Toxins at Ground Zero linked with cancer among thousands of first responders

The tragedy of Sept. 11, 2001 still haunts Americans in countless ways, with many survivors continuing to struggle with the enduring grief and trauma left in its wake. Now, according to a new report from the World Trade Center Health Program at Mount Sinai hospital, yet another catastrophic aftereffect of 9/11 has revealed itself: cancer among first responders.

According to information from the World Trade Center Health Program (WTCHP) and the New York City Fire Department, 2,518 first responders at the World Trade Center site have developed cancer. According to the International Myeloma Foundation, which hosted a congressional briefing Wednesday on environmental exposures and cancer, myeloma is among the top four cancers reported among first responders.

Laura E. Crowley

“We know there were multiple carcinogens down at the site,” Laura E. Crowley, MD, assistant clinical professor of preventive medicine at Mount Sinai School of Medicine and deputy director of clinical operations at the WTCHP, told HemOnc Today. “It’s well known that there was benzene and polychlorinated biphenyls (PCBs), which are a cause of myeloma. We know that from looking at the dust.”

Crowley, along with Jacqueline Moline, MD, adjunct associate professor of medicine at Mount Sinai, conducted a case study of myeloma incidence among 9/11 first responders. Crowley reported results of the study at the congressional briefing.

“The bottom line is, our cohort should be monitored very closely because we’re seeing myeloma patients who are younger than the typical age of onset,” she said. “We’re seeing younger folks with a disease that typically affects older people.”

Surprising findings

Crowley and colleagues evaluated all cases of multiple myeloma among World Trade Center responders diagnosed between Sept. 11, 2001 and Sept. 10, 2007. Eight cases were identified, which exceeded the expected figure of 6.8. Instead of the expected 1.2 cases in patients aged younger than 45 years, the researchers identified four cases — half of the cohort.

“Typically, what is seen is that the age group is between 70 and 74 years of age,” Crowley said. “So this finding of four of the patients being younger than 45 [years] was pretty concerning.”

Another noteworthy finding, according to Crowley, was that three of the four patients who served at Ground Zero were found to have the highest exposures to toxins.

“It’s also important to note that all of these patients were law enforcement officers, and none of them had any occupational exposures that would have increased their risk for multiple myeloma.”

A “highly toxic mixture”

Crowley said the most prevalent cancers identified among first responders fall under the category of hematopoietic cancers, which include lymphoma, multiple myeloma, thyroid cancers and prostate cancer.

According to the study, other potential exposures at the site include paint and solvent vapors, aromatic hydrocarbons, dioxin, pesticides, engine exhaust and metals. All of these have been linked to an increase in multiple myeloma incidence in previous studies.

“What complicates matters is that it is a mixture [of exposures] — a highly toxic mixture — and so it’s difficult to tease out one particular cause,” she said.

Similarly, it is difficult to identify any preventive measure that may have reduced responders’ exposure to the toxins and prevented the ensuing cases.

“That is the million dollar question,” Crowley said.

She emphasized that the most important conclusion she draws from these findings is that patients with multiple myeloma need ongoing care and surveillance.

“I think we can just stress the importance of continued follow-up and surveillance of this cohort, especially considering what the findings have been,” Crowley said. “I hope we’ll be able to.” – by Jennifer Byrne