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Member Research and Reports

Member Research and Reports

Rutgers Study Examines Excess HPV-Related Head and Neck Cancer in 9/11 Responders

A recent Rutgers School of Public Health study found an excess of head and neck cancers, including oropharyngeal and laryngeal cancer, among World Trade Center Health Program (WTCHP) general responders.

The attacks of September 11, 2001 (9/11) on the World Trade Center (WTC) exposed those involved in the rescue, recovery, and clean-up efforts to a complex mix of toxicants. The WTC debris cloud contained many known and suspected human carcinogens, including asbestos, silica, benzene, polychlorinated biphenyls, polycyclic aromatic hydrocarbons, volatile organic compounds, and many types of particles including wood, cement, and metal dust.  Exposures ranged from acute immersion in the dust cloud on 9/11 to chronic exposures that extended into the summer of 2002. A significant excess of all cancers, particularly prostate and thyroid, has been observed in WTC-exposed cohorts through 2011. No prior studies have examined increases in head and neck cancers of WTCHP general responders.

This research began when clinicians treating WTC-exposed first responders in the WTC Health program, became concerned that there was an usually high number of patients with cancer of the head and neck.   While an excess of head and neck cancer had not been previously reported in WTC exposed cohorts, the researchers hypothesized that such an excess was plausible because the main route of exposure was inhalation; the exposures were high intensity in the first days after the towers’ collapse; and, the WTC dusts included many human carcinogens. The researchers also hypothesized that WTC exposure might potentiate the already well known personal risk factors for some HNC, including tobacco smoking, heavy alcohol drinking, and oral infection with oncogenic types if the human papillomavirus (HPV).

The researchers, led by Dr. Judith Graber, found that while there was not a significant overall increase in head and neck cancers, a significant excess was seen in the latest observation period. This pattern was driven by excess oropharyngeal cancer (often HPV-related) and laryngeal cancer, but not for non- HPV-related sites (oral-nasal cancer). In multivariable survival analysis, head and neck cancer was significantly associated with increasing age and non-Hispanic white race-ethnicity. The researchers also found a borderline association with the 9/11 occupation of military/protective services versus others.

“Almost two decades after the attacks on the World Trade Center on September 11, 2001 we are seeing newly emerging physical and mental health issues among the estimated 90,000 rescue, recovery and clean-up workers and volunteers and among the 400,000 residents and workers who were in the surrounding areas of New York City,” comments Dr. Graber.  “Given that cancers are generally diseases of long latency, the findings of excess cancer in our study and studies by other WTC researchers point to the need for ongoing monitoring and treatment of WTC-exposed persons.”

“Excess HPV-related head and neck cancer in the World Trade Center Health Program General Responder cohort,” was published in the International Journal of Cancer.