World Trade Center rescue workers have an increased incidence of multiple myeloma, thyroid, and prostate cancer

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Image: CC/Nephron. Malignant Plasma Cells.

 1. Among rescue/recovery workers, the incidence of multiple myeloma, prostate and thyroid cancer has been increased. 

2. No increase in the incidence of cancers was detected in non-rescue/recovery workers.

Eleven years after the terrorist attacks on the World Trade Center, it now appears that rescue and recovery workers exposed to the carcinogenic debris may have higher rates of certain cancers, specifically prostate, thyroid, and multiple myeloma. The causative carcinogenic agents cannot be identified, and there does not appear to be an obvious known link between the pathophysiology of prostate and thyroid cancers. Regardless of mechanism, the study supports the public health concern about the danger resulting from the exposure of toxins from the terrorist attacks.

It should be noted that this study looked at the incidence of cancers up to seven years after the terrorist attacks, which is a relatively short time period relative to the latent period for many cancers. Hence as further time elapses, it is likely that the cancer incidence among these individuals will likely increase, allowing for verification of the results and yielding other significant findings. While this study continues long-term observation of these participants, these preliminary findings represent the first WTC cancer incidence study to include a diverse cohort and stratify them based on presumed exposure status. The study will continue long-term observation of these participants, and it will hopefully allow for an even better understanding of increased long-term cancer risks posed to rescue workers in future analyses.

Click to read the study in JAMA

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Image: CC/Nephron. Malignant Plasma Cells.

 1. Among rescue/recovery workers, the incidence of multiple myeloma, prostate and thyroid cancer has been increased. 

2. No increase in the incidence of cancers was detected in non-rescue/recovery workers. 

Primer: Cancer is the leading cause of death in the United States accounting for approximately 13 million cases and claims nearly 8 million lives each year worldwide. There is overwhelming evidence that many of types of cancer are preventable. It is thought that tobacco use, obesity, and lack of exercise contribute to nearly two-thirds of cancers in the US. Carcinogens are also an identifiable risk factor for cancer and include air pollution such as smoke, dust and aerosols. In 2001, the September 11th terrorist attacks on the World Trade Center (WTC) in New York City claimed many lives and exposed thousands of rescue workers, bystanders, and residents to dust, debris, and potentially toxic building materials. In this study, the authors investigated the cancer risk among rescue workers and bystanders in order to determine the incidence and types of cancer they have developed since the exposure event.

Background reading:

1. Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study.

2. Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001.

This [prospective, observational] study: This study enrolled 55,778 New York residents exposed to the WTC debris. Of those participants, 33,928 were not involved in rescue or recovery while 21,850 were rescue/recovery workers. The participants were followed through December 31, 2008. In all, 1187 first incident cancers were diagnosed with an accumulated 253,269 person years. Among the rescue/recovery workers there was an increase in the standard incidence ratio (SIR) for thyroid cancer (SIR= 2.02), prostate cancer (SIR= 1.43), and multiple myeloma (SIR= 2.85) when compared to New York state residents. There was no increased incidence of cancers among the non-rescue/recovery workers.  Among those diagnosed with cancer, they were significantly more likely to be Caucasian, never smokers, and have no pre-existing medical conditions. This was true among both rescue/recovery workers and non-rescue/recovery workers.

In sum: Eleven years after the terrorist attacks on the World Trade Center, it now appears that rescue and recovery workers exposed to the carcinogenic debris may have higher rates of certain cancers, specifically prostate, thyroid, and multiple myeloma. The causative carcinogenic agents cannot be identified, and there does not appear to be an obvious known link between the pathophysiology of prostate and thyroid cancers. Regardless of mechanism, the study supports the public health concern about the danger resulting from the exposure of toxins from the terrorist attacks.

It should be noted that this study looked at the incidence of cancers up to seven years after the terrorist attacks, which is a relatively short time period relative to the latent period for many cancers. Hence as further time elapses, it is likely that the cancer incidence among these individuals will likely increase, allowing for verification of the results and yielding other significant findings. While this study continues long-term observation of these participants, these preliminary findings represent the first WTC cancer incidence study to include a diverse cohort and stratify them based on presumed exposure status. The study will continue long-term observation of these participants, and it will hopefully allow for an even better understanding of increased long-term cancer risks posed to rescue workers in future analyses.

Click to read the study in JAMA

By [BH] and [RR]

More from this author:Protease inhibitor-based antiretroviral therapy in HIV-infected children decreases malaria in Sub-Saharan Africa, Low pre-operative Hepatitis C viral load associated with better survival in hepatocellular carcinoma, Autologous bone marrow cell infusion following myocardial infarction elicits no improvement in left ventricular function, Family history is the strongest risk factor for development of Parkinson disease

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Brittany Hasty: Brittany is a 3rd year M.D. candidate at Boston University in Boston, Massachusetts. Originally from Florida, she completed her undergraduate degree at the University of South Florida in Biomedical Sciences. She has previously carried out research in the areas of maternal and child health with a focus in immunology and autoimmune diseases. Currently, she is conducting research with Boston Medical Center’s Division of Trauma and Acute Care Surgery. During her free time, she enjoys traveling, snowboarding, and yoga. She is strongly interested in surgery and critical care.

Rif Rahman: Rif is a 4th year M.D. candidate at Harvard Medical School, currently completing a research year investigating the use of conventional and advanced imaging techniques to assess treatment response of high grade gliomas. His medical interests are in the areas of internal medicine and neurology.

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