December 19, 2012
9-11 Study Casts Doubt On Government’s Move To Include Cancer In Compensation Fund
Lawrence LeBlond for redOrbit.com - Your Universe Online
More than a decade after the World Trade Center terrorist attack on September 11, 2001, the US government added cancer to the list of sicknesses covered by a $4.3 billion fund set up to help rescue workers and others who were adversely affected by the cleanup process after the tragedy. The health issues were directly related to the dust, debris and fumes released from the twin towers´ wreckage.
The addition of cancer to the WTC fund came in light of a study by the New York City Fire Department (FDNY) that revealed a 19 percent higher incidence of all cancers for exposed firefighters compared with those who had no exposure to dust from the WTC wreckage.
However, most of that increase came from prostate and thyroid cancers, non-Hodgkin lymphoma and melanoma, according to Jiehui Li, MBBS, of the New York City Department of Health and Mental Hygiene.
In a follow-up study, led by Li, researchers found a 43 percent higher risk of prostate cancer, double the risk of thyroid cancer, and a nearly three-fold increased risk of myeloma through 2008. The study examined nearly 56,000 people, including rescue and recovery workers who were present at the WTC site, were on barges nearby or were at the Staten Island landfill where debris was taken in the nine months after the attack. The study also included residents of Lower Manhattan, students, workers and passers-by exposed on the day of the attacks.
But Li and her colleagues cautioned that it was too early to know if their findings were related to September 11, and added that the number of people they found affected was small–only seven cases of myeloma (2 to 3 more than expected), 13 cases of thyroid cancer (7 more than expected), and 67 cases of prostate cancer (20 more than expected). The authors said several factors also made it difficult to draw any conclusive conclusions from the results, including the possibility that the rescue and recovery workers were screened more routinely–a factor researchers call “surveillance bias”–than the general population.
“There's a lot of interest in the question of, does exposure to the World Trade Center cause cancer?” said Dr. Thomas Farley, the New York City Health Commissioner.
Based on Li´s study, Farley said it is “complicated” to draw any conclusions between WTC exposure and cancer risk. “Most of the people who have had cancer so far would have had it anyway,” he told Reuters Health.
Cancer generally takes 20 years or longer to develop, so the true risks may become evident for many years to come, Farley added.
Of the 55,778 people enrolled in the World Trade Center Health Registry study, 21,850 were rescue and recovery workers. Using state cancer records, the team recorded any new diagnoses among those groups and compared their chance of cancer to data from all of New York State during the same period. In total, there were 1,187 new cancers among everyone in the Registry. Out of 23 types of cancers the researchers examined, only prostate, thyroid and myeloma were more common in the rescue and recovery workers during the last two years of the study.
Reporting the findings in the Journal of the American Medical Association (JAMA), the researchers said aid workers were between 1.4 and 2.9 times more likely to be diagnosed with one of those three cancers in 2007 or 2008 than other New Yorkers.
But proximity to the site did not increase the overall cancer risk, the researchers said. People, who lived or were near the towers when the attacks occurred and at regular times thereafter, yet did not participate in the rescue or recovery efforts, did not have an increased risk of any specific cancers. And intensity of exposure to the WTC site did not increase cancer risk.
Given the mixed results, the researchers were cautious in their assessments.
“Given the relatively short follow-up time and lack of data on medical screening and other risk factors, the increase in prostate and thyroid cancers and multiple myeloma should be interpreted with caution,” they advised. “The etiological role of WTC exposures in these three cancers is unclear. Longer follow-up of rescue/recovery works and participants not involved in rescue/recovery is needed with attention to selected cancer sites and to examine risk for cancers with typically long latency periods.”
The lack of clear evidence of a link between cancer and the 9-11 dust and debris casts doubt on the government´s decision to add 50 different types of cancer to the list of illnesses covered under the James Zadroga 9/11 Health and Compensation Act, signed by President Barack Obama in 2011. With the inclusion of cancers to the fund, it is likely those with other sicknesses better linked to ground zero will receive less money.
While Farley noted that many cancers will take 20 to 30 years to develop as a result of 9/11, he said people aren´t going to want to wait that long to get a clear answer for those who are suffering now.
Dr. John Howard, head of the National Institute for Occupational Safety and Health (NIOSH), who made the final decision on covering cancer in the WTC fund, said on Tuesday, “The W.T.C. Health Program welcomes this addition to the peer-reviewed scientific literature, and we have long encouraged the growth of such peer-reviewed research.”
D. Alfred I. Neugut, an oncologist and professor of epidemiology at the Mailman School of Public Health at Columbia University, said he was not surprised by the study.
“I think, given the time frame and the exposures,” he said, “that there wasn´t a high likelihood that there would be an elevated risk, certainly for cancer, and to the degree that it was, it would not be for the cancers that they´re finding.”
Neugut told the New York Times he sympathized with those who had cancer they attributed to 9/11, but noted their emotional response was not necessarily valid on a scientific level.
“The 9/11 attack was a terrible thing, but it doesn´t cause everything in the world,” he told the Times. “Cancer is a very specific outcome, and in most exposures, you have to be exposed for an extended time before you get the cancer.”
While Li´s study is too late to influence Howard´s decision, it may not be too late to influence public opinion going forward or to affect whether Congress will decide to either replenish or remove monies from the compensation fund depending on health outcomes.
Initially, the money set aside by the law–$2.8 billion for compensation and $1.5 billion for health monitoring–has covered only respiratory illnesses and mental health problems. The NYC health dept. found that asthma and PTSD were both linked to the 2001 attacks. But cancer is expected to be far more expensive to treat than other illnesses, and the economic loss caused by cancer could require far more compensation.
The fund has yet to hand out any payments, but is expected to conclude the payment process by 2017. Some police officers and rescue and recovery workers who have been diagnosed with cancer are already receiving monies from their pensions based on a 2005 law that said they were presumed to have contracted cancer from the dust and debris from 9/11.
As for the WTC fund, part of Howard´s rationale for adding cancer to the list was the fact that dust, fumes, smoke and debris from the wreckage were known to contain potential carcinogens like asbestos, silica, benzene and other volatile organic compounds and metals.
Patricia Workman, who volunteered at ground zero and now has myeloma and melanoma, both on the list of qualifying cancers, said she was disappointed by the findings of the study.
“It´s like one thing comes out that´s good, and then it´s just a setback,” said Workman, who has become an advocate for people with myeloma. She said she was surprised to find that several leukemia patients who were first responders at the scene on 9/11, and had later died, had not been covered under the WTC fund.
Workman suggested that the government might have unnecessarily invited criticism of the treatment and compensation program by covering so many types of cancer so soon.
“They gave too much away in the beginning to say every cancer was covered and everybody that was down there was covered,” she said. “You´ve got to prove that it´s linked to being down there. But I hope that people will speak up and fight.”
Dr. Jacqueline Moline from North Shore-LIJ Health System (NSLIJ) in Great Neck, New York, said studies have consistently shown a higher rate of thyroid cancer in responders - but it's unclear why rescue workers would also be at increased risk of prostate cancer, which is not known to be linked to such factors.
Moline, who has studied cancer in World Trade Center responders but wasn't involved in the new report, also noted that seven years isn't a very long time to track the growth of solid tumors.
"I think as times goes on we are going to see increased rates of cancer in those who were exposed, at higher rates than we would expect if they weren't exposed," she told Genevra Pittman of Reuters Health. "We don't have a really good handle on what happens when people are exposed to a complex mixture of carcinogens," she added.
"I think we're not going to get a full answer for many years," said Moline, adding that this should be a big concern. She noted that the Zadroga Act only provides health monitoring and care through 2016, which may be long before related cancers are even diagnosed.
Farley said he and his colleagues will continue to monitor cancer in relief workers and residents.
Li and colleagues said the study had some limitations. WTC exposure was self-reported 2 to 3 years after 9/11 and was subject to recall error. Also, the cancer cases identified through links with state cancer registries may have been underestimated; especially among those without a Social Security number (about 25 percent of the enrollees had not provided one). The authors also noted there was a lack in data on other cancer risk factors, such as family history and occupational exposures before or after 9/11.