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Abstract
Background
Following the September 11, 2001, attacks on the World Trade Center (WTC), thousands of workers were exposed to an array of toxins known to cause adverse health effects, including cancer. This study evaluates cancer incidence in the WTC Health Program General Responder Cohort occurring within 12 years post exposure.
Methods
The study population consisted of 28 729 members of the General Responder Cohort enrolled from cohort inception, July 2002 to December 31, 2013. Standardized incidence ratios (SIRs) were calculated with cancer case inclusion and follow-up starting post September 11, 2001 (unrestricted) and, alternatively, to account for selection bias, with case inclusion and follow-up starting 6 months after enrollment in the WTC Health Program (restricted). Case ascertainment was based on linkage with six state cancer registries. Under the restricted criterion, hazard ratios were estimated using multivariable Cox proportional hazards models for all cancer sites combined and for prostate cancer.
Results
Restricted analyses identified 1072 cancers in 999 responders, with elevations in cancer incidence for all cancer sites combined (SIR = 1.09, 95% confidence interval [CI] = 1.02 to 1.16), prostate cancer (SIR = 1.25, 95% CI = 1.11 to 1.40), thyroid cancer (SIR = 2.19, 95% CI = 1.71 to 2.75), and leukemia (SIR = 1.41, 95% CI = 1.01 to 1.92). Cancer incidence was not associated with any WTC exposure index (composite or individual) for all cancer sites combined or for prostate cancer.
Conclusion
Our analyses show statistically significant elevations in cancer incidence for all cancer sites combined and for prostate and thyroid cancers and leukemia. Multivariable analyses show no association with magnitude or type of exposure.
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Details
1 World Trade Center Health Program General Responder Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
2 World Trade Center Health Program Clinical Center of Excellence at Mount Sinai, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
3 World Trade Center Health Program Clinical Center of Excellence, NYU Langone Medical Center, New York University School of Medicine, New York, NY
4 World Trade Center Health Program Clinical Center of Excellence, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY
5 World Trade Center Health Program Clinical Center of Excellence, Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
6 World Trade Center Health Program Clinical Center of Excellence, Environmental and Occupational Health Sciences Institute, Robert Wood Johnson Medical Center, Piscataway, NJ