Cancer in General Responders Participating in World Trade Center Health Programs, 2003–2013

Abstract Background Following the September 11, 2001, attacks on the World Trade Center (WTC), thousands of workers were exposed to an array of toxins known to cause adverse health effects, including cancer. This study evaluates cancer incidence in the WTC Health Program General Responder Cohort occurring within 12 years post exposure. Methods The study population consisted of 28 729 members of the General Responder Cohort enrolled from cohort inception, July 2002 to December 31, 2013. Standardized incidence ratios (SIRs) were calculated with cancer case inclusion and follow-up starting post September 11, 2001 (unrestricted) and, alternatively, to account for selection bias, with case inclusion and follow-up starting 6 months after enrollment in the WTC Health Program (restricted). Case ascertainment was based on linkage with six state cancer registries. Under the restricted criterion, hazard ratios were estimated using multivariable Cox proportional hazards models for all cancer sites combined and for prostate cancer. Results Restricted analyses identified 1072 cancers in 999 responders, with elevations in cancer incidence for all cancer sites combined (SIR = 1.09, 95% confidence interval [CI] = 1.02 to 1.16), prostate cancer (SIR = 1.25, 95% CI = 1.11 to 1.40), thyroid cancer (SIR = 2.19, 95% CI = 1.71 to 2.75), and leukemia (SIR = 1.41, 95% CI = 1.01 to 1.92). Cancer incidence was not associated with any WTC exposure index (composite or individual) for all cancer sites combined or for prostate cancer. Conclusion Our analyses show statistically significant elevations in cancer incidence for all cancer sites combined and for prostate and thyroid cancers and leukemia. Multivariable analyses show no association with magnitude or type of exposure.

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Risk factors for incident prostate cancer in a cohort of world trade center responders

BMC Psychiatry ◽

10.1186/s12888-019-2383-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Sean A. P. Clouston ◽

Peifen Kuan ◽

Roman Kotov ◽

Soumyadeep Mukherjee ◽

Patricia Thompson-Carino ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Incidence ◽

World Trade ◽

Proportional Hazards ◽

Traumatic Event ◽

World Trade Center ◽

Cox Proportional Hazards ◽

Stressful Events ◽

Prostate Cancer Incidence ◽

Trade Center

Abstract Background Despite a relatively young average age and no routine screening, prostate cancer is one of the most common cancers in men who worked at the World Trade Center (WTC) following the 9/11/2001 disaster. This study evaluated whether re-experiencing stressful memories of a traumatic event was associated with prostate cancer incidence. Methods Participants were males from one clinical center that monitors the health of first-responders (N = 6857). Monitoring began in July 2002 and occurs annually but does not include prostate cancer screening. Severity of physical exposures and of re-experiencing memories and stress responses were measured at study enrollment using standardized and validated methods in all participants. The outcome was incidence of diagnosed prostate cancer after enrollment (n = 68). Bivariate analyses provided age-adjusted incidence rates (aIR). Cox proportional hazards modeling was used to calculate incidence; hazards ratios (HR) were reported. Results The mean age of responders on 9/11/2001 was 37.9 years. Prostate cancer incidence was lowest in responders with no re-experiencing stress (aIR = 250.83/100,000 person-years, [233.41–268.25]) and highest in responders with severe re-experiencing stress (aIR = 818.49/100,000 person-years, [801.07–835.91]). Cox proportional hazards regression revealed that re-experiencing the stressful events of 9/11/2001 was associated with increased prostate cancer incidence (HR = 1.96 [1.26–3.05], P = 0.003), even upon adjusting for confounders. Conclusions This is the first study to identify a positive association between re-experiencing a traumatic event and prostate cancer incidence. Our results are consistent with recent rodent model evidence demonstrating a direct biological link between stress pathways and prostate tumorigenesis and offer new hypotheses in the causality of prostate cancer.

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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

American Journal of Industrial Medicine ◽

10.1002/ajim.22638 ◽

2016 ◽

Vol 59 (9) ◽

pp. 709-721 ◽

Cited By ~ 22

Author(s):

Jiehui Li ◽

Robert M. Brackbill ◽

Tim S. Liao ◽

Baozhen Qiao ◽

James E. Cone ◽

...

Keyword(s):

Cancer Incidence ◽

World Trade ◽

World Trade Center ◽

September 11 ◽

Terrorist Attacks ◽

The World ◽

Trade Center

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Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab165 ◽

2021 ◽

Author(s):

Jiehui Li ◽

Janette Yung ◽

Baozhen Qiao ◽

Erin Takemoto ◽

David G Goldfarb ◽

...

Keyword(s):

Cancer Risk ◽

Cancer Incidence ◽

World Trade ◽

Cox Regression ◽

World Trade Center ◽

Cancer Registries ◽

Increased Risk ◽

Long Term Follow Up ◽

Trade Center

Abstract Background Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure. Methods From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk. Results Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both. Conclusions In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.

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