Ankura Singh1,2, Rachel Zeig-Owens1,2,3, William Moir1,2, Charles B Hall4, Theresa Schwartz1,2, Madeline Vossbrinck1,2, Nadia Jaber2, Mayris P Webber2,3, Kerry J Kelly2, Viola Ortiz2, Ellen Koffler2, David J Prezant1,2. 1. Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. 2. The Bureau of Health Services and Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York. 3. Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 4. Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
Abstract
Importance: Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers. Objective: To project the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence. Design, Setting, and Participants: A total of 14 474 WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12 374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNY WTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data. Exposures: World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002. Main Outcomes and Measures: (1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers. Results: On January 1, 2012, the cohort was 96.8% male, 87.1% white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95% CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95% CI, 2638-2786] vs 2596 [95% CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95% CI, 1383-1495] vs 863 [95% CI, 816-910]), thyroid (73 [95% CI, 60-86] vs 57 [95% CI, 44-69]), and melanoma cases (201 [95% CI, 179-223] vs 131 [95% CI, 112-150), but fewer lung (237 [95% CI, 212-262] vs 373 [95% CI, 343-405]), colorectal (172 [95% CI, 152-191] vs 267 [95% CI, 241-292]), and kidney cancers (66 [95% CI, 54-80] vs 132 [95% CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235 835 412 (95% CI, $187 582 227-$284 088 597). Conclusions and Relevance: We project that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.
Importance: Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers. Objective: To project the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence. Design, Setting, and Participants: A total of 14 474 WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12 374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNY WTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data. Exposures: World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002. Main Outcomes and Measures: (1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers. Results: On January 1, 2012, the cohort was 96.8% male, 87.1% white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95% CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95% CI, 2638-2786] vs 2596 [95% CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95% CI, 1383-1495] vs 863 [95% CI, 816-910]), thyroid (73 [95% CI, 60-86] vs 57 [95% CI, 44-69]), and melanoma cases (201 [95% CI, 179-223] vs 131 [95% CI, 112-150), but fewer lung (237 [95% CI, 212-262] vs 373 [95% CI, 343-405]), colorectal (172 [95% CI, 152-191] vs 267 [95% CI, 241-292]), and kidney cancers (66 [95% CI, 54-80] vs 132 [95% CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235 835 412 (95% CI, $187 582 227-$284 088 597). Conclusions and Relevance: We project that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.
Authors: Rachel Zeig-Owens; Mayris P Webber; Charles B Hall; Theresa Schwartz; Nadia Jaber; Jessica Weakley; Thomas E Rohan; Hillel W Cohen; Olga Derman; Thomas K Aldrich; Kerry Kelly; David J Prezant Journal: Lancet Date: 2011-09-03 Impact factor: 79.321
Authors: Jiehui Li; James E Cone; Amy R Kahn; Robert M Brackbill; Mark R Farfel; Carolyn M Greene; James L Hadler; Leslie T Stayner; Steven D Stellman Journal: JAMA Date: 2012-12-19 Impact factor: 56.272
Authors: Robert D Daniels; Travis L Kubale; James H Yiin; Matthew M Dahm; Thomas R Hales; Dalsu Baris; Shelia H Zahm; James J Beaumont; Kathleen M Waters; Lynne E Pinkerton Journal: Occup Environ Med Date: 2013-10-14 Impact factor: 4.402
Authors: Samara Solan; Sylvan Wallenstein; Moshe Shapiro; Susan L Teitelbaum; Lori Stevenson; Anne Kochman; Julia Kaplan; Cornelia Dellenbaugh; Amy Kahn; F Noah Biro; Michael Crane; Laura Crowley; Janice Gabrilove; Lou Gonsalves; Denise Harrison; Robin Herbert; Benjamin Luft; Steven B Markowitz; Jacqueline Moline; Xiaoling Niu; Henry Sacks; Gauri Shukla; Iris Udasin; Roberto G Lucchini; Paolo Boffetta; Philip J Landrigan Journal: Environ Health Perspect Date: 2013-04-23 Impact factor: 9.031
Authors: Philip J Landrigan; Paul J Lioy; George Thurston; Gertrud Berkowitz; L C Chen; Steven N Chillrud; Stephen H Gavett; Panos G Georgopoulos; Alison S Geyh; Stephen Levin; Frederica Perera; Stephen M Rappaport; Christopher Small Journal: Environ Health Perspect Date: 2004-05 Impact factor: 9.031
Authors: Paul J Lioy; Clifford P Weisel; James R Millette; Steven Eisenreich; Daniel Vallero; John Offenberg; Brian Buckley; Barbara Turpin; Mianhua Zhong; Mitchell D Cohen; Colette Prophete; Ill Yang; Robert Stiles; Glen Chee; Willie Johnson; Robert Porcja; Shahnaz Alimokhtari; Robert C Hale; Charles Weschler; Lung Chi Chen Journal: Environ Health Perspect Date: 2002-07 Impact factor: 9.031
Authors: Olivia Diab; Jonathan DePierro; Leo Cancelmo; Jamie Schaffer; Clyde Schechter; Christopher R Dasaro; Andrew Todd; Michael Crane; Iris Udasin; Denise Harrison; Jacqueline Moline; Benjamin Luft; Steven M Southwick; Adriana Feder; Robert H Pietrzak Journal: Adm Policy Ment Health Date: 2020-05
Authors: Hilary L Colbeth; Rachel Zeig-Owens; Mayris P Webber; David G Goldfarb; Theresa M Schwartz; Charles B Hall; David J Prezant Journal: Int J Environ Res Public Health Date: 2019-05-16 Impact factor: 3.390
Authors: Albeliz Santiago-Colón; Robert Daniels; Dori Reissman; Kristi Anderson; Geoffrey Calvert; Alexis Caplan; Tania Carreón; Alan Katruska; Travis Kubale; Ruiling Liu; Rhonda Nembhard; W Allen Robison; James Yiin; John Howard Journal: Int J Environ Res Public Health Date: 2020-10-06 Impact factor: 3.390
Authors: Nedim Durmus; Yongzhao Shao; Alan A Arslan; Yian Zhang; Sultan Pehlivan; Maria-Elena Fernandez-Beros; Lisette Umana; Rachel Corona; Sheila Smyth-Giambanco; Sharon A Abbott; Joan Reibman Journal: Int J Environ Res Public Health Date: 2020-10-01 Impact factor: 3.390
Authors: Nedim Durmus; Sultan Pehlivan; Yian Zhang; Yongzhao Shao; Alan A Arslan; Rachel Corona; Ian Henderson; Daniel H Sterman; Joan Reibman Journal: Int J Environ Res Public Health Date: 2021-03-07 Impact factor: 3.390