Excess HPV‐related head and neck cancer in the world trade center health program general responder cohort

Abstract

The World Trade Center (WTC) attacks exposed rescue and recovery workers to a complex mix of toxicants, including carcinogens. our study compared site-specific cancer incidence of head and neck cancers (HNC) from 2003 through 2012 among 33,809 consented WTC General Responder Cohort (GRC) members to the New Jersey State Cancer Registry, using standardized incidence ratios (SIRs). HNC grouped using SEER ICD-O-3 codes into HPV-related (oropharyngeal) and non-related (other oral-nasal; laryngeal) tumors based on anatomical site. For the 73 GRC members identified with HNC, proportional hazard regression assessed the relationship between WTC exposure and other socio-demographic characteristics. An overall excess of HNC was not observed (SIR = 1.00, 95% CI: 0.78, 1.25) but excess cancer was seen in the latest observation period (2009-2012: SIR = 1.4; 95% CI: 1.01, 1.89). A similar temporal pattern was seen for HPV-related oropharyngeal cancer and laryngeal cancer, but not for non-HPV-related sites (oral-nasal cancer). HNC was significantly associated with increasing age (8% per year, 95% CI: 5%, 12%), non-Hispanic white ethnic group-ethnicity (hazard ratio (HR) = 3.51, 95 CI: 1.49, 8.27); there was a borderline association with the 9/11 occupation of military/protective services vs. others (HR = 1.83 95% CI: 0.99, 3.38; p = 0.0504). Caution is needed in interpreting these results given the small number of cases, potential for surveillance bias, and long latency for most cancers. Our findings highlight the need to examine the potentially carcinogenic effects of WTC exposure in the context of other strong risk factors, and the need for continued medical monitoring of WTC responders.

Assessment of Trends in Second Primary Cancers in Patients With Metastatic Melanoma From 2005 to 2016

“…This study has limitations. The SEER database lacks detailed information on cancer risk factors, including socioeconomic status, genetic variants, and behavior factors . Other factors that might be associated with the changes in incidence of SPCs but that are not in the SEER database include differences over time in disease severity at diagnosis, differences in exposure history to environmental carcinogens, differences in overall health and comorbidities, differences in availability of and barriers to medical care, and differences in other aspects of medical care than immunotherapy.…”

Cancer risk among World Trade Center rescue and recovery workers: A review

“…In addition, FDNY firefighters have been shown to have an elevated rate of the precursor disease to multiple myeloma (monoclonal gammopathy of undetermined significance) compared with the general population 26 . An analysis of 73 cases of head and neck cancer in the GRC showed no overall increased risk for this group of cancers; an excess risk was observed after 2008 for oropharyngeal and laryngeal cancers, but not for oral or nasal cancers 27 . In another analysis of GRC members, an association was reported between high WTC exposure and advanced clinical stage of prostate cancer 28 ; and, in an analysis of a subset of GRC members, 29 an association was found between re‐experiencing a traumatic event and prostate cancer incidence.…”

“…26 An analysis of 73 cases of head and neck cancer in the GRC showed no overall increased risk for this group of cancers; an excess risk was observed after 2008 for oropharyngeal and laryngeal cancers, but not for oral or nasal cancers. 27 In another analysis of GRC members, an association was reported between high WTC exposure and advanced clinical stage of prostate cancer 28 ; and, in an analysis of a subset of GRC members, 29 an association was found between re-experiencing a traumatic event and prostate cancer incidence. As noted above, elevated thyroid cancer rates have also been observed, 13,16,[19][20][21]30 ; however, these rates may have been influenced by incidental detection related to medical surveillance, 30,31 with the majority of patients being asymptomatic at diagnosis.…”

World Trade Center Health Program: First Decade of Research

“…Consequentially, cancer research accounts for a large portion (21%) of the funds awarded. There are descriptive and analytic studies examining cancer mortality and incidence, with a few studies examining mechanisms or treatment [ 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. There are also notable reviews [ 77 , 78 ].…”