World Trade Center Disaster Research Articles

DNA Methylation as a Molecular Mechanism of Carcinogenesis in World Trade Center Dust Exposure: Insights from a Structured Literature Review.

The collapse of the World Trade Center (WTC) buildings in New York City generated a large plume of dust and smoke. WTC dust contained human carcinogens including metals, asbestos, polycyclic aromatic hydrocarbons (PAHs), persistent organic pollutants (POPs, including polychlorinated biphenyls (PCBs) and dioxins), and benzene. Excess levels of many of these carcinogens have been detected in biological samples of WTC-exposed persons, for whom cancer risk is elevated. As confirmed in this structured literature review (n studies = 80), all carcinogens present in the settled WTC dust (metals, asbestos, benzene, PAHs, POPs) have previously been shown to be associated with DNA methylation dysregulation of key cancer-related genes and pathways. DNA methylation is, therefore, a likely molecular mechanism through which WTC exposures may influence the process of carcinogenesis.

P3.01F.02 Retrospective Characterization of Patients with Primary Lung Cancer Related to World Trade Center Disaster Exposure

P3.01F.02 Retrospective Characterization of Patients with Primary Lung Cancer Related to World Trade Center Disaster Exposure

Managing cancer following the World Trade Center disaster.

Managing cancer following the World Trade Center disaster.

Association of firefighting exposures with lung function using a novel job exposure matrix (JEM)

ObjectivesCharacterisation of firefighters’ exposures to dangerous chemicals in smoke from non-wildfire incidents, directly through personal monitoring and indirectly from work-related records, is scarce. The aim of this study was to...

Mediterranean diet intervention among World Trade Center responders with post-traumatic stress disorder: Feasibility and outcomes of a pilot randomized controlled trial.

Responders of the World Trade Center (WTC) disaster suffer from co-morbidities. A Mediterranean Diet (MedDiet) nutrition intervention with physical activity was implemented among WTC responders with overweight/obesity and post-traumatic stress disorder (PTSD). WTC Health Program members (N=62), 45-65years, males 87%, body mass index (BMI) 27-45kg/m2 randomized to MedDiet (n=31) or usual nutrition counseling (n=31). The 10-week intervention included online nutrition education, text messages, and group experiential cooking; both groups had three in-person individual nutrition counseling. Anthropometrics, serum biomarkers, psychosocial factors, MedDiet score, and PTSD symptoms were assessed at baseline, post-intervention, and 3-months (follow-up). The primary outcome was intervention feasibility and secondary outcomes were within- and between-group changes of all measures at post-intervention and follow-up. Nonparametric Wilcoxon rank sum tests for between-group comparisons and Wilcoxon signed rank tests for pre-post within-group comparisons. A total of 58(94%) and 46(74%) participants completed the post-intervention and follow-up measurements, respectively. Both groups experienced significant improvements in anthropometrics, MedDiet score, oxidized low-density lipoprotein, and PTSD symptoms. Baseline median (range) were weight 100.42 (73.66-135.17)kg, BMI 33.20 (27.50-41.75)kg/m2, and Waist circumference (WC) 109.22 (90.17-150.62)cm. Median % weight loss at post-intervention was MedDiet: -3% (-11%-7%), p=0.0002; Control: -1% (-13%-4%), p=0.008 and at follow-up MedDiet: -2% (-14%-12%), p=0.07; Control: -2% (-20%-3%), p=0.006. The overall BMI was reduced by -0.68kg/m2 (-4.61-2.09)kg/m2 p<0.0001 at post-intervention and by -0.60kg/m2 (-6.91-3.39)kg/m2, p<0.0009 at follow-up. Overall, median WC was reduced (p<0.0001); post-intervention -3.81cm (-33.00-3.30)cm and follow-up -4.45(-38.10-4.57)cm. There were group differences in HbA1c (p=0.019) and serum ω6/ω3 (p=0.029) at post-intervention. Online intervention with personal counseling was feasible in this population. Improvements in anthropometrics, MedDiet score, selected serum biomarkers and PTSD symptoms were found in both groups; group differences in HbA1c and serum ω6/ω3. A larger study with a delayed control is needed to better assess intervention effects.

Cluster Analysis of World Trade Center Related Lower Airway Diseases.

Introduction: Cluster analysis can classify without a priori assumptions the heterogeneous chronic lower airway diseases found in former workers at the World Trade Center (WTC) disaster site. Methods: We selected the first available chest computed tomography scan with quantitative computed tomography measurements on 311 former WTC workers with complete clinical, and spirometric data from their closest surveillance visit. We performed a nonhierarchical iterative algorithm K-prototype cluster analysis, using gap measure. Results: A five-cluster solution was most satisfactory. Cluster 5 had the healthiest individuals. In cluster 4, smoking was most prevalent and intense but there was scant evidence of respiratory disease. Cluster 3 had symptomatic subjects with reduced forced vital capacity impairment (low FVC). Clusters 1 and 2 had less dyspneic subjects, but more functional and quantitative computed tomography evidence of chronic obstructive pulmonary disease (COPD) in cluster 1, or low FVC in cluster 2. Clusters 1 and 4 had the highest proportion of rapid first-second forced expiratory volume decliners. Conclusions: Cluster analysis confirms low FVC and COPD/pre-COPD as distinctive chronic lower airway disease phenotypes on long-term surveillance of the WTC workers.

Exposure to Fine Particulate Matter (PM2.5) Is Associated with Worse Multiple Myeloma Outcomes in a Large, Urban, Multi-Ethnic Cohort

Introduction Outdoor air pollution (OAP) is a complex mixture, primarily consisting of black carbon (BC), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and particulate matter with an aerodynamic diameter of less than 2.5 microns (PM2.5). OAP is typically generated by the combustion process from motor vehicles, fossil fuel burning and industrial waste. The potential impact of air pollutants on cancer outcomes has not been systematically studied in communities of color. Multiple Myeloma (MM) is a hematologic malignancy defined by the clonal expansion of plasma cells leading to subsequent monoclonal protein expression resulting in multiple complications including anemia, renal disease, significant bone pain and increased fracture risk. MM is the second most common hematologic malignancy. The US Surveillance, Epidemiology, and End Results (SEER) registry estimates 34,000 new cases diagnosed and 13,000 deaths annually from MM. Risk factors for multiple myeloma include race, BMI, and occasionally genetic predisposition. Blacks and Hispanics were shown to have a higher incidence of MM that of non-Hispanic whites (Kaur G et al Clin Lymphoma Myeloma Leuk. 2021). There is recent evidence to suggest that environmental exposures, OAP in particular, may play a role in propagating disease progression in multiple myeloma (Landgren O JAMA Oncol 2015). A recent study demonstrated that first responders to the World Trade Center disaster had a higher rate of developing myeloma precursor disease (MGUS) and an earlier age of developing multiple myeloma (Landgren O JAMA Oncol. 2018). Our study seeks to further characterize patterns of exposure to OAP in patients with MM. Methods A retrospective cohort was developed of patients diagnosed with Multiple Myeloma at Montefiore Health System (Bronx, NY) between 1997-2018 (n=1608), using the Montefiore Electronic Data Warehouse. Of those patients, 1525 were identified as having 1 st cancer diagnosis of MM. Patient addresses (n=1514) were then used to geospatially overlay with OAP and Organic Matter from 2000-2018 using land use regression models. Ground-level PM2.5 was estimated by combining Aerosol Optical Depth (AOD) retrievals from the NASA MODIS, MISR, and SeaWIFS instruments with the GEOS-Chem chemical transport model, and subsequently calibrated to regional ground-based observations of both total and compositional mass using Geographically Weighted Regression (Hammer M.S et al Environ. Sci. Technol. 2020). This initial analysis focuses specifically on PM2.5, which was summarized as the number of years each patient was exposed to levels higher than the EPA standard of 12ug/m 3 and if the patient experienced an average PM2.5 &amp;gt;12ug/m 3 across their entire follow-up in the cohort. Additional information regarding demographics, dates of diagnosis and certain clinical parameters (Hgb, Cr, albumin, etc) were extracted. Differences in PM2.5 exposures, and clinical parameters, were compared by race and ethnicity using t-tests and chi-squared tests. Cox proportional hazards regression estimated the risk of death during follow-up associated with PM2.5 exposure, adjusting for confounders. Results Our patient population was highly diverse. Patients were 21% White, 50% Black with 27% having Race classified as Other. Thirty percent were Hispanic. Age at mean diagnosis was 66.24 years. On average, Bronx MM patients had higher exposure to PM2.5 than the EPA safe standard of 12 µg/m 3 from years 2000-2007 and the WHO safe standard of 5 µg/m 3 in all years of follow-up. Improved overall survival among our Multiple Myeloma patients was associated with fewer number of years exposed to PM2.5 &amp;gt;12 µg/m 3 (Hazard Ratio (HR)=1.12, 95% Confidence Interval (CI)=0.99- 1.27), when adjusting for sex and race. Further adjustment for smoking status yielded similar results (HR = 1.13, 95%CI = 0.98-1.30). Conclusion In this large urban, multi-ethnic cohort of MM patients, many patients experienced annual exposures to PM2.5 that were higher than the EPA and WHO safe standards of 12 µg/m 3 and 5 µg/m 3. Overall survival in MM patients was associated with fewer years of exposure to PM2.5, suggesting that reducing exposure to environmental pollutants, particularly OAP for our patients may lead to better outcomes. Additional analyses are needed to better understand the impact of treatment and clinical factors, as well as the other air pollutants in this patient population.

The Association of Air Pollution Exposure With Glucose and Lipid Levels: The Role of an Extreme Air Pollution Event Alongside 2 Decades of Moderate Exposure.

Extreme air pollution events and moderate exposure to fine particulate matter (PM2.5) are associated with increased cardiometabolic risk. The World Trade Center (WTC) Health Program general responder cohort includes responders to the WTC disaster. We investigated whether their exposure to this extreme air pollution event (2001) was associated with long-term metabolic outcomes, independently from the associations of intermediate-term PM2.5 exposure later in life (2004-2019). We included 22,447 cohort members with cholesterol (n= 96,155) and glucose (n= 81,599) laboratory results. Self-reported WTC exposure was derived from a questionnaire. PM2.5 exposure was derived from a satellite-based model. We observed an increase of 0.78 mg/dL (95% confidence interval (CI): 0.30, 1.26) in glucose and 0.67 mg/dL (95% CI: 1.00, 2.35) in cholesterol levels associated with an interquartile range increase in PM2.5 averaged 6 months before the study visit. Higher WTC-exposure categories were also associated with higher cholesterol (0.99 mg/dL, 95% CI: 0.30, 1.67, for intermediate exposure) and glucose (0.82 mg/dL, 95% CI: 0.22, 1.43, for high exposure) levels. Most associations were larger among people with diabetes. Extreme air pollution events and intermediate PM2.5 exposure have independent metabolic consequences. These exposures contributed to higher glucose and lipids levels among WTC responders, which may be translated into increased cardiovascular risk.

Association of World Trade Center (WTC) Occupational Exposure Intensity with Chronic Obstructive Pulmonary Disease (COPD) and Asthma COPD Overlap (ACO).

Reported associations between World Trade Center (WTC) occupational exposure and chronic obstructive pulmonary disease (COPD) or asthma COPD overlap (ACO) have been inconsistent. Using spirometric case definitions, we examined that association in the largest WTC occupational surveillance cohort. We examined the relation between early arrival at the 2001 WTC disaster site (when dust and fumes exposures were most intense) and COPD and ACO in workers with at least one good quality spirometry with bronchodilator response testing between 2002 and 2019, and no physician-diagnosed COPD before 9/11/2001. COPD was defined spirometrically as fixed airflow obstruction and ACO as airflow obstruction plus an increase of ≥ 400ml in FEV1 after bronchodilator administration. We used a nested 1:4 case-control design matching on age, sex and height using incidence density sampling. Of the 17,928 study participants, most were male (85.3%) and overweight or obese (84.9%). Further, 504 (2.8%) and 244 (1.4%) study participants met the COPD and ACO spirometric case definitions, respectively. In multivariable analyses adjusted for smoking, occupation, cohort entry period, high peripheral blood eosinophil count and other covariates, early arrival at the WTC site was associated with both COPD (adjusted odds ratio [ORadj] = 1.34, 95% confidence interval [CI] 1.01-1.78) and ACO (ORadj = 1.55, 95%CI 1.04-2.32). In this cohort of WTC workers, WTC exposure intensity was associated with spirometrically defined COPD and ACO. Our findings suggest that early arrival to the WTC site is a risk factor for the development of COPD or of fixed airway obstruction in workers with pre-existing asthma.

Artificial intelligence in forensic odontology – A review

Revolutionary advancements in dentistry have been brought about by robotic advancements that mimic the functions of the human brain. Over an extended period, both dental and medical documentation has undergone computerization, with cloud servers serving as reliable backups. These records have played a crucial role in identifying victims of major catastrophes such as the World Trade Centre disaster and the Indian Ocean tsunami. Often, in these cases, the bodies are severely damaged and unidentifiable, except for the remaining teeth and the resilient jawbone, which exhibit remarkable resistance to harsh conditions. These elements have proven to be vital in the process of identifying disaster victims. To conduct the present review, extensive online research was performed using databases such as Google Scholar, PubMed, Medline, and IEEE Xplore, up until December 2022.

TERT and BRAF V600E mutations in thyroid cancer of World Trade Center Responders.

The 2-fold excess thyroid cancer risk reported in multiple World Trade Center (WTC) disaster exposed cohorts cannot entirely be explained by surveillance and physician bias thus highlighting the need to investigate the potential consequences of the dust exposure, containing carcinogenic and endocrine disruptive elements, on the thyroid. This study investigated the presence of TERT promoter and BRAF V600E mutations in 20 WTC-exposed versus 23 matched non-exposed thyroid cancers as potential mechanism explaining the excess risk. Although no significant difference in BRAF V600E mutation was found, TERT promoter mutations were significantly more prevalent in WTC thyroid cancer versus non-exposed thyroid cancers (P = 0.021). The odds of a TERT promoter mutation was significantly higher in the WTC versus the non-WTC thyroid cancers after adjustment [ORadj: 7.11 (95% CI: 1.21-41.83)]. These results may indicate that exposure to the mixture of pollutants present in the WTC dust resulted in an excess thyroid cancer risk and potentially more aggressive thyroid cancer, warranting investigating WTC responders on thyroid-associated symptoms during their health checkups. Future studies should include long-term follow-up to provide important insights in whether thyroid-specific survival is negatively affected by WTC dust exposure and whether this is because of the presence of one or more driver mutations.

Modeling complex interactions in a disrupted environment: Relational events in the WTC response

AbstractWhen subjected to a sudden, unanticipated threat, human groups characteristically self-organize to identify the threat, determine potential responses, and act to reduce its impact. Central to this process is the challenge of coordinating information sharing and response activity within a disrupted environment. In this paper, we consider coordination in the context of responses to the 2001 World Trade Center (WTC) disaster. Using records of communications among 17 organizational units, we examine the mechanisms driving communication dynamics, with an emphasis on the emergence of coordinating roles. We employ relational event models (REMs) to identify the mechanisms shaping communications in each unit, finding a consistent pattern of behavior across units with very different characteristics. Using a simulation-based “knock-out” study, we also probe the importance of different mechanisms for hub formation. Our results suggest that, while preferential attachment and pre-disaster role structure generally contribute to the emergence of hub structure, temporally local conversational norms play a much larger role in the WTC case. We discuss broader implications for the role of microdynamics in driving macroscopic outcomes, and for the emergence of coordination in other settings.

Association of Lung Function Decline with All-Cause and Cancer-Cause Mortality after World Trade Center Dust Exposure.

Rationale: In numerous cohorts, lung function decline is associated with all-cause and cardiovascular-cause mortality, but the association between the decrease in forced expiratory volume in 1 second (FEV1) and cancer-cause mortality, particularly after occupational/environmental exposure(s), is unclear. Exposure to dust/smoke from the World Trade Center (WTC) disaster caused inflammation and lung injury in Fire Department of the City of New York rescue/recovery workers. In addition, prior research found that >10% of the cohort experienced greater than twice the age-related decrease in FEV1 (⩾64 ml/yr). Objectives: To evaluate the association of longitudinal lung function with all-cause and cancer-cause mortality after exposure to the WTC disaster. Methods: We conducted a prospective cohort study using longitudinal prebronchodilator FEV1 data for 12,264 WTC-exposed firefighters and emergency medical service providers. All-cause and cancer-cause mortality were ascertained using National Death Index data from September 12, 2001, through December 31, 2021. Joint longitudinal survival models evaluated the association of baseline FEV1 and change in FEV1 from baseline with all-cause and cancer-cause mortality adjusted for age, race/ethnicity, height, smoking, work assignment (firefighters vs. emergency medical service providers), and WTC exposure. Results: By December 31, 2021, 607 of the 12,264 individuals in the cohort (4.9%) had died (crude rate = 259.5 per 100,000 person-years), and 190 of 12,264 (1.5%) had died from cancer (crude rate = 81.2 per 100,000 person-years). Baseline FEV1 was ⩾80% predicted in 10,970 of the 12,264 (89.4%); final FEV1 was ⩾80% in 9,996 (81.5%). Lower FEV1 at baseline was associated with greater risk for all-cause mortality (hazard ratio [HR] per liter = 2.32; 95% confidence interval [95% CI] = 1.98-2.72) and cancer-cause mortality (HR per liter = 1.99; 95% CI = 1.49-2.66). Longitudinally, each 100-ml/yr decrease in FEV1 was associated with an 11% increase in all-cause mortality (HR = 1.11; 95% CI = 1.06-1.15) and a 7% increase in cancer-cause mortality (HR = 1.07; 95% CI = 1.00-1.15). Compared with FEV1 decrease <64 ml/yr, those with FEV1 decrease ⩾64 ml/yr had higher all-cause (HR = 2.91; 95% CI = 2.37-3.56) and cancer-cause mortality (HR = 2.68; 95% CI = 1.90-3.79). Conclusions: Baseline FEV1 and longitudinal FEV1 decrease are associated with increased risk of all-cause and cancer-cause mortality in a previously healthy occupational cohort, the majority of whom had normal lung function, after intense exposure to dust/smoke. Further investigation is needed to define pathways by which lung function impacts mortality after an irritant exposure.

Association of Rheumatoid Arthritis with Opioid Pain Medication Overuse among Persons Exposed to the 9/11 World Trade Center Disaster.

We examined the association of post-9/11 rheumatoid arthritis (RA) diagnosis with opioid pain medication overuse among enrollees in the World Trade Center Health Registry (WTCHR). Opioid overuse was defined as the self-reported intake of prescribed opioids at a higher dosage or more often than directed in the last 12 months on one of the two most recent WTCHR surveys (2015-2016, 2020-2021). Post-9/11 RA was ascertained through self-reports and subsequently validated following medical record release by the enrollees' physicians or medical records review. We excluded those with self-reported RA that was not validated by their physicians and those who did not report being prescribed opioid pain medication in the last 12 months. Multivariable log-binomial regression was conducted to examine the relationship between post-9/11 RA diagnosis and opioid pain medication overuse, adjusting for sociodemographic characteristics and 9/11-related posttraumatic stress disorder (PTSD) symptoms. Of the 10,196 study enrollees, 46 had confirmed post-9/11 RA. The post-9/11 RA patients were mostly females (69.6% vs. 37.7%), less frequently non-Hispanic White (58.7% vs. 73.2%) individuals, and less often had attained a higher level of education (76.1% vs. 84.4%) compared to those without post-9/11 RA. Opioid pain medication overuse was significantly associated with a post-9/11 RA diagnosis (Adjusted Risk Ratio: 2.13, 95% CI: 1.44-3.17). More research is needed to better understand the use and management of prescribed opioids among WTC-exposed individuals with RA.

Novel approach to studying effects of inhalational exposure on lung function in civilians exposed to the World Trade Center disaster

It is increasingly important to study the impact of environmental inhalation exposures on human health in natural or man-made disasters in civilian populations. The members of the World Trade Center Environmental Health Center (WTC EHC; WTC Survivors) had complex exposures to environmental disaster from the destruction of WTC towers and can serve to reveal the effects of WTC exposure on the entire spectrum of lung functions. We aimed to investigate the associations between complex WTC exposures and measures of spirometry and oscillometry in WTC Survivors and included 3605 patients enrolled between Oct 1, 2009 and Mar 31, 2018. We performed latent class analysis and identified five latent exposure groups. We applied linear and quantile regressions to estimate the exposure effects on the means and various quantiles of pre-bronchodilator (BD) % predicted forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio, as well as the resistance at an oscillating frequency of 5 Hz (R5), frequency dependence of resistance R5–20, and reactance area (AX). Compared with Group 5, which had low or unknown exposure and was treated as the reference group, Group 1, the local workers with both acute and chronic exposures, had a lower median of % predicted FVC (−3.6; 95% CI: −5.4, −1.7) and higher (more abnormal) measures of AX at 10th quantile (0.77 cmH2O L–1 s; 95% CI: 0.41, 1.13) and 25th quantile (0.80 cmH2O L−1 s; 95% CI: 0.41, 1.20). Results suggested heterogeneous exposures to the WTC disaster had differential effects on the distributions of lung functions in the WTC Survivors. These findings could provide insights for future investigation of environmental disaster exposures.

PROMOTING HEALTHY AGING OF WORLD TRADE CENTER RESPONDERS

Abstract By 2030 the majority of World Trade Center (WTC) rescue and recovery workers (general responders) will be aged 65 and over and at risk for age-related conditions and consequences. Despite the US government’s commitment to support WTC responders who have exposure-related health conditions (e.g., cancers, PTSD), little research to date has focused on age-related issues in this population. Because WTC responders were exposed to high levels of toxicants and intense psychological trauma in the emergency response and cleanup following the 2001 WTC disaster—hazards that can accelerate the aging process – they are likely at increased risk for premature aging and associated age-related syndromes (e.g., functional decline, falls). An improved understanding of how aging affects the health of WTC responders is critically important to improving their clinical care, health outcomes, and overall quality of life. In this symposium we will present 3 studies that have shed light on the aging of WTC responders. First, we assess frailty among responder using a frailty phenotype. In the next study we examine the extent of polypharmacy among WTC responders and associated factors. Finally, we examine trajectories of frailty in this population over 2 decades of follow up using a validated clinical frailty index. This work represents the first examination of frailty and aging among WTC responders and will be an area of growing research as the population ages.

Mutagenicity of the organic fraction of World Trade Center dust.

Most studies of the health effects and chemical characterization of the dust resulting from the catastrophic collapse of the World Trade Center (WTC) on September 11, 2001, have focused on the large inorganic fraction of the dust; however, chemical analyses have identified mutagens and carcinogens in the smaller organic fraction. Here, we determined the mutagenicity of the organic fraction of WTC dust in Salmonella. Only 0.74% of the mass of the particulate matter (PM) <53 μm in diameter was extractable organic matter (EOM). Because the EOM was 10 times more mutagenic in TA100 +S9 than in TA98 +S9 and was negative in TA98 -S9, we inferred, respectively, that polycyclic aromatic hydrocarbons (PAHs) played a role in the mutagenicity and not nitroarenes. In TA98 +S9, the mutagenic potency of the EOM (0.1 revertant/μg EOM) was within the range of EOMs from air and combustion emissions. However, the EOM-based mutagenic potency of the particles (0.0007 revertants/μg PM) was 1-2 orders of magnitude lower than values from a review of 50 combustion emissions and various air samples. We calculated that 37 PAHs analyzed previously in WTC EOM were 5.4% of the EOM mass and 0.04% of the PM mass; some air contained 0.3 μg WTC EOM/m3 (0.02 μg PAHs/m3 ). Populations exposed to WTC dust have elevated levels of prostate and thyroid cancer but not lung cancer. Our data support earlier estimates that PAH-associated cancer risk among this population, for example, PAH-associated lung cancer, was unlikely to be significantly elevated relative to background PAH exposures.

Characteristics of Cancers in Community Members Exposed to the World Trade Center Disaster at a Young Age.

The destruction of the World Trade Center (WTC) towers on 11 September 2001 (9/11) released tons of dust and smoke into the atmosphere, exposing hundreds of thousands of community members (survivors) and responders to carcinogens. The WTC Environmental Health Center (WTC EHC) is a federally designated surveillance and treatment program for community members who were present in the New York City disaster area on 9/11 or during the months that followed. WTC EHC enrollment requires exposure to the WTC dust and fumes and a federally certifiable medical condition, which includes most solid and blood cancers. Several studies have described the prevalence and characteristics of cancers in responders and survivors exposed to the WTC dust and fumes as adults. Cancers in those exposed at a young age warrant specific investigation since environmental toxin exposure at a younger age may change cancer risk. We describe the characteristics of 269 cancer patients with 278 cancer diagnoses among WTC EHC enrollees who were young in age (aged 0 to 30) on 9/11. These include 215 patients with a solid tumor (79.9%) and 54 with a lymphoid and/or hematopoietic cancer (20.1%). Among them, 9 patients had a known second primary cancer. A total of 23 different types of cancer were identified, including cancer types rare for this age group. Many were diagnosed in individuals lacking traditional cancer-specific risk factors such as tobacco use. The current study is the first to report specifically on cancer characteristics of younger enrollees in the WTC EHC program.

Scientific Value of the Sub-Cohort of Children in the World Trade Center Health Registry.

The World Trade Center Health Registry (WTCHR) was established in 2002 as a public health resource to monitor the health effects from the World Trade Center (WTC) disaster. We evaluated the representativeness of the WTC youth population (<18 years on 11 September 2001) by comparing the distributions of age, gender, race/ethnic groups, and income to 2000 census data for the matched geographic area, including distance from disaster. There were 2379 WTCHR enrolled children living in Lower Manhattan south of Canal Street on 11 September 2001, along with 752 enrolled students who attended school in Lower Manhattan but were not area residents. The WTCHR sub-group of children who were residents was similar to the geographically corresponding census population on age and sex. Black and Hispanic children are moderately overrepresented at 0.9% and 2.4% in the WTCHR compared to 0.8% and 1.7% in census population, respectively, while lower-income households are slightly under-represented, 28.8% in the WTCHR and 30.8% for the corresponding census information. Asian children appear underrepresented at 3.0% participation compared to 6.3% in the census. While the demographics of WTCHR youth are somewhat skewed, the gaps are within expected patterns of under-representation observed in other longitudinal cohorts and can be effectively addressed analytically or through targeted study design.

Myeloma precursor disease (MGUS) among rescue and recovery workers exposed to the World Trade Center disaster

An elevated risk of myeloma precursor disease, monoclonal gammopathy of undetermined significance (MGUS), was identified among Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed firefighters. Further investigation was needed to determine if these findings were reproducible in a more heterogeneous WTC-exposed rescue/recovery workers cohort, the Stony Brook University-General Responder Cohort GRC (SBU-GRC). MGUS risk was compared between the cohorts and to published general population estimates from Olmsted County, MN, USA. In this observational seroprevalence study, odds ratios (OR) and age-standardized risk ratios (RR) of MGUS (M-spike and light-chain-MGUS combined), M-spike, and light-chain-MGUS were estimated using logistic regression. Age-standardized prevalences were calculated for white males aged 50–79; RRs were estimated by comparing risk in the WTC-exposed cohort with the Olmsted County screened cohort. SBU-GRC had elevated odds of MGUS compared with FDNY (OR = 1.38; 95%CI = 1.00–1.89). The age-standardized prevalence of MGUS was 9.0/100 persons (95%CI = 7.5–10.6), over two-fold higher than the general population (RR = 2.08; 95%CI = 1.72–2.51); the age-standardized prevalence of light-chain-MGUS was 3.5-fold higher (RR = 3.54; 95%CI = 2.52–4.97). This study adds to mounting evidence supporting an association between WTC/environmental exposures and MGUS among rescue/recovery workers. Access to MGUS screenings for the entire WTC-exposed cohort could allow for treatment interventions that improve survival.