Detection and Incidence of Thyroid Cancer Among Three Cohorts of WTC-Exposed Rescue and Recovery Workers

Details

• Personal Author:
  Boffetta P ; Hall CB ; Prezant D ; Webber M ; Zeig-Owens R
• Description:
  Background: We, and others, documented a positive association of World Trade Center (WTC)-exposure with thyroid cancer -at least twice that of the general population - though none of the WTC exposures have been definitively shown to be associated with thyroid cancer; only normally-occurring baseline levels of radiation were reported at the WTC site after the disaster. Nonetheless, the elevated risk of thyroid cancer might be due to WTC-related exposure, such as synergistic chemical effects, exposures to chemicals, or doses not studied in other settings, or it might be due to other factors experienced by the WTC-exposed cohorts, such as incidental detection as a result of increased medical surveillance. This project aimed to quantify the extent to which the association between WTC exposure and thyroid cancer is influenced by increased medical surveillance among WTC-exposed rescue/recovery workers. Methods: For the first two aims using data from Fire Department of the City of New York (FDNY) WTC-exposed members of this project we classified the detection method (i.e., incidental vs. symptomatic) of thyroid cancer cases via chart review, and then compared the risk of thyroid cancer, overall, and by detection method (i.e., incidental vs. symptomatic), among FDNY rescue/recovery workers to the risk among demographically similar Olmsted County residents from the Rochester Epidemiology Project (REP). For the third aim using data from all NYC based WTC-exposed rescue/recovery workers, we compared thyroid cancer risk among rescue/recovery workers in the WTC Health Program to the risk among WTC-exposed rescue/recovery workers not in the WTC Health Program (WTCHP). Person-time began on 9/12/2001 or at enrollment in a WTC cohort and ended at death or 12/31/2015. Cancer data were obtained through linkages with thirteen state cancer registries. We used Poisson regression to estimate rate ratios (RR) and 95% confidence intervals (CI) for WTCHP and non-WTCPH participants. New York State (NYS) rates were used as the reference. To estimate potential changes over time in WTC-associated risk, change points in RRs were estimated using profile likelihood. Results: Aims 1&2 results: The overall age-standardized incidence of thyroid cancer was significantly higher in the FDNY cohort: 24.7 (95%CI=17.4-52.3) vs. 10.4 (95%CI=8.5-12.7) per 100,000 in the REP. Overall, the incidence rate of FDNY thyroid cancer was twice that of the REP (Relative Rate (RR)=2.3; 95%CI=1.7-3.2). The rate of incidental cancers was over 3 times greater among FDNY compared with REP (RR=3.2; 95%CI=2.1-4.7). The comparison of FDNY and REP symptomatic rates did not exhibit a significant difference. Aim 3 results: The thyroid cancer rate among WTCPH participants was more than twice that of NYS population rates (RR=2.31; 95%CI=2.00-2.68). Non-WTCPH participants had a risk similar to NYS (RR=0.96, 95%CI=0.72-1.28). We observed no change points in the follow-up period. Conclusions: These findings support the hypothesis that no-cost screening (a benefit provided by WTC-medical monitoring and treatment programs) is associated with elevated identification of thyroid cancer. Given the high survival rate for thyroid cancer, it is important to weigh the costs and benefits of treatment, as many of these cancers were asymptomatic and may have been detected incidentally. [Description provided by NIOSH]
• Subjects:
  Demography Emergency Responders Environmental Exposure Epidemiology Health Promotion Neoplasms Occupational Health Risk Assessment Risk Factors Safety September 11 Terrorist Attacks

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• Keywords:
  Cancer Demographic Characteristics Emergency Responders Exposure Levels Health Programs Rescue Workers Risk Factors Statistical Analysis Thyroid Gland Disorders World Trade Center WTC

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• 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:
  New York ; OSHA Region 2
• 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:
  1-46
• NIOSHTIC Number:
  nn:20066345
• 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-011931, 2021 Sep; :1-46
• Contact Point Address:
  Rachel Zeig-Owens, DrPH, MPH, Albert Einstein College of Medicine, 1301 Morris Park Avenue, Bronx, NY 10461
• Federal Fiscal Year:
  2021
• Performing Organization:
  Albert Einstein College of Medicine, New York
• Peer Reviewed:
  False
• Start Date:
  20190101
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20200630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:9035c1af35bc78b53283888e7d9c6f69245227d87c6e87fade078a18f42a4b8361e5a3e463418c988b1f5e63425ca2a0da0be3e2631a3ca8b801f6b1d171ebfb
• Download URL:
  https://stacks.cdc.gov/view/cdc/219157/cdc_219157_DS1.pdf
• File Type:
  [PDF - 1.02 MB ]