Studies find higher cancer rates in 9/11 rescuers

New York City firefighters who worked to rescue victims of the 9/11 attacks and who later helped recover remains are more likely to have cancer, as well as a range of other health problems from asthma to mental illness, a series of studies published in The Lancet medical journal finds.

But so far, anyway, they are no more likely to die sooner than the average person of similar age and background, a third study found.

The studies are certain to add to the debate over long-term health effects from the collapse of the twin World Trade Center towers, which sent a cloud of dust and ash over much of lower Manhattan.

"Over 50,000 workers were exposed while responding to the World Trade Center incident, attempting to rescue survivors and recover the dead, clearing the site, or cleaning the surrounding buildings," James Melius of the Laborers' Health Fund in Albany wrote in a commentary published alongside the Lancet studies.

"These workers were exposed to an incompletely characterized mix of asbestos, alkaline cement dust, pulverized building materials, and fire smoke for many days and weeks, often without proper protection," Melius wrote. "Hundreds of these people are disabled and can no longer work, and thousands have become ill and continue to receive medical treatment nearly 10 years after 9/11."

For the study on cancer, the New York City Fire Department's chief medical officer, Dr. David Prezant, and colleagues at Yeshiva University and Montefiore Medical Center studied more than 9,800 male firefighters. Those who worked at the World Trade Center site were 19 percent more likely to have cancer than colleagues who didn't go to the site, they found.

They found 263 cases of cancer in the men who went to the World Trade Center. In a normal population of men of similar age and background, 238 cases would be expected. The findings are notable because firefighters generally have lower rates of cancer than the general population, probably because they are fit, healthy, and less likely to smoke.

The firefighters were especially likely to have been diagnosed with melanoma, thyroid cancer, prostate cancer, and non-Hodgkin's lymphoma.

"An association between ... World Trade Center exposure and cancer is biologically plausible, because some contaminants in the WTC dust, such as polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and dioxins, are known carcinogens," Prezant's team wrote. "Continued follow-up will be important and should include cancer screening and prevention strategies."

Melius added: "The study also comes at an important time for the federally funded medical follow-up of these workers, which has just been guaranteed for the next 5 years. This medical program does not currently cover cancer treatment."

In a second study, data from 27,000 first-responders and cleanup workers show high rates of asthma, sinus infections, and inflammation and gastrooesophageal reflux disease, or GERD. More than 40 percent of the men had reduced lung function nine years after the attcks, Dr. Juan Wisnivesky of the Mount Sinai School of Medicine and colleagues reported.

Nine years into the study, 28 percent of the workers had asthma, 42 percent had sinusitis, and 39 percent had GERD. "Inhalation of toxic, highly alkaline dust is the probable cause of upper- and lower-respiratory injury in rescue and recovery workers," Wisnivesky and colleagues wrote.

This compares to a rate of about 10 percent of asthma and sinusitis and 6 percent for GERD in the men before the attacks.

Among police, rates for depression grew from 1.7 percent a year after the attacks to 7 percent by year nine. Rates of post-traumatic stress disorder rose from 2.5 percent the first year to 9.3 percent of police officers involved in rescue and recovery nine years later. Rates were higher for other rescue workers; depression rates more than doubled, from 10.8 percent the first year to 27.5 percent the ninth year.

"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," Wisnivesky's team wrote.

The good news is that death rates have not risen for these workers.

But death rates are higher for people exposed to the dust who were not involved in the rescue or recovery efforts, found Dr. Hannah Jordan, Dr. Steven Stellman, and colleagues at the New York City Department of Health and Mental Hygiene.

"Among World Trade Center Health Registry participants residing in New York City, overall death rates in 2003-09 were not higher than expected when compared to the general New York City population," they wote.

"However, within the cohort, non-rescue and non-recovery participants with high levels of WTC-related exposure had an increased risk of all-cause mortality and heart-disease-related mortality compared with those with low exposure. Continued monitoring of all-cause mortality and disease-specific mortality will be needed."

The administrations of then-President George W. Bush and then-New York City Mayor Rudolph Giuliani were both accused at the time of downplaying the health risks of the debris and dust. "The air quality is safe and acceptable," Giuliani said weeks after the attacks.

In November 2001, Giuliani suggested to Congress that New York's liability for any World Trade Center-related illnesses be limited to $350 million. First-responders and others have sued the city, saying firefighters, police, and rescue workers were not issued proper face ventilators to protect them from toxic dust.

In March 2010, U.S. District Judge Alvin Hellerstein rejected a legal settlement that would have given at least $575 million to people sickened by ash and dust from the attacks, saying the deal shortchanged 10,000 Ground Zero workers whom he called heroes. "In my judgment, this settlement is not enough," he said at the time.

In November, plaintiffs accepted a $625 million settlement. In December, the Democratic-led Senate passed a 9/11 Health Bill providing $1.8 billion until 2015 to monitor and treat injuries caused by toxic dust and debris, but Republicans blocked it and proposed a less-costly version.