[Show abstract][Hide abstract] ABSTRACT: Background: World Trade Center rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens. The purpose of this investigation was to evaluate cancer incidence in responders during the first seven years after September 11, 2001.
Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure.
Results: A total of 575 cancers were diagnosed in 552 individuals. Increases over registry-based expectations were noted for all cancer sites combined (SIR 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR 1.36; 95% CI: 1.07, 1.71) and soft tissue cancers (SIR 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed six or more months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust compared with responders who reported lower levels of exposure.
Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow up and surveillance of WTC responders.
[Show abstract][Hide abstract] ABSTRACT: The terrorist attacks on the World Trade Center (WTC) of September 11, 2001 resulted in the deaths of 2,823 persons. They also generated a long-lasting burden of multiple physical and mental health illnesses among the cohort of 50,000 rescue workers who responded to the attacks and in the 400,000 residents and workers in nearby areas of New York City. A comprehensive health surveillance program was developed from the first months after the accidents and was further developed in the subsequent ears. Individual exposure and health data were stored in ad hoc databases and produced epidemiological outcomes on the various exposure-related illnesses.
About 10 years of longitudinal assessment of this large cohort of WTC rescue and recovery workers, yielded data from participants in the WTC Screening, Monitoring, and Treatment Program. Police officers, firefighters, construction workers, and municipal workers were included in the cohort. Cumulative and annual incidence were estimated for various physical disorders including asthma, sinusitis, and gastroesophageal reflux disease, mental health disorders including depression, post-traumatic stress disorder [PTSD], and panic disorder. Respiratory functionality was also assessed. Exposure was characterized with qualitative parameter including working on the pile and being engulfed in the dust cloud, and quantitative parameters including the time of arrival on site and the exposure duration.
Upper and lower respiratory conditions such as rhinosinusitis and asthma have been found in a significant number of people in WTC-exposed populations. A lack of appropriate respiratory protection may have contributed to these effects. Other commonly observed physical health conditions include gastro-esophageal reflux disease, obstructive sleep apnea and musculo-skeletal injuries. Many WTC-exposed individuals also suffer from mental health conditions, primarily post-traumatic stress disorder, depression, panic disorder, and substantial stress reaction. Recent studies suggest that WTC exposure may increase the risk of cancer and of mortality from cardiac disease.
Ten years of systematic health surveillance after the 9/11 WTC attacks, show long lasting burden of physical and mental health problems. Continued monitoring and treatment of this population is needed for early diagnoses of initial clinical conditions that can be treated more effectively. The experience of September 11 offers also indications on how to approach the acute and delayed health effects of civilian catastrophes. Critical lessons are derived about the importance of having trained responders--medical and non-medical--in place in advance of disasters, and about the need to proceed with adequate exposure assessment in a timely manner.
Giornale italiano di medicina del lavoro ed ergonomia 07/2012; 34(3 Suppl):529-33.
[Show abstract][Hide abstract] ABSTRACT: More than 50,000 people participated in the rescue and recovery work that followed the Sept 11, 2001 (9/11) attacks on the World Trade Center (WTC). Multiple health problems in these workers were reported in the early years after the disaster. We report incidence and prevalence rates of physical and mental health disorders during the 9 years since the attacks, examine their associations with occupational exposures, and quantify physical and mental health comorbidities.
In this longitudinal study of a large cohort of WTC rescue and recovery workers, we gathered data from 27,449 participants in the WTC Screening, Monitoring, and Treatment Program. The study population included police officers, firefighters, construction workers, and municipal workers. We used the Kaplan-Meier procedure to estimate cumulative and annual incidence of physical disorders (asthma, sinusitis, and gastro-oesophageal reflux disease), mental health disorders (depression, post-traumatic stress disorder [PTSD], and panic disorder), and spirometric abnormalities. Incidence rates were assessed also by level of exposure (days worked at the WTC site and exposure to the dust cloud).
9-year cumulative incidence of asthma was 27·6% (number at risk: 7027), sinusitis 42·3% (5870), and gastro-oesophageal reflux disease 39·3% (5650). In police officers, cumulative incidence of depression was 7·0% (number at risk: 3648), PTSD 9·3% (3761), and panic disorder 8·4% (3780). In other rescue and recovery workers, cumulative incidence of depression was 27·5% (number at risk: 4200), PTSD 31·9% (4342), and panic disorder 21·2% (4953). 9-year cumulative incidence for spirometric abnormalities was 41·8% (number at risk: 5769); three-quarters of these abnormalities were low forced vital capacity. Incidence of most disorders was highest in workers with greatest WTC exposure. Extensive comorbidity was reported within and between physical and mental health disorders.
9 years after the 9/11 WTC attacks, rescue and recovery workers continue to have a substantial burden of physical and mental health problems. These findings emphasise the need for continued monitoring and treatment of the WTC rescue and recovery population.
Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health.
The Lancet 09/2011; 378(9794):888-97. DOI:10.1016/S0140-6736(11)61180-X · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: More than 20,000 responders have been examined through the World Trade Center (WTC) Medical Monitoring and Treatment Program since September 11, 2001. Studies on WTC firefighters have shown elevated rates of sarcoidosis. The main objective of this study was to report the incidence of "sarcoid like" granulomatous pulmonary disease in other WTC responders.
Cases of sarcoid like granulomatous pulmonary disease were identified by: patient self-report, physician report and ICD-9 codes. Each case was evaluated by three pulmonologists using the ACCESS criteria and only "definite" cases are reported.
Thirty-eight patients were classified as "definite" cases. Six-year incidence was 192/100,000. The peak annual incidence of 54 per 100,000 person-years occurred between 9/11/2003 and 9/11/2004. Incidence in black responders was nearly double that of white responders. Low FVC was the most common spirometric abnormality.
Sarcoid like granulomatous pulmonary disease is present among the WTC responders. While the incidence is lower than that reported among firefighters, it is higher than expected.
American Journal of Industrial Medicine 03/2011; 54(3):175-84. DOI:10.1002/ajim.20924 · 1.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Determine if World Trade Center (WTC) disaster responders had lower lung function and higher bronchodilator responsiveness than those with respiratory symptoms and conditions.
We evaluated cardinal respiratory symptoms (dyspnea, wheezing, dry cough, productive cough) and determined the difference in FEV1, FVC, and bronchodilator responsiveness.
All respiratory symptoms were associated with a lower FEV1 and FVC, and a larger bronchodilator response. Responders reporting chronic productive cough, starting during WTC work and persisting, had a mean FEV1 109 mL lower than those without chronic persistent cough; their odds of having abnormally low FEV1 was 1.40 times higher; and they were 1.65 times as likely to demonstrate bronchodilator responsiveness.
Responders reporting chronic persistent cough, wheezing or dyspnea at first medical examination were more likely to have lower lung function and bronchodilator responsiveness.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 01/2011; 53(1):49-54. DOI:10.1097/JOM.0b013e3182028e5c · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A heterogeneous group of traditional and non-traditional workers and volunteers performed rescue, recovery, service restoration, and clean up in the aftermath of the WTC attacks. The World Trade Center Medical Monitoring and Treatment Program NY/NJ Consortium is a federally funded network of regional Centers of Excellence that provides annual standardized medical monitoring examinations and physical and mental health care for responders with WTC-covered conditions. Between July 2002 and February 2009, the WTC MMTP examined over 25,000 responders, and provided over 44,000 monitoring examinations. Between January 1, 2008 and December 31, 2008, 6,140 responders received over 21,500 treatment services. This talk will provide an update on recent findings from the NY/NJ Consortium Monitoring and Treatment Programs, with an emphasis on respiratory conditions including asthma, sarcoidosis, and aerodigestive disorders.
137st APHA Annual Meeting and Exposition 2009; 11/2009
[Show abstract][Hide abstract] ABSTRACT: We report on cases of multiple myeloma (MM) observed in World Trade Center (WTC) responders registered in the WTC Medical Program.
Possible cases of MM diagnosed between September 11, 2001, and September 10, 2007, in responders were confirmed if they met the World Health Organization and Mayo Clinic diagnostic criteria.
Among 28,252 responders of known sex and age, eight cases of MM were observed (6.8 expected). Four of these cases were observed in responders younger than 45 years at the time of diagnosis (1.2 expected). A slight deficit of MM cases was observed in responders older than 45 years (4 observed, 5.6 expected).
In this case series, we observe an unusual number of MM cases in WTC responders under 45 years. This finding underscores the importance of maintaining surveillance for cancer and other emerging diseases in this highly exposed population.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 08/2009; 51(8):896-902. DOI:10.1097/JOM.0b013e3181ad49c8 · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Multiple studies have demonstrated an initial high prevalence of spirometric abnormalities following World Trade Center (WTC) disaster exposure. We assessed prevalence of spirometric abnormalities and changes in spirometry between baseline and first follow-up evaluation in participants in the WTC Worker and Volunteer Medical Monitoring Program. We also determined the predictors of spirometric change between the two examinations.
Prebronchodilator and postbronchodilator spirometry, demographics, occupational history, smoking status, and respiratory symptoms and exposure onset were obtained at both examinations (about 3 years apart).
At the second examination, 24.1% of individuals had abnormal spirometry findings. The predominant defect was a low FVC without obstruction (16.1%). Between examinations, the majority of individuals did not have a greater-than-expected decline in lung function. The mean declines in prebronchodilator FEV(1) and FVC were 13 mL/yr and 2 mL/yr, respectively (postbronchodilator results were similar and not reported). Significant predictors of greater average decline between examinations were lack of bronchodilator responsiveness at examination 1 and weight gain [corrected].
Elevated rates of spirometric abnormalities were present at both examinations, with reduced FVC most common. Although the majority had a normal decline in lung function, lack of bronchodilator response at examination 1 and weight gain were significantly associated with greater-than-normal lung function declines [corrected]. Due to the presence of spirometric abnormalities > 5 years after the disaster in many exposed individuals, longer-term monitoring of WTC responders is essential.