Ten‐year cancer incidence in rescue/recovery workers and civilians exposed to the September 11, 2001 terrorist attacks on the World Trade Center

Li, Jiehui; Brackbill, Robert M.; Liao, Tim; Qiao, Baozhen; Cone, James E.; Farfel, Mark R.; Hadler, James L.; Kahn, Amy R.; Konty, Kevin; Stayner, Leslie T.; Stellman, Steven D.

doi:10.1002/ajim.22638

Cited by 54 publications

(90 citation statements)

References 34 publications

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“…However, there is substantial concordance between many Registry findings and clinical studies of World Trade Center survivors by other groups, as well as internal validation studies of cancer (Li et al 2016). Furthermore, the association between PTSD and heart disease based on self-report (Jordan et al 2011) is in good agreement with results based on hospital discharge records (Jordan et al 2013).…”

Section: Discussionmentioning

confidence: 72%

“…If the enrollee experienced multiple chronic diseases, the first was considered the endpoint. Cancer incidence has been reported twice previously in this cohort (Li et al 2012; Li et al 2016) and was therefore treated as a censoring event but not an endpoint of interest; i.e. if cancer occurred before any other disease, the year of diagnosis was the censoring date.…”

Section: Methodsmentioning

confidence: 99%

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Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Alper

Stellman

et al. 2017

Inj. Epidemiol.

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BackgroundThe World Trade Center attack of September 11, 2001 in New York City (9/11) exposed thousands of people to intense concentrations of hazardous materials that have resulted in reports of increased levels of asthma, heart disease, diabetes, and other chronic diseases along with psychological illnesses such as post-traumatic stress disorder (PTSD). Few studies have discriminated between health consequences of immediate (short-term or acute) intense exposures versus chronic residential or workplace exposures.MethodsWe used proportional hazards methods to determine adjusted hazard ratios (AHRs) for associations between several components of acute exposures (e.g., injury, immersion in the dust cloud) and four chronic disease outcomes: asthma, other non-neoplastic lung diseases, cardiovascular disease, and diabetes, in 8701 persons free of those conditions prior to exposure and who were physically present during or immediately after the World Trade Center attacks. Participants were followed prospectively up to 11 years post-9/11.ResultsHeart disease exhibited a dose-response association with sustaining injury (1 injury type: AHR =2.0, 95% CI (Confidence Interval) 1.1–3.6; 2 injury types: AHR = 3.1, 95% CI 1.2–7.9; 3 or more injury types: AHR = 6.8, 95% CI 2.0–22.6), while asthma and other lung diseases were both significantly associated with dust cloud exposure (AHR = 1.3, 95% CI 1.0–1.6). Diabetes was not associated with any of the predictors assessed in this study.ConclusionIn this study we demonstrated that the acute exposures of injury and dust cloud that were sustained on 9/11/2001 had significant associations with later heart and respiratory diseases. Continued monitoring of 9/11 exposed persons’ health by medical providers is warranted for the foreseeable future.

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Section: Discussionmentioning

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Alper

Stellman

et al. 2017

Inj. Epidemiol.

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“…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 ].…”

Section: Research Portfoliomentioning

confidence: 99%

World Trade Center Health Program: First Decade of Research

Santiago-Colón

Daniels

Reissman

et al. 2020

IJERPH

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The terrorist attacks on 11 September 2001 placed nearly a half million people at increased risk of adverse health. Health effects research began shortly after and continues today, now mostly as a coordinated effort under the federally mandated World Trade Center (WTC) Health Program (WTCHP). Established in 2011, the WTCHP provides medical monitoring and treatment of covered health conditions for responders and survivors and maintains a research program aimed to improve the care and well-being of the affected population. By 2020, funds in excess of USD 127 M had been awarded for health effects research. This review describes research findings and provides an overview of the WTCHP and its future directions. The literature was systematically searched for relevant articles published from 11 September 2001 through 30 June 2020. Synthesis was limited to broad categories of mental health, cancer, respiratory disease, vulnerable populations, and emerging conditions. In total, 944 WTC articles were published, including peer-reviewed articles funded by the WTCHP (n = 291) and other sources. Research has focused on characterizing the burden and etiology of WTC-related health conditions. As the program moves forward, translational research that directly enhances the care of individuals with chronic mental and physical health conditions is needed.

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“…The WTC debris cloud contained many known and suspected human carcinogens, including asbestos, silica, benzene, polychlorinated biphenyls, polycyclic aromatic hydrocarbons (PAH), volatile organic compounds (VOC), and many types of particles including wood, cement and metal dusts . A significant excess of all cancers (8% to 15%) has been observed in longitudinally followed, WTC‐exposed cohorts through 2011, an excess driven largely by prostate and thyroid cancers …”

Section: Introductionmentioning

confidence: 99%

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

Graber

Harris

Black

et al. 2019

Intl Journal of Cancer

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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.

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Ten‐year cancer incidence in rescue/recovery workers and civilians exposed to the September 11, 2001 terrorist attacks on the World Trade Center

Cited by 54 publications

References 34 publications

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001

World Trade Center Health Program: First Decade of Research

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

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