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Study Finds World Trade Center Responders May Be at Increased Risk for Head and Neck Cancers

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Key Points

  • The study, which is the first to report on head and neck cancers in WTC first responders, found a 40% increase in diagnosis of these diseases between 2009 and 2012.
  • The most prevalent increases were in oropharyngeal cancers and laryngeal cancer.
  • Head and neck cancers were most associated with responders who were over 55; were non-Hispanic whites; and who had worked in military or protective service occupations and performed rescue and recovery and maintained the perimeter after the attacks.

A study by Graber et al in the International Journal of Cancer has found a significant increase in head and neck cancers among workers and volunteers who responded to the September 11 terrorist attacks on the World Trade Center (WTC), pointing to newly emerging risks that require ongoing monitoring and treatment of those who were exposed during the initial response.

The study found a 40% increase in diagnosis of these diseases between 2009 and 2012.

In an earlier 87-patient study published by Leeman et al in the International Journal of Cancer, a group from Memorial Sloan Kettering Cancer Center had reported WTC-exposed patients with human papillomavirus (HPV)-positive oropharyngeal cancer experienced significantly inferior outcomes compared to their non-WTC exposed counterparts.

The findings highlight the need to examine the potentially carcinogenic effects of WTC exposure in the context of other strong risk factors and the need for continued medical monitoring of WTC responders, particularly the police and military.

“Since cancers are diseases of long latency, the findings of significant excess cancer in this period point to a newly emerging trend that requires ongoing monitoring and treatment of WTC-exposed persons,” said lead author Judith Graber, PhD, Associate Professor at Rutgers School of Public Health and a researcher at Rutgers Environmental and Occupational Health Sciences Institute.

Study Findings

The results were part of a 2-year study funded by the U.S. Centers for Disease Control and Prevention examining whether first responders were at greater risk of human papillomavirus (HPV)-related throat and tongue cancer because of their exposure during recovery efforts in lower Manhattan.

The most prevalent increases were oropharyngeal cancers (which are often associated with HPV infection) and laryngeal cancer, but not oral and nasal cancers. The study also found that head and neck cancers were most associated with responders who were over 55; were non-Hispanic whites; and who had worked in military or protective service occupations and performed rescue and recovery and maintained the perimeter after the attacks.

The research began when clinicians treating WTC-exposed responders at Rutgers’ World Trade Center Health Program became concerned about an usually high number of patients with cancers of the head and neck. They compared the incidence of head and neck cancers in 73 people among the program's 33,809 WTC responders from 2003 through 2012 to the number of expected cases based on the New Jersey State Cancer Registry.

“This excess occurrence in head and neck cancers is plausible since first responders inhaled debris clouds containing many known carcinogens,” said Dr. Graber, who is also an associate member in the Cancer Prevention and Control Program at Rutgers Cancer Institute of New Jersey. “In addition, these carcinogenic exposures might add to or increase the effect of known personal risk factors for some head and neck cancers, such as tobacco smoking, heavy alcohol use, and oral HPV infection.”

The findings highlight the need to examine the potentially carcinogenic effects of WTC exposure in the context of other strong risk factors and the need for continued medical monitoring of WTC responders.

Disclosure: The study authors’ full disclosures can be found at onlinelibrary.wiley.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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