
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-32
• NIOSHTIC Number:
  nn:20066109
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-010984, 2020 Dec; :1-32
• Contact Point Address:
  Emanuela Taioli, MD, PhD, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574
• Email:
  Emanuela.Taioli@mountsinai.org
• Federal Fiscal Year:
  2021
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20160901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20190831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:86db62b48c12d835218576ca798581017fc879f7a6f04cbc3f2e5dd4a009daa7f4a00b398499c32311be5af3ea12926dc22f19e207ed572e3c79276ad1f29a16
• Download URL:
  https://stacks.cdc.gov/view/cdc/219139/cdc_219139_DS1.pdf
• File Type:
  [PDF - 1.35 MB ]