Temporal association of prostate cancer incidence with World Trade Center rescue/recovery work

Abstract

BackgroundThe World Trade Center (WTC) attacks on 11 September 2001 created a hazardous environment with known and suspected carcinogens. Previous studies have identified an increased risk of prostate cancer in responder cohorts compared with the general male population.ObjectivesTo estimate the length of time to prostate cancer among WTC rescue/recovery workers by determining specific time periods during which the risk was significantly elevated.MethodsPerson-time accruals began 6 months after enrolment into a WTC cohort and ended at death or 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. New York State was the comparison population. We used Poisson regression to estimate hazard ratios and 95% CIs; change points in rate ratios were estimated using profile likelihood.ResultsThe analytic cohort included 54 394 male rescue/recovery workers. We observed 1120 incident prostate cancer cases. During 2002–2006, no association with WTC exposure was detected. Beginning in 2007, a 24% increased risk (HR: 1.24, 95% CI 1.16 to 1.32) was observed among WTC rescue/recovery workers when compared with New York State. Comparing those who arrived earliest at the disaster site on the morning of 11 September 2001 or any time on 12 September 2001 to those who first arrived later, we observed a positive, monotonic, dose-response association in the early (2002–2006) and late (2007–2015) periods.ConclusionsRisk of prostate cancer was significantly elevated beginning in 2007 in the WTC combined rescue/recovery cohort. While unique exposures at the disaster site might have contributed to the observed effect, screening practices including routine prostate specific antigen screening cannot be discounted.

Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the US adult male population: 2001–2016

“…While these increased rates may be driven by higher participation in medical monitoring after 2007, they could also reflect prostate cancer latency. 41 Evidence is slowly accruing about cancer and other long latency illnesses in relation to WTC exposure, although much remains to be determined. Molecular epidemiological studies of biomarkers may provide better understanding of chronic disease development in firefighters, both WTC-exposed and non-WTC-exposed.…”

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

“…In particular, 1120 incident prostate cancer cases in 54,394 male RRWs were diagnosed between March 12, 2002, and December 31, 2015. 36 From 2002 through 2006, no association with WTC exposure was detected; the incidence of prostate cancer was the same as that in the NYS reference population through 2006 (HR, 0.99; 95% CI, 0.83-1.19). Beginning in 2007, however, a 24% increased risk HR, 1.24 (95% CI, 1.16-1.32) was observed among these workers.…”

“…Temporal trends in incidence were explored in detail for selected cancers and showed increased incidence in the overall analysis. In particular, 1120 incident prostate cancer cases in 54,394 male RRWs were diagnosed between March 12, 2002, and December 31, 2015 36 . From 2002 through 2006, no association with WTC exposure was detected; the incidence of prostate cancer was the same as that in the NYS reference population through 2006 (HR, 0.99; 95% CI, 0.83‐1.19).…”

World Trade Center Health Program: 20 years after 9/11

“…3 The other WTCrelated paper published in this issue is helping to increase our understanding of latency between occupational exposure and cancer incidence, which for prostate cancer may be as short as 5.25 years, substantially shorter than studies of non-9/11 occupational exposures. 4 Cancer research findings among WTC responders and survivors were an important factor leading to the addition in 2012 of most cancer types to the list of covered conditions. 6 Among the other nine 9/11-related papers previously published in OEM, at least three provided important insights on the early-onset and persistent respiratory effects following 9/11 exposures.…”