Characteristics of Cancer Patients in the World Trade Center Environmental Health Center

Our plain-English summary of Characteristics of Cancer Patients in the World Trade Center Environmental Health Center, by N. Durmus, Y. Shao, A.A. Arslan, et al (International Journal of Environmental Research and Public Health, 2020).

The study

• Authors: N. Durmus, Y. Shao, A.A. Arslan, Y. Zhang, S. Pehlivan, M.E. Fernandez-Beros, L. Umana, R. Corona, S. Smyth-Giambanco, S.A. Abbott, J. Reibman
• Journal: International Journal of Environmental Research and Public Health
• Published: 2020;17(19)
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The destruction of the World Trade Center (WTC) towers on 11 September 2001 released many tons of aerosolized dust and smoke with potential for carcinogenic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members ("Survivors"), including local residents and workers, present in the NYC disaster area on 9/11 or in the days or weeks following. We report a case series of cancers identified in the WTC EHC as of 31 December 2019. Descriptive characteristics are presented for 2561 cancer patients (excluding non-melanoma skin cancer) and 5377 non-cancer WTC-EHC participants who signed informed consent. We identified a total of 2999 cancer diagnoses in 2561 patients: 2534 solid tumors (84.5%) and 465 lymphoid and hematopoietic tissue cancers (15.5%) with forty-one different cancer types. We describe the distribution, frequency, median age of cancer diagnosis and median latency from 9/11 by cancer site. In addition to common cancer types, rare cancers, including male breast cancers and mesotheliomas have been identified. The current study is the first report on cancer characteristics of enrollees at WTC EHC, a federally designated treatment and surveillance program for local community members affected by the 9/11 terrorist attack on the WTC.

In plain English

This case series described cancers among community members ("Survivors") in the World Trade Center Environmental Health Center, a New York City program for people present in the disaster area on 9/11 or in the days or weeks following. Of 11,038 people enrolled between May 2002 and 31 December 2019, the authors studied 2561 cancer patients (excluding non-melanoma skin cancer), who had 2999 diagnoses at forty-one sites. They compared them with 5377 non-cancer participants who had signed research consent and were enrolled at Bellevue Hospital. Breast (22%) and prostate (16%) cancers were most common, then lung (9%), thyroid (7%) and lymphoma (7%). Thirteen percent of cancer patients had more than one primary cancer. Rare cancers included nine male breast cancer patients, two patients with peritoneal mesothelioma and one with lung mesothelioma. The three mesotheliomas had a median latency of 15.4 years from 9/11. Across all cancers, median age at diagnosis was 59 years and median latency 12.8 years. Because the population was self-referred and only program-certifiable cancers could be included, the authors said they could not directly assess incidence or mortality rates.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive case series of cancers recorded in a clinical treatment and surveillance program, with a reference group of non-cancer enrollees
• Who was studied: Community members ("Survivors") enrolled in the WTC Environmental Health Center, New York City, between May 2002 and 31 December 2019. Of 11,038 enrollees, 2840 had any cancer. After excluding 279 with non-melanoma skin cancer, 2561 cancer patients with 2999 diagnoses remained. The reference group was 5377 non-cancer participants who had signed research consent and were enrolled at one clinical site (Bellevue Hospital).
• Exposure: Dust and fumes from the destruction of the World Trade Center. Exposure was simplified into "acute" exposure (being in the dust cloud on 9/11, yes or no) and potential chronic exposure by activity category (local resident, local worker, student, clean-up worker). No fiber types or doses were measured for individuals.
• Main results:
  • Of the 2999 cancer diagnoses in 2561 patients, 2534 (84.5%) were solid tumors and 465 (15.5%) were lymphoid and hematopoietic tissue cancers.
  • Across both sexes, the most common diagnoses were breast (22%) and prostate (16%) cancer, followed by lung (9%), thyroid (7%) and lymphoma (7%).
  • Among women, breast cancer was the most common diagnosis (46%).
  • Among men, prostate cancer was the most common diagnosis (30%).
  • Of the 2561 cancer patients, 13% (n = 335) had more than one primary cancer diagnosis.
  • Rare cancers included two patients with peritoneal mesothelioma and one patient with lung mesothelioma.
  • For the 3 mesotheliomas (2 in men, 1 in a woman), median age at diagnosis was 57 years (range 38 to 70). Median latency from 9/11 was 15.4 years (range 15.0 to 16.7).
  • Nine male breast cancer patients were identified, two of them with two primary breast cancer diagnoses.
  • Across all cancer sites, median age at diagnosis was 59 years (range 5 to 95).
  • Across all cancer types, median latency from 9/11 was 12.8 years (range 0.7 to 18.3).
  • Most participants were never smokers: 65% of cancer patients and 69.2% of non-cancer participants.
• The authors' conclusion: The authors concluded that they had provided an initial description of cancers in local community members exposed to WTC dust and fumes. They said it would facilitate future analyses of this population and clinical management.
• Limitations the authors state:
  • The population was self-referred and therefore subject to selection bias.
  • Only cancers named as "certifiable" by the WTC Health Program could be included.
  • For these reasons, cancer incidence or mortality rates could not be directly assessed.
  • Routine screening within the program may explain the detection of some cancers.
  • Some cancer diagnoses may be missing, because some patients may have died of early cancers before being identified.

Topics

Medical terms in this study, explained in our Lexicon: Carcinogenic, Informed Consent, Latency, Mesothelioma.

Related studies

• Health consequences of the September 11 World Trade Center attacks: a review — J. Moline, R. Herbert, et al. (2006)
• Assessing truck driver exposure at the World Trade Center disaster site: personal and area monitoring for particulate matter and volatile organic compounds during October 2001 and April 2002 — A.S. Geyh, S. Chillrud, et al. (2005)
• The legacy of World Trade Center dust — J.M. Samet, A.S. Geyh, et al. (2007)
• Summary of the development of a signature for detection of residual dust from collapse of the World Trade Center buildings — H.A. Lowers, G.P. Meeker, et al. (2009)
• Evaluation of vacuum and wet-wipe methods for removal of World Trade Center dust from indoor environments — K.M. Tang, C.G. Nace, et al. (2004)
• Chest CT scan findings in World Trade Center workers — R.E. de la Hoz, J. Weber, et al. (2019)

Browse more research in International Journal of Environmental Research and Public Health, or return to medical research.