Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study

Goldfarb, David G.; Zeig‐Owens, Rachel; Kristjansson, Dana; Li, Jiehui; Brackbill, Robert M.; Farfel, Mark R.; Cone, James E.; Kahn, Amy R.; Qiao, Baozhen; Schymura, Maria J.; Webber, Mayris P.; Dasaro, Christopher R.; Lucchini, Roberto; Todd, Andrew C.; Prezant, David J.; Hall, Charles B.; Boffetta, Paolo

doi:10.1002/ajim.23278

Cited by 9 publications

(7 citation statements)

References 48 publications

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“…In summary, we report a doubling in risk of overall MGUS and an over 3.5-fold elevated risk of light-chain-MGUS suggesting unambiguous associations between environmental exposures present at the WTC disaster site and myeloma precursor disease. Recently, it was reported that rescue/recovery worker cancer patients enrolled in a WTC Health Program had improved survival relative to the New York state population, potentially due to reduced barriers to systematic health surveillance and treatment and no out-of-pocket medical care costs [ 31 ]. While a randomized controlled trial examining the risks and benefits of MGUS screening is ongoing and will provide clearer guidance on public health recommendations [ 32 ], if improved survival among MGUS screened cohorts is demonstrated, the important findings from our current study provide evidence that screening of WTC-exposed cohorts should be recommended.…”

Section: Discussionmentioning

confidence: 99%

Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster

et al. 2022

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An elevated risk of myeloma precursor disease, monoclonal gammopathy of undetermined significance (MGUS), was identified among Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed firefighters. Further investigation was needed to determine if these findings were reproducible in a more heterogeneous WTC-exposed rescue/recovery workers cohort, the Stony Brook University-General Responder Cohort GRC (SBU-GRC). MGUS risk was compared between the cohorts and to published general population estimates from Olmsted County, MN, USA. In this observational seroprevalence study, odds ratios (OR) and age-standardized risk ratios (RR) of MGUS (M-spike and light-chain-MGUS combined), M-spike, and light-chain-MGUS were estimated using logistic regression. Age-standardized prevalences were calculated for white males aged 50–79; RRs were estimated by comparing risk in the WTC-exposed cohort with the Olmsted County screened cohort. SBU-GRC had elevated odds of MGUS compared with FDNY (OR = 1.38; 95%CI = 1.00–1.89). The age-standardized prevalence of MGUS was 9.0/100 persons (95%CI = 7.5–10.6), over two-fold higher than the general population (RR = 2.08; 95%CI = 1.72–2.51); the age-standardized prevalence of light-chain-MGUS was 3.5-fold higher (RR = 3.54; 95%CI = 2.52–4.97). This study adds to mounting evidence supporting an association between WTC/environmental exposures and MGUS among rescue/recovery workers. Access to MGUS screenings for the entire WTC-exposed cohort could allow for treatment interventions that improve survival.

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Section: Discussionmentioning

confidence: 99%

Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster

et al. 2022

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“…The availability of the WTC Health Program at no out-of-pocket cost to enrollees also might have impacted cancer-specific mortality. Being enrolled in the WTC Health Program has been associated with lower cancer-specific mortality in RRW, 5 and individuals with self-reported 9/11-related physical or mental health conditions have been targeted in outreach efforts to increase WTC Health Program enrollment. 38 When we stratified the post-9/11 group by enrollee group, we observed that witnessing ≥3 traumatic events was associated with a 2-fold increased risk in RRW, which was similar in magnitude to the association between PTSD and non-cancer mortality in this enrollee group and aligns with previous research in the WTCHR that has found witnessing traumatic events on 9/11 to be a major predictor of PTSD.…”

Section: Discussionmentioning

confidence: 99%

“…We conducted sensitivity analyses in the post‐9/11 group by repeating the fully adjusted model for the association between 9/11‐related exposure and mortality in the following subgroups: (1) Excluding those aged ≥65 years on 9/11/2001 to capture potential premature mortality; (2) excluding firefighters and police responders affiliated with the Fire Department of New York City (FDNY) and the New York City Police Department (NYPD), respectively, because previous research suggests lower rates of PTSD 31 and higher survival 5 in traditional versus non‐traditional responders (defined elsewhere 32 ); and (3) excluding those with multiple cancers because subsequent cancer may have a worse survival rate than the first. Statistical analyses were performed using SAS, v9.4 (SAS Institute Inc.).…”

Section: Methodsmentioning

confidence: 99%

“…A recent study compared cancer mortality in WTC‐exposed rescue and recovery workers (RRW) with the general cancer population in New York state and found that all‐cause mortality and cancer‐specific mortality were lower in RRW who were enrolled in one of the federal WTC Health Program's medical monitoring and treatment programs (WTC‐MMTP) but not among those who were not enrolled in the program 5 . These findings likely reflect the benefits of WTC‐MMTP, including freely available cancer screenings, diagnostic procedures, and treatments for certified 9/11‐related conditions, including cancers, at no cost to patients.…”

Section: Introductionmentioning

confidence: 99%

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Mortality after the 9/11 terrorist attacks among world trade center health registry enrollees with cancer

Kehm

Takemoto

et al. 2022

Cancer Medicine

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Background While several studies have reported the association between 9/11 exposure and cancer risk, cancer survival has not been well studied in the World Trade Center (WTC) exposed population. We examined associations of 9/11‐related exposures with mortality in WTC Health Registry enrollees diagnosed with cancer before and after 9/11/2001. Patients and Methods This is a longitudinal cohort study of 5061 enrollees with a first‐ever primary invasive cancer diagnosis between 1995 and 2015 and followed through 2016. Based on the timing of first cancer diagnosis, pre‐9/11 (n = 634) and post‐9/11 (n = 4427) cancer groups were examined separately. 9/11‐related exposures included witnessing traumatic events, injury on 9/11, and 9/11‐related post‐traumatic stress disorder (PTSD). Associations of exposures with all‐cause mortality were examined using Cox proportional hazards regression. In the post‐9/11 group, cancer‐specific mortality was evaluated by enrollee group (WTC rescue/recovery workers vs. non‐workers) using Fine and Gray's proportional sub‐distribution hazard models, adjusting for baseline covariates, tumor characteristics, and treatment. Results In the pre‐9/11 group, 9/11‐related exposures were not associated with all‐cause mortality. In the post‐9/11 group, increased risk of all‐cause mortality was associated with PTSD (adjusted HR = 1.35; 95% CI = 1.11–1.65), but not with injury or witnessing traumatic events. Cancer‐specific mortality was not statistically significantly associated with 9/11‐related exposures. In rescue/recovery workers, increased non‐cancer mortality risk was associated with PTSD (aHR = 2.13, 95% CI = 1.13–4.00) and witnessing ≥3 traumatic events (aHR = 2.00, 95% CI = 1.13–3.55). Conclusions We did not observe associations between 9/11‐related exposures and cancer‐specific mortality. Similar to findings in the non‐cancer WTC exposed population, PTSD was associated with increased risk of all‐cause mortality in cancer patients.

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“…As an intervention, Goldfarb et al (2021) compared survival among cancer patients in three groups: responders enrolled in medical monitoring and treatment programs in New York City (NYC, the treatment group); responders who do not participate in the NYC programs; and New York State cancer patients who are not in the responder group. 54 Survival was improved among the treatment group compared with either control group after adjusting for demographic factors and temporal trends. This suggests that participating in treatment offered at no-cost by the WTC Health Program may benefit survival among cancer patients.…”

Section: Special Issue: Examples Of New Researchmentioning

confidence: 90%

The World Trade Center Health Program: Twenty years of health effects research

Daniels

Kubale

Reissman

et al. 2021

American J Industrial Med

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It has been 20 years since the devastating terrorist attacks on September 11, 2001.Thousands were injured or killed during the attacks and many more are at risk of adverse health stemming from physical, psychological, and emotional stressors born out of the attacks. Private, federal, state, and local resources were gathered soon after the attacks to address impacts to the community, including the health and wellbeing of both responders and survivors. Many of these efforts are now largely consolidated under the federally mandated World Trade Center (WTC) Health Program. This program provides medical monitoring and treatment of qualifying conditions among the 9/11-exposed population and supports related physical and mental health research. In this commentary, we describe the WTC Health Program, with emphasis on the health-effects research it has funded since inception in 2011.We describe sentinel research publications, and how science has impacted the program. We provide examples relating studies in this special issue to important roles in the WTC Health Program research agenda. Finally, we provide a perspective on future research needs. | INTRODUCTIONAs we approach the 20th anniversary of the 9/11 terrorist attacks, we are once again reminded of the thousands who lost their lives or were injured that day. We also grieve for many more who now suffer from adverse health effects stemming from the physical, psychological, and emotional stressors born out of the attacks. The health of nearly a half million people is potentially at risk from exposures attributable to 9/11. 1 In the aftermath of the attacks, private, federal, state, and local resources supported several postdisaster activities, including recovery actions, the World Trade Center (WTC) Health Registry, and caring for the affected population in several surrounding health-care facilities. Health-care activities were later consolidated with the passing of the James Zadroga 9/11 Health and Compensation Act of 2010 (The Act), establishing the WTC Health Program 1 . The WTC Health Program is a limited health benefits program for qualifying health conditions related to the 9/11 attacks and aftermath. It provides medical monitoring and treatment of eligible responders, initial health evaluations for eligible survivors, and medical monitoring treatment for survivors who have health conditions certified by the Program. The Program resides under the U.S.

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Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study

Cited by 9 publications

References 48 publications

Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster

Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster

Mortality after the 9/11 terrorist attacks among world trade center health registry enrollees with cancer

The World Trade Center Health Program: Twenty years of health effects research

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