Molecular Study of Thyroid Cancer in World Trade Center Responders.

Maaike A G Van Gerwen,Stephanie Tuminello,Thais B Mendes,Michael Donovan,Emma K.T Benn,Gregory J Riggins,Eric Genden,Emanuela Taioli,Janete M Cerutti

doi:10.3390/ijerph16091600

Abstract

Thyroid cancer incidence is higher in World Trade Center (WTC) responders compared with the general population. It is unclear whether this excess in thyroid cancer is associated with WTC-related exposures or if instead there is an over-diagnosis of malignant thyroid cancer among WTC first responders due to enhanced surveillance and physician bias. To maximize diagnostic yield and determine the false positive rate for malignancy, the histological diagnoses of thyroid cancer tumors from WTC responders and age, gender, and histology matched non-WTC thyroid cancer cases were evaluated using biomarkers of malignancy. Using a highly accurate panel of four biomarkers that are able to distinguish benign from malignant thyroid cancer, our results suggest that over-diagnosis by virtue of misdiagnosis of a benign tumor as malignant does not explain the increased incidence of thyroid cancer observed in WTC responders. Therefore, rather than over-diagnosis due to physician bias, the yearly screening visits by the World Trade Center Health Program are identifying true cases of thyroid cancer. Continuing regular screening of this cohort is thus warranted.

Highlights

A significantly increased risk of thyroid cancer has been reported in the Mount Sinai HealthProgram of World Trade Center (WTC) responders [1], WTC-exposed firefighters [2], and the New YorkCity Department of Health exposed residents [3], with an excess risk in the range of 2–3 times the incidence reported by cancer registries.The etiology behind this increased incidence of thyroid cancer remains unclear
We have previously developed a panel of molecular markers to distinguish benign from malignant thyroid cancer, which can be used to cost-effectively identify the presence of over-diagnosis [14,15,16]
Remaining WTC thyroid cancer patients showed that the groups were not significantly different for age at diagnosis, gender, and histology (Table 1)

Summary

Introduction

A significantly increased risk of thyroid cancer has been reported in the Mount Sinai Health. Program of World Trade Center (WTC) responders [1], WTC-exposed firefighters [2], and the New York. City Department of Health exposed residents [3], with an excess risk in the range of 2–3 times the incidence reported by cancer registries. The etiology behind this increased incidence of thyroid cancer remains unclear. Though multiple carcinogens were identified at Ground Zero, including soot, benzene, and other volatile organic. Res. Public Health 2019, 16, 1600; doi:10.3390/ijerph16091600 www.mdpi.com/journal/ijerph

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