Incidence, Latency, and Survival of Cancer Following World Trade Center Exposure

Details

• Personal Author:
  Boffetta P ; Brackbill RM ; Colbeth HL ; Cone, James E. ; Dasaro CR ; Farfel MR ; Goldfarb DG ; Hall CB ; Kahn AR ; Khalifeh M ; Kristjansson D ; Li J ; Lucchini RG ; Prezant DJ ; Qiao B ; Schymura MJ ; Shapiro MZ ; Skerker M ; Solomon A ; Takemoto E ; Todd AC ; Vaeth B ; Walker DJ ; Webber MP ; Yung J ; Zeig-Owens R
• Description:
  The terrorist attacks on the World Trade Center (WTC) on 9/11/2001 (9/11) involved collision of two aircraft into the buildings and the combustion of many thousands of pounds of jet fuel. The subsequent collapse on the towers, and the rescue/recovery effort that followed, led to large numbers of responders being exposed to a wide variety of hazardous material including cement dust, glass, asbestos, lead, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), organochlorine pesticides, and polychlorinated furans and dioxins. We wished to examine cancer incidence, latency, and survival in WTC rescue/recovery workers exposed to these known and potential carcinogens. Three cohorts of rescue and recovery workers have been established since the WTC disaster, the Fire Department of the City of New York (FDNY) Cohort; the General Responder Cohort, maintained by Icahn School of Medicine at Mount Sinai (ISMMS); and the World Trade Center Health Registry (WTCHR), maintained by New York City Department of Health and Mental Hygiene (DOHMH). Each of the three cohorts had reported modest and mostly non-statistically significantly elevated cancer rates post-exposure to the WTC-site have been reported despite limited follow-up time 9/11/2001. We combined the three cohorts to account for individuals who are in more than one cohort, to increase the sample size, and to make the results more generalizable. We examined incidence, latency, and survival controlling for age, sex, race, and calendar time since exposure. Our findings confirmed prior studies in individual cohorts for elevated incidence of thyroid cancer (all 3), skin melanoma (2 of 3), prostate cancer (2 of 3), and confirmed prior studies in individual cohorts showing reduced incidence of lung cancer, and found modestly elevated incidence of tonsil cancer, previously not reported. Some gastrointestinal cancers, female breast cancer, and uterine cancer were found to have lower than expected incidence, findings worthy of further investigation. We did not confirm prior findings in the individual cohorts of elevated rates of hematologic cancers. Rescue/recovery workers experiencing higher intensity exposures had higher rates of prostate and thyroid cancer and of all cancers combined compared to responders with lower exposure. We found an unexpectedly short induction/latency period between exposure and incidence for prostate cancer and skin melanoma, part of which might have been from increased medical surveillance or screening. An important finding was a strong survival benefit for rescue/recovery workers who enrolled in a World Trade Center Medical Monitoring and Treatment Program (WTC MMTP) sponsored by the National Institute for Occupational Safety and Health (NIOSH). This benefit was observed for most cancers, both cancers with elevated incidence and cancers with reduced incidence. This work has added to the understanding of long-term consequences of WTC-exposure and should encourage prompt surveillance efforts after future environmental disasters. The nature of the strong survival benefit is particularly worthy of further study; if programs such as the WTC MMTP could be generalized beyond the WTC cohorts there could be tremendous benefits for workers who develop cancer after exposure to carcinogens. [Description provided by NIOSH]
• Subjects:
  Carcinogens Cohort Studies Emergency Responders Health Care Facilities Workforce And Services Neoplasms Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Cancer Rates Cancer Survivors Cohort Studies Disaster Recovery Medical Monitoring Rescue Workers Surveillance 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:
  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:
  1-28
• NIOSHTIC Number:
  nn:20068325
• 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-011932, 2022 Nov; :1-28
• Contact Point Address:
  Charles B. Hall, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10463
• Email:
  charles.hall@einsteinmed.edu
• Federal Fiscal Year:
  2023
• Performing Organization:
  Albert Einstein College of Medicine, Bronx, New York
• Peer Reviewed:
  False
• Start Date:
  20190101
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20200831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:9cf85c6ad198b1b688ec17c4291dfeaba4879041e151da8937564a8ff9c2b8fa6c9b7a0d47781c8cf6b5c248afc2ee9f6a60e36dd65231882c0091eb2bc117be
• Download URL:
  https://stacks.cdc.gov/view/cdc/219212/cdc_219212_DS1.pdf
• File Type:
  [PDF - 1.46 MB ]