Cancer Cases in WTC Rescuers Higher Than Previously Reported

Roxanne Nelson

August 01, 2014

For rescuers who worked at Ground Zero in the aftermath of the 2001 World Trade Center (WTC) terrorist attack, the number of cancer cases might be higher than previously thought.

Currently, 1646 certified cases have been documented by the WTC Health Program Data Center at the Icahn School of Medicine at Mount Sinai in New York City. However, the Fire Department City of New York (FDNY) has released its own set of numbers for both fire fighters and emergency medical services (EMS) personnel.

"The current number of FDNY members with cancer is 863," said FDNY press officer Frank Dwyer. "That includes both fire and EMS." In this group, there are 180 certified cases of nonmelanoma skin cancer, 734 certified cases of all other cancers, and 51 certified cases of both. "These are our most up-to-date numbers," he told Medscape Medical News.

Together, that brings the total number of certified cancer cases to 2509.

Some media outlets have reported that this represents a "doubling" of cancer cases during the past year, but that appears to be more of an exaggeration than fact, according to Roberto Lucchini, MD, director of the WTC Health Program Data Center. However, it is impossible to say that the number of cases have even increased since 2013 because the data have not been completely updated.

"In terms of a doubling of cases, we can't really speak to that," said Dr. Lucchini. "I'm not sure how that number came out, but we are probably not comparing the same things. They included data from the firefighters, and we do not have those data."

Mount Sinai is part of the national consortium of Clinical Centers of Excellence of the federal WTC Program, which has medically screened more than 37,000 WTC rescue and recovery workers and volunteers since 2002. The 1646 certified cases of cancer that have been confirmed since 2002 do not include cases in current and retired members of the FDNY because those data are maintained in a separate FDNY database.

An Actual Increase?

The current flurry of media about these cancer cases stemmed from an article published in the New York Post, which stated that the "grim toll has skyrocketed from the 1140 cancer cases reported last year." In the article, the updated statistics from the FDNY were combined with the Mount Sinai statistics, making the incidence of cancer appear higher than previously reported. However, the FDNY numbers are cumulative, not just cases diagnosed in 2013. Thus, it is unclear whether the actual number of cases has even increased during the past year, let alone doubled.

The Mount Sinai data do not go beyond 2010, Dr. Lucchini told Medscape Medical News.

"Our data show that there has been about a 20% increase in cancer incidence in the rescue workers, compared with the general population." In particular, there has been an increase in thyroid cancer, prostate cancer, myeloma, and leukemia.

Aging is associated with an increased risk for cancer, so as time goes on, the rescue workers have the dual risk of aging and exposure, Dr. Lucchini explained. "I'm very concerned that in the next 4 years we are going to see an increase in cases."

Dr. Lucchini and colleagues are in the process of compiling data for 2012. He acknowledged that it is a lengthy process because the data are self-reported and need to be matched and certified with various registries.

An important part of the work at Mount Sinai is prevention, not just identifying and treating cancer cases. "We have a preventive program and we can screen those at risk," he said. Preventive surgery for precancerous lesions or early-stage cancer can save lives, he added.

Because the program is voluntary, exposed individuals do not have to participate. In addition, "it is difficult to keep track of responders because many have moved and are no longer living in the New York City area," he said.

Cancer Risk Previously Reported

On the tenth anniversary of 911, the Lancet published a special issue devoted to the health risks associated with exposure to environmental toxins in first responders, and reported that exposed firefighters had a 10% increased risk of developing cancer compared with a similar demographic mix of men in the United States, and a 19% increased risk compared with unexposed New York firefighters. Known carcinogens in the WTC dust, including polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and dioxins, likely contributed to the higher cancer rate.

In a study published in JAMA (2012;308:2479-2488), Steven D. Stellman, PhD, MPH, from the Mailman School of Public Health at Columbia University in New York City, and colleagues found small increases in rescue and recovery workers in rates of prostate cancer, thyroid cancer, and multiple myeloma beginning 6 years after the event. However, there were no increases in cancer overall. "Because of the long latency periods for many cancers, this is still a very early study," Dr. Stellman told Medscape Medical News at that time.

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