September 2, 2011
WTC Responders Face Long-term Health Issues
Nearly ten years after The United States´ darkest day in history, rescuers who were exposed to toxic dust and smoke from the World Trade Center (WTC) terrorist attacks on September 11, 2001 have a 19 percent higher risk of getting cancer of all kinds than colleagues who were not exposed, according to a long-term study.
The study, published this week in a special 9/11 issue of the medical journal The Lancet, evaluated more than 27,000 police officers, construction workers, firefighters and municipal workers over nine years following 9/11 and found a high incidence of several conditions, including asthma, PTSD, depression, sinusitis, and gastro-esophageal reflux disease (GERD). More than one in five of all responders studied had multiple physical and/or mental health conditions.
The study is the first to look at cancer rates among all emergency responders exposed to the toxic dust from the WTC attacks on 9/11. The findings may help pave the way for federal health benefits for rescue workers now suffering from cancer nearly a decade after the atrocity.
The WTC destruction has taken a severe toll on the health of those who tried to rescue people from the site, those who took part in the clean-up, and for those who lived nearby, the research shows.
Dr David Prezant, chief medical officer of New York City fire department, and colleagues from Albert Einstein College of Medicine at Yeshiva University, and Montefiore Medical Centre, New York, and also researchers at Mount Sinai Medical Center took on the long-term study of firefighters and other responders.
In the years following the disaster firefighters began to ask about cancer, said Prezant. The WTC tragedy was like no other they had ever encountered.
“Firefighters are not environmental scientists, but they have the common sense test,” Prezant told The Guardian. “What they said after coming out of those buildings after participating in the rescue and recovery effort was not just that the magnitude was great; they felt they were affected in a different way.”
“Most firefighters have learned there are different smells to fires. They repeatedly said to us that this area smelled different. They said this was unlike any other firefight we´ve had before,” he said.
But this did not stop them from risking their lives.
“We have a unique group of people. On 9/11 the firefighters ran into these towers, many of them after the south tower had collapsed, with nothing in their minds except saving everyone who was in there. We concentrate on the nearly 3,000 people who died there and the 343 firefighters who died that day, as we should, but we should never forget that 20,000 to 30,000 people were evacuated from that building because of the heroic efforts of these responders,” said Prezant.
“In subsequent years they did voice concern, asking: ℠What's going to happen to me?℠ From day one we have said we will find out and we will provide you with the services necessary to help you,” Prezant added.
Prezant noted that one of the strengths of the study is that every firefighter who responded to the 9/11 tragedy has had many health checkups since. The researchers´ efforts to avoid an over-screening bias have brought the percentage estimates down. Originally they found an increase of 32 percent.
The most common types of cancer found were those of skin, prostate, thyroid and non-Hodgkin´s lymphoma. The researchers say a link between exposure to the pollutants given off by the WTC and cancer is biologically plausible because “some contaminants in the WTC dust, such as polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and dioxins, are known carcinogens.”
“This study clearly shows World Trade Center exposure in these firefighters led to an increase in cancer,” said Prezant.
Studies so far have not found an increased risk of lung cancer, however. That form generally takes years to develop, and this study was no exception, finding no increased risk of lung cancer for exposed firefighters versus those not exposed.
Previous studies have shown increased rates of PTSD, asthma and other respiratory illnesses in rescue workers of 9/11. But to date, only a handful of smaller studies have shown increased rates of cancer, which can take 5 to 20 years to develop.
Dr John Howard, director of the National Institute for Occupational Safety and Health, concluded in a July report that there was not yet enough evidence to support a link between the 9/11 tragedy and cancer.
Without that evidence, responders to the disaster cannot receive payments for cancer treatments under the James Zadroga 9/11 Health and Compensation Act, which covers some illnesses, but not cancer.
Prezant told Reuters he was not sure whether his report would be enough to get the government to approve federal health benefits for firefighters who developed cancer after the 9/11 attacks, but said Dr Howard, who makes that decision, is aware of his study.
Dr James Melius of the New York State Laborers' health fund called for inclusion of cancer in the government-funded medical program for firefighters, according to The Guardian.
“Waiting to do so until definitive cancer studies have been completed (probably many years from now) would be unfair and would pose a hardship for workers who willingly risked their health by responding without hesitation to the WTC crisis,” he said.
So far, rescue workers and civilians exposed to the dust have lower death rates than other comparable groups in NY, according to another study. But researchers are not surprised, because most were employed or volunteers -- both groups that generally have better health -- and the illnesses they might succumb to as a result of 9/11 generally do not cause death within 10 years.
Nonetheless, the more than 50,000 WTC rescue and recovery workers are suffering from high levels of mental and physical illness, according to Dr Juan Wisnivesky and colleagues from Mount Sinai School of Medicine in NY.
“Our findings show a substantial burden of persistent physical and mental disorders in rescue and recovery workers who rushed to the site of the WTC and labored there for weeks and months 10 years ago. Many of these individuals now suffer from multiple health problems,” wrote Wisnivesky and colleagues.
They found that 28 percent of the WTC rescue and recovery workers have suffered depression at some time since 9/11, 32 percent have experienced PTSD, and 21 percent experienced panic disorder. They found that police officers had lower rates -- 7, 8 and 9 percent respectively. Researchers believe the smaller percentages in police officers could be due to previous stressful experiences in their jobs, the type of people recruited, or under-reporting for fear of job-related repercussions.
Many of the rescue and recovery workers who have been monitored since 9/11 have breathing-related problems. 42 percent have respiratory problems.
Prezant´s team only looked at cancers that developed in the first 7 years after the WTC attacks, comparing rates among exposed and non-exposed firefighters. They also made several adjustments to the overall groups to exclude information that might distort the results.
For example, data was excluded on 576 firefighters who were over the age of 60 on September 11, 2001, because the small number of men in that age group would have made the results statistically unstable. They also excluded data on 32 women, 13 Asians and 8 native Americans for the same reason.
They also excluded data on 85 men who had a prior cancer diagnosis. After adjusting for those factors, they found the exposed firefighters had a 19 percent higher rate of having any type of cancer.
The results of the study “support the need to continue monitoring firefighters and others who responded to the World Trade Center disaster or participated in recovery and cleanup at the site. This monitoring should include cancer screening and efforts to prevent cancer from developing in exposed individuals,” Prezant said.
“As we mark the 10th anniversary of 9/11, reports of persistent health effects are a sobering reminder that the disaster has had far-reaching effects. One cannot help but wonder what will be reported when we mark the 20th anniversary of this tragedy,” said Matthew Mauer of the NY State department of health in a commentary piece.
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