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Cancer in World Trade Center Health Program (WTCHP)

Cancer in World Trade Center Health Program (WTCHP). Dr. Laura Crowley Assistant Clinical Professor Preventive Medicine Dr. Jacqueline Moline Vice President and Chair, Population Health North Shore LIJ Health System. Introduction.

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Cancer in World Trade Center Health Program (WTCHP)

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  1. Cancer in World TradeCenter Health Program (WTCHP) Dr. Laura Crowley Assistant Clinical Professor Preventive Medicine Dr. Jacqueline Moline Vice President and Chair, Population Health North Shore LIJ Health System

  2. Introduction The attacks on the World Trade Center (WTC) on Sept 11, 2001: Exposed hundreds of thousands of people to dust, debris, pulverized building materials, and potentially toxic emissions, resulting in short- and medium term health effects Created an environmental disaster of unprecedented scale for the New York areawith occupational exposure to many well known carcinogens, increasing risk of cancer among WTC responders

  3. Exposure on 9/11 Carcinogens present at the WTC site included dioxins, polychlorinated biphenyls, volatile organic compounds, benzene, asbestos and numerous metals Airborne carcinogens— most notably benzene as well as polychlorinated biphenyls, other organochlorines, dioxins, and furans—were present in measurable quantities, especially in the first 24 to 48 hours after the attacks.

  4. Carcinogens and Cancers Polyaromatic hydrocarbons, a product of combustion, have been shown to cause bladder, skin and lung cancer Benzene is associated with hematologic malignancies, notably leukemia Dioxin exposure is associated with increased cancer mortality rate, and increased rates of soft tissue sarcoma, lymphoma and respiratory tract cancers Liver and biliary tract cancers have been found in individuals exposed to PCBs Asbestos causes lung cancer, mesothelioma, and is associated with elevated risks for colorectal and laryngeal cancers

  5. Multiple Myeloma in World Trade Center Responders: A Case Series Multiple Myeloma (MM) is the 2nd most common hematological malignancy in the U.S., after Non-Hodgkin’s Lymphoma Risk of MM was observed to be 10-fold greater in those 70 to 74 years of age compared with those 45 to 49 years, according to the National Cancer Institute SEER program, 2005 Known risk factors are: male gender and increasing age, African American race, obesity, a positive family history of lymphatohematopoietic cancer, and monoclonal gammopathy of undetermined significance Potential exposures at the WTC such as benzene, paint and solvent vapors, aromatic hydrocarbons, polychlorinated biphenyls, dioxin, pesticides, engine exhaust, and metals have been associated with increased rates of myeloma as per previous studies

  6. Multiple Myeloma in World Trade Center Responders: A Case Series Case identification Diagnosis of MM: Self reported by a responder to a WTC MMTP clinician during a baseline, monitoring, or treatment visit Self reported by a responder to the WTC MMTP either via a phone or email Reported by a WTCMMTP physician or outside physician Confirmatory medical records reviewed by a hematologist Diagnostic criteria were based on the presence of abnormal bone marrow as per WHO and Mayo Clinic diagnostic criteria

  7. Multiple Myeloma in World Trade Center Responders: A Case Series Results: 8 histopathologically confirmed cases of MM since September 11, 2001, were reported among eligible WTC responders registered in the WTCMMTP 4 of these 8 cases were seen in responders younger than 45 years 3 of these 4 cases arrived at Ground Zero on September 11, the day of heaviest exposure None of these 4 cases had occupational exposures that might have increased the risk of developing MM

  8. Multiple Myeloma in World Trade Center Responders: A Case Series Results: Observed vs Expected cases: Among 28,252 responders of known sex and age, 8 cases of MM were observed in the study and 6.8 were expected From these 8 cases 4 cases were observed under the age 45, while three sources predicted 1.0 to 1.2 cases in this young age group

  9. Multiple Myeloma in World Trade Center Responders: A Case Series Summary: MM is typically a disease of the elderly Atypically, 4 of the 8 these MM cases occurred in responders younger than 45 years 4 cases were all members of law enforcement and had no other occupational exposures that might have increased the risk for developing MM The latency period reported in these cases is significantly shorter than the latency period for MM reported in literature as a result of benzene exposure or other organic solvents, e.g.: ranging from 10 to 19 years in one study and more than 20 years in other studies Clinicians treating WTC responders should be aware that the age distribution of MM and other chronic diseases may be skewed in this population

  10. Conclusion The exact nature of the complex mixture of toxins released into the air on September 11, 2001, and, consequently, the extent and precise nature of the exposures sustained by workers and volunteers will never be fully known Based on extensive analysis of dust samples collected from sites around lower Manhattan after 9/11, it is certain that the air contained many known carcinogens Continued follow-up of this cohort and other WTC-exposed cohorts is crucial and should include cancer screening and prevention strategies

  11. References Moline JM, Herbert R, Crowley L, Troy K, Hodgman E, Shukla G, Udasin I, Luft B, Wallenstein S, Landrigan P, Savitz DA. 2009. Multiple myeloma in World Trade Center responders: a case series. J Occup Environ Med. 51(8):896-902. Solan S, Wallenstein S, Shapiro M, Teitelbaum SL, Stevenson L, Kochman A, Kaplan J, Dellenbaugh C, Kahn A, Biro FN, Crane M, Crowley L, Gabrilove J, Gonsalves L, Harrison D, Herbert R, Luft B, Markowitz SB, Moline J, Niu X, Sacks H, Shukla G, Udasin I, Lucchini RG, Boffetta P, Landrigan PJ. 2013. Cancer incidence in world trade center rescue and recovery workers, 2001-2008. Environ Health Perspect. 121(6):699-704. Li J, Cone JE, Kahn AR, Brackbill RM, Farfel MR, Greene CM, Hadler JL, Stayner LT, Stellman SD. 2012. Association between World Trade Center exposure and excess cancer risk. JAMA.308(23):2479-88. Zeig-Owens R, Webber MP, Hall CB, Schwartz T, Jaber N, Weakley J, Rohan TE, Cohen HW, Derman O, Aldrich TK, Kelly K, Prezant DJ. 2011. Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study. Lancet. 378(9794):898-905. Moline J, Herbert R, Nguyen N. Health consequences of the September 11 World Trade Center attacks: a review. Cancer Invest. 24(3):294-301.

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