Rutgers School of Public Health faculty members Dr. Judith Graber and Dr. Iris Udasin have co-authored a case series report of head and neck cancer (HNC) among World Trade Center (WTC) responders who participated in the rescue and recovery efforts at or near ground zero during the events of 9/11. The study looked at patients enrolled in the WTC Health Program, who were seen at Rutgers World Trade Center General Responders Health Program (WTC-HP) Center of Clinical Excellence, directed by Dr. Udasin. The case series was prompted by Dr. Udasin’s observation of what appeared to be an unusually high number of HNC diagnoses among WTC-HP cohort patients.
HNC can be devastating as these cancers have a high risk for primary treatment failure and death. Surviving patients are often left disfigured from the disease or its treatment. Compared with other cancer survivors, patients with HNC are at increased risk for depression, unemployment, substance abuse, and even suicide. These adverse outcomes can be even more severe among 9/11 responders, who even 15 years after the WTC attacks, have higher than expected rates of adverse physical and psycho-social health outcomes.
The researchers, who are also part of the Environmental and Occupational Safety and Health Institute (EOHSI), examined sixteen WTC-HO patients diagnosed with HNC and seen at the Rutgers clinic between Sept. 12, 2005 and Sept. 11, 2016. Thirteen of these patients arrived at ground zero on 9/11 or within the following two days – the time of peak acute exposure. Of the sixteen HNC cases examined, ten patients had tumors in the pharynx oral cavity, while five others had tumors located in the larynx, the hollow, muscular organ that holds one’s vocal cords and forms an air passage to the lungs.
The researchers propose that excess cancer in 9/11 responders is biologically plausible due to the intensity of the exposure to airborne toxins that included many known and suspected human carcinogens, including asbestos, glass fibers and dioxins. The WTC exposures were further complicated due to large, non-respirable airborne particles, forcing people trapped within and around the debris cloud to resort to mouth-breathing, intensifying exposure to the oral cavity. For many responders, WTC exposure was not limited to 9/11/2001, as dusts remained suspended in the air space surrounding the WTC collapse site for weeks and thereafter was constantly resuspended by ongoing recovery and cleanup efforts occurring at ground zero, in residences and businesses south of Canal Street, and at the landfill on Staten Island where WTC rubble was transferred.
“This research highlights the need for ongoing monitoring of this highly exposed population as many types of cancers, and other possible health-related sequelae, have latency periods of many years or even decades.” comments lead author and Rutgers School of Public Health epidemiology professor Dr. Graber. “More research is necessary to understand if there is indeed an excess of head and neck cancers among WTC responders, and to enumerate the risk factor profile for these cancers. Such research may contribute to better understanding the mechanisms by which WTC exposure might lead to carcinogenesis, as well as be useful methods for cancer prevention and early detection strategies.”
“Head and Neck Cancer in World Trade Center Responders: A Case Series” was published in the Journal of Occupational and Environmental Medicine.