Evaluation of Medical Surveillance and Incidence of Post-September 11, 2001, Thyroid Cancer in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers

Details

• Personal Author:
  Brito JP ; Colbeth HL ; El Kawkgi OM ; Genere N ; Goldfarb DG ; Hall CB ; Jaber N ; Prezant DJ ; Schwartz TM ; Webber MP ; Zeig-Owens R
• Description:
  IMPORTANCE: Elevated incidence rates of thyroid cancer amongWorld Trade Center (WTC)-exposed individuals may be associated with the identification of asymptomatic cancers during medical surveillance. OBJECTIVE: To examine the association betweenWTC exposure and thyroid cancer among Fire Department of the City of New York (hereafter, Fire Department) rescue/recovery workers as well as the association with medical surveillance. DESIGN, SETTING, AND PARTICIPANTS: This closed-cohort study classified the method of detection (asymptomatic and symptomatic) of thyroid cancers in 14 987 men monitored through the Fire Department-WTC Health Program diagnosed from September 12, 2001, to December 31, 2018. Age-, sex-, and histologic-specific Fire Department incidence rates were calculated and compared with demographically similar men in Olmsted County, Minnesota, from the Rochester Epidemiology Project using age-standardized rates, relative rates (RRs), and 95%CIs. The secondary analysis was restricted to papillary carcinomas. EXPOSURES World Trade Center exposure was defined as rescue/recovery work at theWTC site from September 11, 2001, to July 25, 2002. MAIN OUTCOMES AND MEASURES: The outcomes evaluated comprised (1) number of incident thyroid cancers and their detection method categorizations in the Fire Department and Rochester Epidemiology Project cohorts; (2) Fire Department, Rochester Epidemiology Project, and Surveillance, Epidemiology, and End Results-21 age-standardized incidence rates of thyroid cancer; and (3) RRs comparing Fire Department and Rochester Epidemiology Project overall and by detection method categorization. RESULTS: Seventy-two post-9/11 Fire Department cases of thyroid cancer were identified. Among the 65 cases (90.3%) with a categorized detection method, 53 cases (81.5%) were asymptomatic and 12 cases (18.5%) were symptomatic. Median (interquartile range) age at diagnosis was 50.2 (44.0-58.6) vs 46.6 (43.9-52.9) years for asymptomatic vs symptomatic cases. Associated primarily with asymptomatic cancers, the overall age-standardized incidence of Fire Department thyroid cancers (24.7; 95%CI, 17.4-52.3) was significantly higher than the Rochester Epidemiology Project (10.4; 95%CI, 8.5-12.7) and Surveillance, Epidemiology, and End Results-21 (9.1; 95%CI, 9.0-9.1) per 100 000 person-years. Furthermore, the RR of thyroid cancer among symptomatic men in Fire Department cases was not significantly different from that of men in the Rochester Epidemiology Project (0.8; 95%CI, 0.4-1.5); however, the rate of asymptomatic cancers was more than 3-fold that of the Rochester Epidemiology Project rate (RR, 3.1; 95%CI, 2.1-4.7). CONCLUSIONS AND RELEVANCE: Excess asymptomatic thyroid cancer in Fire Department WTC-exposed rescue/recovery workers is apparently attributable to the identification of occult lesions during medical surveillance. Among WTC-exposed cohorts and the general population, these findings appear to have important implications for how thyroid cancer incidence rates are interpreted and how diagnoses should be managed. [Description provided by NIOSH]
• Subjects:
  Aging Demography Emergency Responders Environmental Exposure Epidemiology Firefighters Men Neoplasms Occupational Health Risk Assessment Risk Factors Safety September 11 Terrorist Attacks

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• Keywords:
  Age Groups Cancer Demographic Characteristics Emergency Medical Services Workers Emergency Responders EMS Exposure Levels Fire Fighters First Responders Humans Rescue Workers Risk Factors Statistical Analysis Surveillance Thyroid Gland Disorders World Trade Center WTC

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• ISSN:
  2168-6106
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  Minnesota ; New York ; OSHA Region 2 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  180
• Issue:
  6
• NIOSHTIC Number:
  nn:20061875
• Citation:
  JAMA Intern Med 2020 Jun; 180(6):888-895
• Contact Point Address:
  Rachel Zeig-Owens, DrPH, MPH, Fire Department of the City of New York, Bureau of Health Services, FDNY Headquarters, 9 Metrotech Center, Brooklyn, NY 11201
• Email:
  rachel.zeig-owens@fdny.nyc.gov
• Federal Fiscal Year:
  2020
• Performing Organization:
  Albert Einstein College of Medicine, Inc., New York
• Peer Reviewed:
  True
• Start Date:
  20180701
• Source Full Name:
  JAMA Internal Medicine
• End Date:
  20200630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:8106b7c845fe087bb031d95b3e06c8509dc32a50529cf570784e0a0d1db96c403ce8c89ab2b2303ac3f313e33aa7a08353dc3f92be64bb361b56a6103cba19fe
• Download URL:
  https://stacks.cdc.gov/view/cdc/225227/cdc_225227_DS1.pdf
• File Type:
  [PDF - 403.33 KB ]