24% higher risk of prostate cancer among 9/11 World Trade Center rescue / recovery workers

The greatest risk appears to be among first responders on the day of the attack.

The risk of prostate cancer was 24% higher among 9/11 emergency responders and rescuers after the 2001 World Trade Center attacks, with the highest risk among first responders, according to research published online in review Occupational and environmental medicine.

The results indicate a shorter latency period between occupational exposure and disease development than that reported in other studies on men not involved in the 9/11 recovery / rescue work, although the impact of the practice of screening cannot be ruled out, according to the researchers.

The World Trade Center attacks of September 11, 2001 created a dangerous environment with known and suspected carcinogens. Previous studies have indicated an increased risk of prostate cancer among on-scene responders compared to men in the general population.

But the length of time between exposure to toxins at the disaster site and a cancer diagnosis is not known.

The researchers therefore wanted to know if there were specific periods after the attacks when the risk of prostate cancer could be significantly higher.

They monitored the health of 69,102 rescue / recovery workers from three World Trade Center responder groups: the New York City Fire Department; the cohort of general respondents; and participants from the World Trade Center Health Registry.

Responders included firefighters, emergency medical services, police, construction and communications workers, volunteers, and those involved in the cleanup.

Levels of exposure to carcinogens, such as asbestos, sulfuric acid acid, benzo (a) pyrene, benzene and arsenic, were estimated by time of arrival at the World Trade Center site: the day of the attacks or caught in the cloud of dust resulting from the collapse of the twin towers; the next day; at any other time from September 13, 2001 to June 30, 2002.

Cancer diagnoses were tracked through a link with 13 state cancer registries in the United States until the end of the study period in 2015.

The final analysis included 54,394 men, of which 1,120 were diagnosed with prostate cancer between March 12, 2002 and December 31, 2015. The average age at diagnosis was 60 years.

Compared with responders who did not develop prostate cancer, those who did were more likely to be current smokers or former smokers. They were also more likely to have another type of cancer diagnosed during the study period.

More than 3 in 4 prostate cancer cases (867; 77%) were early stage and localized; just over 15% (171) had spread locally; and 2.5% (28) had spread to other parts of the body.

The average latency period between exposure and diagnosis was 9.4 years, with two-thirds of cases (734) diagnosed between 2009 and 2015, but starting in 2006, just five years after the attacks.

This is shorter than that reported in other studies, not involving World Trade Center responders, and may reflect the type of exposure experienced at the site, the researchers say.

The World Trade Center cases were compared to those of men in New York State over the same time period, and using the same inclusion criteria, but who were not involved in the rescue work. / recovery at the World Trade Center after the September 11 attacks.

Compared with rates among these men, 207,252 of whom developed prostate cancer, the risk of illness among World Trade Center rescue / recovery workers was 24% higher, from 2007 to the end of 2015, after taking into account. consider potentially influencing factors, such as smoking.

Further analysis revealed a dose-response trend during the initial (2002-2006) and subsequent (2007-2015) monitoring periods, with the highest risk estimated during the initial period.

“The increased risk among those who responded to the disaster earlier or were caught in the dust cloud suggests that a high intensity of exposure may have played a role in premature oncogenesis,” the researchers explain.

“Related to [the New York State group], however, a lower relative risk was observed during the initial period, particularly among those who arrived at [World Trade Center] most recent disaster site.

Certain jobs may carry an additional risk of prostate cancer regardless of exposure to the World Trade Center, the researchers say, as a possible explanation for the increased risk seen in the later period.

This is an observational study, and as such, cannot establish the cause. Higher-than-average screening for prostate cancer among World Trade Center responders may also have influenced the results, the researchers say.

They were also unable to determine to what extent other behavioral, occupational and environmental exposures other than smoking might have contributed to prostate cancer risk.

Nevertheless, their “evidence suggests a relationship between [World Trade Center] exposure and prostate cancer are not fully explained by random or systematic error, ”they write.

“Our results support the need for further research assessing the burden of prostate cancer in [World Trade Center] responders ”, they conclude.

Reference: “Temporal Association of Prostate Cancer Incidence with World Trade Center Rescue / Recovery Work” by David G Goldfarb, Rachel Zeig-Owens, Dana Kristjansson, Jiehui Li, Robert M Brackbill, Mark R Farfel, James E Cone, Janette Yung, Amy R Kahn, Baozhen Qiao, Maria J Schymura, Mayris P Webber, Christopher R Dasaro, Moshe Shapiro, Andrew C Todd, David J Prezant, Paolo Boffetta and Charles B Hall, September 10, 2021, .
DOI: 10.1136 / oem-2021-107405


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