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Zeig-Owens R, Prezant DJ. Managing cancer following the World Trade Center disaster. Nat Rev Cancer 2024:10.1038/s41568-024-00730-6. [PMID: 39261720 DOI: 10.1038/s41568-024-00730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Affiliation(s)
- Rachel Zeig-Owens
- Fire Department of the City of New York, Brooklyn, NY, USA
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA
- Montefiore Medical Center, Department of Medicine, Bronx, NY, USA
| | - David J Prezant
- Fire Department of the City of New York, Brooklyn, NY, USA.
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA.
- Montefiore Medical Center, Department of Medicine, Bronx, NY, USA.
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Tuminello S, Ashebir YA, Schroff C, Ramaswami S, Durmus N, Chen Y, Snuderl M, Shao Y, Reibman J, Arslan AA. Genome-wide DNA methylation profiles and breast cancer among World Trade Center survivors. Environ Epidemiol 2024; 8:e313. [PMID: 38841706 PMCID: PMC11152787 DOI: 10.1097/ee9.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
Background Increased incidence of cancer has been reported among World Trade Center (WTC)-exposed persons. Aberrant DNA methylation is a hallmark of cancer development. To date, only a few small studies have investigated the relationship between WTC exposure and DNA methylation. The main objective of this study was to assess the DNA methylation profiles of WTC-exposed community members who remained cancer free and those who developed breast cancer. Methods WTC-exposed women were selected from the WTC Environmental Health Center clinic, with peripheral blood collected during routine clinical monitoring visits. The reference group was selected from the NYU Women's Health Study, a prospective cohort study with blood samples collected before 9 November 2001. The Infinium MethylationEPIC array was used for global DNA methylation profiling, with adjustments for cell type composition and other confounders. Annotated probes were used for biological pathway and network analysis. Results A total of 64 WTC-exposed (32 cancer free and 32 with breast cancer) and 32 WTC-unexposed (16 cancer free and 16 with prediagnostic breast cancer) participants were included. Hypermethylated cytosine-phosphate-guanine probe sites (defined as β > 0.8) were more common among WTC-exposed versus unexposed participants (14.3% vs. 4.5%, respectively, among the top 5000 cytosine-phosphate-guanine sites). Cancer-related pathways (e.g., human papillomavirus infection, cGMP-PKG) were overrepresented in WTC-exposed groups (breast cancer patients and cancer-free subjects). Compared to the unexposed breast cancer patients, 47 epigenetically dysregulated genes were identified among WTC-exposed breast cancers. These genes formed a network, including Wnt/β-catenin signaling genes WNT4 and TCF7L2, and dysregulation of these genes contributes to cancer immune evasion. Conclusion WTC exposure likely impacts DNA methylation and may predispose exposed individuals toward cancer development, possibly through an immune-mediated mechanism.
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Affiliation(s)
- Stephanie Tuminello
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York
| | - Yibeltal Arega Ashebir
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York
| | - Chanel Schroff
- Department of Pathology, NYU Grossman School of Medicine, New York City, New York
| | - Sitharam Ramaswami
- Department of Pathology, NYU Grossman School of Medicine, New York City, New York
| | - Nedim Durmus
- Department of Medicine, NYU Grossman School of Medicine, New York City, New York
| | - Yu Chen
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York
- NYU Perlmutter Comprehensive Cancer Center, New York City, New York
| | - Matija Snuderl
- Department of Pathology, NYU Grossman School of Medicine, New York City, New York
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York
- NYU Perlmutter Comprehensive Cancer Center, New York City, New York
| | - Joan Reibman
- Department of Medicine, NYU Grossman School of Medicine, New York City, New York
- Division of Environmental Medicine, Department of Medicine, NYU Grossman School of Medicine, New York City, New York
| | - Alan A. Arslan
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York
- NYU Perlmutter Comprehensive Cancer Center, New York City, New York
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York City, New York
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Tuminello S, Nguyen E, Durmus N, Alptekin R, Yilmaz M, Crisanti MC, Snuderl M, Chen Y, Shao Y, Reibman J, Taioli E, Arslan AA. World Trade Center Exposure, DNA Methylation Changes, and Cancer: A Review of Current Evidence. EPIGENOMES 2023; 7:31. [PMID: 38131903 PMCID: PMC10742700 DOI: 10.3390/epigenomes7040031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/22/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction: Known carcinogens in the dust and fumes from the destruction of the World Trade Center (WTC) towers on 9 November 2001 included metals, asbestos, and organic pollutants, which have been shown to modify epigenetic status. Epigenome-wide association analyses (EWAS) using uniform (Illumina) methodology have identified novel epigenetic profiles of WTC exposure. Methods: We reviewed all published data, comparing differentially methylated gene profiles identified in the prior EWAS studies of WTC exposure. This included DNA methylation changes in blood-derived DNA from cases of cancer-free "Survivors" and those with breast cancer, as well as tissue-derived DNA from "Responders" with prostate cancer. Emerging molecular pathways related to the observed DNA methylation changes in WTC-exposed groups were explored and summarized. Results: WTC dust exposure appears to be associated with DNA methylation changes across the genome. Notably, WTC dust exposure appears to be associated with increased global DNA methylation; direct dysregulation of cancer genes and pathways, including inflammation and immune system dysregulation; and endocrine system disruption, as well as disruption of cholesterol homeostasis and lipid metabolism. Conclusion: WTC dust exposure appears to be associated with biologically meaningful DNA methylation changes, with implications for carcinogenesis and development of other chronic diseases.
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Affiliation(s)
- Stephanie Tuminello
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (S.T.)
| | - Emelie Nguyen
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10016, USA
| | - Nedim Durmus
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Ramazan Alptekin
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Muhammed Yilmaz
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | | | - Matija Snuderl
- Department of Pathology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Yu Chen
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (S.T.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (S.T.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
| | - Joan Reibman
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Division of Environmental Medicine, Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10016, USA
| | - Alan A. Arslan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (S.T.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY 10016, USA
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Khalifeh M, Goldfarb DG, Zeig-Owens R, Todd AC, Shapiro MZ, Carwile M, Dasaro CR, Li J, Yung J, Farfel MR, Brackbill RM, Cone JE, Qiao B, Schymura MJ, Prezant DJ, Hall C, Boffetta P. Cancer incidence in World Trade Center rescue and recovery workers by race and ethnicity. Am J Ind Med 2023; 66:1048-1055. [PMID: 37746817 DOI: 10.1002/ajim.23539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION It is unclear whether differences in health outcomes by racial and ethnic groups among World Trade Center (WTC) rescue and recovery workers reflect those of the population of New York State (NYS) or show distinct patterns. We assessed cancer incidence in WTC workers by self-reported race and ethnicity, and compared it to population figures for NYS. METHODS A total of 61,031 WTC workers enrolled between September 11, 2001 and January 10, 2012 were followed to December 31, 2015. To evaluate the association between race/ethnicity and cancer risk, Poisson regression analysis was used to estimate hazard ratios (HR) adjusted for WTC exposure, age, calendar year, sex and, for lung cancer, cigarette smoking. RESULTS In comparison to Whites, Black workers had a higher incidence of prostate cancer (HR = 1.99, 95% CI = 1.69-2.34) and multiple myeloma (HR = 3.57, 95% CI = 1.97-6.45), and a lower incidence of thyroid (HR = 0.41, 95% CI = 0.22-0.78) and colorectal cancer (HR = 0.57; 95% CI = 0.33-0.98). Hispanic workers had a higher incidence of liver cancer (HR = 4.03, 95% CI = 2.23-7.28). Compared with NYS population, White workers had significantly higher incidence of prostate cancer (HR = 1.26, 95% CI = 1.18-1.35) and thyroid cancer (HR = 1.80, 95% CI = 1.55-2.08), while Black workers had significantly higher incidence of prostate cancer (HR = 1.22, 95% CI = 1.05-1.40). CONCLUSION Cancer incidence in WTC workers generally reflects data from the NYS population, but some differences were identified that merit further investigation.
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Affiliation(s)
- Malak Khalifeh
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moshe Z Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madeline Carwile
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles Hall
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Kruger EM, Shehata SA, Toraih EA, Abdelghany AA, Fawzy MS. Type 2 diabetes and thyroid cancer: Synergized risk with rising air pollution. World J Diabetes 2023; 14:1037-1048. [PMID: 37547591 PMCID: PMC10401455 DOI: 10.4239/wjd.v14.i7.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 07/12/2023] Open
Abstract
Diabetes is a complex condition, and the causes are still not fully understood. However, a growing body of evidence suggests that exposure to air pollution could be linked to an increased risk of diabetes. Specifically, exposure to certain pollutants, such as particulate Matter and Ozone, has been associated with higher rates of diabetes. At the same time, air pollution has also been linked to an increased risk of thyroid cancer. While there is less evidence linking air pollution to thyroid cancer than to diabetes, it is clear that air pollution could have severe implications for thyroid health. Air pollution could increase the risk of diabetes and thyroid cancer through several mechanisms. For example, air pollution could increase inflammation in the body, which is linked to an increased risk of diabetes and thyroid cancer. Air pollution could also increase oxidative stress, which is linked to an increased risk of diabetes and thyroid cancer. Additionally, air pollution could increase the risk of diabetes and thyroid cancer by affecting the endocrine system. This review explores the link between diabetes and air pollution on thyroid cancer. We will discuss the evidence for an association between air pollution exposure and diabetes and thyroid cancer, as well as the potential implications of air pollution for thyroid health. Given the connections between diabetes, air pollution, and thyroid cancer, it is essential to take preventive measures to reduce the risk of developing the condition.
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Affiliation(s)
- Eva M Kruger
- School of Medicine, Tulane University, New Orleans, LA 70112, United States
| | - Shaimaa A Shehata
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Eman A Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, United States
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Ahmed A Abdelghany
- Department of Ophthalmology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar 1321, Saudi Arabia
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van Gerwen M, Cerutti JM, Mendes TB, Brody R, Genden E, Riggins GJ, Taioli E. TERT and BRAF V600E mutations in thyroid cancer of World Trade Center Responders. Carcinogenesis 2023; 44:350-355. [PMID: 37144982 PMCID: PMC10290513 DOI: 10.1093/carcin/bgad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/06/2023] Open
Abstract
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.
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Affiliation(s)
- Maaike van Gerwen
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Janete Maria Cerutti
- Genetic Bases of Thyroid Tumor Laboratory, Division of Genetics, Department of Morphology and Genetics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Pedro de Toledo 669, 11 Andar, São Paulo, 04039-032 SP, Brazil
| | - Thais Biude Mendes
- Genetic Bases of Thyroid Tumor Laboratory, Division of Genetics, Department of Morphology and Genetics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Pedro de Toledo 669, 11 Andar, São Paulo, 04039-032 SP, Brazil
| | - Rachel Brody
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gregory J Riggins
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Chen YT, Li J, Chang JN, Luo YC, Yu W, Chen LC, Yang JM. Transcriptomic analysis of World Trade Center particulate Matter-induced pulmonary inflammation and drug treatments. ENVIRONMENT INTERNATIONAL 2023; 177:108027. [PMID: 37321070 DOI: 10.1016/j.envint.2023.108027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
Over 400,000 people are estimated to have been exposed to World Trade Center particulate matter (WTCPM) since the attack on the Twin Towers in Lower Manhattan on September 11, 2001. Epidemiological studies have found that exposure to dust may cause respiratory ailments and cardiovascular diseases. However, limited studies have performed a systematic analysis of transcriptomic data to elucidate the biological responses to WTCPM exposure and the therapeutic options. Here, we developed an in vivo mouse exposure model of WTCPM and administered two drugs (i.e., rosoxacin and dexamethasone) to generate transcriptomic data from lung samples. WTCPM exposure increased the inflammation index, and this index was significantly reduced by both drugs. We analyzed the transcriptomics derived omics data using a hierarchical systems biology model (HiSBiM) with four levels, including system, subsystem, pathway, and gene analyses. Based on the selected differentially expressed genes (DEGs) from each group, WTCPM and the two drugs commonly affected the inflammatory responses, consistent with the inflammation index. Among these DEGs, the expression of 31 genes was affected by WTCPM exposure and consistently reversed by the two drugs, and these genes included Psme2, Cldn18, and Prkcd, which are involved in immune- and endocrine-related subsystems and pathways such as thyroid hormone synthesis, antigen processing and presentation, and leukocyte transendothelial migration. Furthermore, the two drugs reduced the inflammatory effects of WTCPM through distinct pathways, e.g., vascular-associated signaling by rosoxacin, whereas mTOR-dependent inflammatory signaling was found to be regulated by dexamethasone. To the best of our knowledge, this study constitutes the first investigation of transcriptomics data of WTCPM and an exploration of potential therapies. We believe that these findings provide strategies for the development of promising optional interventions and therapies for airborne particle exposure.
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Affiliation(s)
- Yun-Ti Chen
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan, R.O.C; Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA
| | - Jinhui Li
- Department of Urology, Stanford University Medical Center, Stanford, CA 94304, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY 10010, USA
| | - Jen-Ning Chang
- Degree Program of Applied Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan, R.O.C
| | - Yong-Chun Luo
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan, R.O.C
| | - Wuyue Yu
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10010, USA
| | - Lung-Chi Chen
- Department of Environmental Medicine, New York University School of Medicine, New York, NY 10010, USA
| | - Jinn-Moon Yang
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan, R.O.C; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan, R.O.C; Center for Intelligent Drug Systems and Smart Bio-devices, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan, R.O.C.
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DeMarini DM, Warren SH, Brooks LR. Mutagenicity of the organic fraction of World Trade Center dust. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2023; 64:16-25. [PMID: 36433931 PMCID: PMC9989947 DOI: 10.1002/em.22519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 05/07/2023]
Abstract
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.
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Affiliation(s)
- David M. DeMarini
- Biomolecular and Computational Toxicology Division, Center for Computational Toxicology and ExposureOffice of Research and Development, U.S. Environmental Protection AgencyResearch Triangle ParkNorth CarolinaUSA
| | - Sarah H. Warren
- Biomolecular and Computational Toxicology Division, Center for Computational Toxicology and ExposureOffice of Research and Development, U.S. Environmental Protection AgencyResearch Triangle ParkNorth CarolinaUSA
| | - Lance R. Brooks
- Homeland Security and Materials Management Division, Center for Environmental Solutions and Emergency ResponseOffice of Research and Development, U.S. Environmental Protection AgencyResearch Triangle ParkNorth CarolinaUSA
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Florsheim RL, Zhang Q, Durmus N, Zhang Y, Pehlivan S, Arslan AA, Shao Y, Reibman J. Characteristics of Cancers in Community Members Exposed to the World Trade Center Disaster at a Young Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15163. [PMID: 36429881 PMCID: PMC9690329 DOI: 10.3390/ijerph192215163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Rebecca Lynn Florsheim
- Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Qiao Zhang
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Nedim Durmus
- Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Yian Zhang
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Sultan Pehlivan
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Alan A. Arslan
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Joan Reibman
- Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY 10016, USA
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Zhang Y, Rosen R, Reibman J, Shao Y. Posttraumatic Stress Disorder Mediates the Association between Traumatic World Trade Center Dust Cloud Exposure and Ongoing Systemic Inflammation in Community Members. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148622. [PMID: 35886474 PMCID: PMC9322679 DOI: 10.3390/ijerph19148622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Abstract
Exposure to World Trade Center (WTC) dust/fumes and traumas on 11 September 2001 has been reported as a risk factor for post-traumatic stress disorder (PTSD) and other mental/physical health symptoms in WTC-affected populations. Increased systemic inflammation and oxidative stress from the exposure and subsequent illnesses have been proposed as contributors to the underlying biological processes. Many blood-based biomarkers of systemic inflammation, including C-reactive protein (CRP), are useful for non-invasive diagnostic and monitoring of disease process, and also potential targets for therapeutic interventions. Twenty years after 9/11, however, the relationships between WTC exposure, chronic PTSD, and systemic inflammation are only beginning to be systematically investigated in the WTC-affected civilian population despite the fact that symptoms of PTSD and systemic inflammation are still common and persistent. This paper aims to address this knowledge gap, using enrollees of the WTC Environmental Health Center (EHC), a federally designated treatment and surveillance program for community members (WTC Survivors) exposed to the 9/11 terrorist attack. We conducted a mediation analysis to investigate the association between acute WTC dust cloud traumatic exposure (WDCTE) on 9/11, chronic PTSD symptoms, and levels of systemic inflammation. The data indicate that the chronic PTSD symptoms and some specific symptom clusters of PTSD significantly mediate the WDCTE on systemic inflammation, as reflected by the CRP levels. As both chronic PTSD and systemic inflammation are long-term risk factors for neurodegeneration and cognitive decline, further research on the implications of this finding is warranted.
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Affiliation(s)
- Yian Zhang
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA;
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- NYU Alzheimer Disease Research Center, 145 E 32 Street, New York, NY 10016, USA
| | - Rebecca Rosen
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- Department of Psychiatry, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Joan Reibman
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- Department of Medicine, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
- Correspondence: (J.R.); (Y.S.)
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA;
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- NYU Alzheimer Disease Research Center, 145 E 32 Street, New York, NY 10016, USA
- Correspondence: (J.R.); (Y.S.)
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11
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Boffetta P, Hall CB, Todd AC, Goldfarb DG, Schymura MJ, Li J, Cone JE, Zeig-Owens R. Cancer risk among World Trade Center rescue and recovery workers: A review. CA Cancer J Clin 2022; 72:308-314. [PMID: 35325473 DOI: 10.3322/caac.21723] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/18/2022] Open
Abstract
Twenty years after the September 11th, 2001 terrorist attacks, the association between exposures present at the World Trade Center (WTC) site and the risk of several specific types of cancer has been reported among rescue and recovery workers. The authors' objective was to conduct an updated review of these data. Most studies have found elevated rates of both prostate and thyroid cancers compared with rates in the general population, and some have reported statistically significant differences for the rates of all cancers as well. Studies including a larger combined cohort of WTC-exposed rescue and recovery workers from 3 main cohorts have since replicated findings for these cancers, with additional years of follow-up. Among this combined cohort, although a lower-than-expected standardized incidence ratio for all cancers was observed, WTC exposure was also related to an increased risk of cutaneous melanoma and tonsil cancer. Importantly, another study found that WTC-exposed rescue and recovery workers who are enrolled in the federally funded medical monitoring and treatment program experienced improved survival post-cancer diagnosis compared with New York state patients with cancer. On the basis of these combined cohort studies, the full effect of WTC exposure on cancer risk is becoming clearer. Consequently, the authors believe that surveillance of those with WTC exposure should be continued, and in-depth analysis of epidemiologic, molecular, and clinical aspects of specific cancers in these workers should be pursued.
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Affiliation(s)
- Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, New York, New York
- Fire Department of the City of New York, Brooklyn, New York
| | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - James E Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Rachel Zeig-Owens
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Department of Medicine, Montefiore Medical Center, New York, New York
- Fire Department of the City of New York, Brooklyn, New York
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12
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Yu H, Tuminello S, Alpert N, van Gerwen M, Yoo S, Mulholland DJ, Aaronson SA, Donovan M, Oh WK, Gong Y, Wang L, Zhu J, Taioli E. Global DNA methylation of WTC prostate cancer tissues show signature differences compared to non-exposed cases. Carcinogenesis 2022; 43:528-537. [PMID: 35239955 PMCID: PMC9234756 DOI: 10.1093/carcin/bgac025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 12/31/2022] Open
Abstract
There is increased incidence of prostate cancer (PC) among World Trade Center (WTC)-exposed responders and community members, with preliminary evidence suggestive of more aggressive disease. While previous research is supportive of differences in DNA methylation and gene expression as a consequence of WTC exposure, as measured in blood of healthy individuals, the epigenetics of WTC PC tissues has yet to be explored. Patients were recruited from the World Trade Center Health Program. Non-WTC PC samples were frequency matched on age, race/ethnicity and Gleason score. Bisulfite-treated DNA was extracted from tumor tissue blocks and used to assess global DNA methylation with the MethylationEPIC BeadChip. Differential and pathway enrichment analyses were conducted. RNA from the same tumor blocks was used for gene expression analysis to further support DNA methylation findings. Methylation data were generated for 28 samples (13 WTC and 15 non-WTC). Statistically significant differences in methylation were observed for 3,586 genes; on average WTC samples were statistically significantly more hypermethylated (P = 0.04131). Pathway enrichment analysis revealed hypermethylation in epithelial mesenchymal transition (EMT), hypoxia, mitotic spindle, TNFA signaling via NFKB, WNT signaling, and TGF beta signaling pathways in WTC compared to non-WTC samples. The androgen response, G2M and MYC target pathways were hypomethylated. These results correlated well with RNA gene expression. In conclusion, long-term epigenic changes associated with WTC dust exposure were observed in PC tissues. These occurred in genes of critical pathways, likely increasing prostate tumorigenesis potential. This warrants analysis of larger WTC groups and other cancer types.
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Affiliation(s)
- Haocheng Yu
- Sema4, a Mount Sinai venture, Stamford, CT, USA
| | - Stephanie Tuminello
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health, New York University Langone Health, New York, NY, USA
| | - Naomi Alpert
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maaike van Gerwen
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - David J Mulholland
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart A Aaronson
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William K Oh
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yixuan Gong
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Li Wang
- Sema4, a Mount Sinai venture, Stamford, CT, USA
- Icahn Institute for Data Science and Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Zhu
- Sema4, a Mount Sinai venture, Stamford, CT, USA
- Icahn Institute for Data Science and Genomics Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NYUSA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Characteristics of Women with Lung Adenocarcinoma in the World Trade Center Environmental Health Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137618. [PMID: 35805276 PMCID: PMC9265949 DOI: 10.3390/ijerph19137618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/20/2022] [Indexed: 12/31/2022]
Abstract
The destruction of the World Trade Center towers on 11 September 2001 exposed local residents, workers, and individuals in the area (Survivors) to dust and fumes that included known and suspected carcinogens. Given the potential for inhalation of toxic substances and the long latency after exposure, the incidence of lung cancer is expected to increase in WTC-exposed individuals. We describe the characteristics of women WTC Survivors with lung adenocarcinoma who were enrolled in the WTC Environmental Health Center (WTC EHC) between May 2002 and July 2021. A total of 173 women in WTC EHC had a diagnosis of any type of lung cancer, representing 10% of all cancers in women. Most of the lung cancers (87%) were non-small cell carcinomas, with adenocarcinoma (77%) being the most common subtype. Nearly half (46%) of these patients were exposed to dust clouds on 11 September 2001. Race and ethnicity varied by smoking status, as follows: 44% of Asian women compared with 29% of non-Hispanic White women were never-smokers (p < 0.001). There was no significant difference between the pathologic characteristics of adenocarcinomas between never and ever smokers. We also summarize EGFR, ALK, KRAS, ROS-1 and BRAF mutation status stratified by smoking, race and ethnicity. The identification of a relatively high proportion of women never-smokers with lung cancer warrants further investigation into the role of WTC dust exposure.
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14
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Tuminello S, Zhang Y, Yang L, Durmus N, Snuderl M, Heguy A, Zeleniuch-Jacquotte A, Chen Y, Shao Y, Reibman J, Arslan AA. Global DNA Methylation Profiles in Peripheral Blood of WTC-Exposed Community Members with Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095104. [PMID: 35564499 PMCID: PMC9105091 DOI: 10.3390/ijerph19095104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 12/22/2022]
Abstract
Breast cancer represents the most common cancer diagnosis among World Trade Center (WTC)-exposed community members, residents, and cleanup workers enrolled in the WTC Environmental Health Center (WTC EHC). The primary aims of this study were (1) to compare blood DNA methylation profiles of WTC-exposed community members with breast cancer and WTC-unexposed pre-diagnostic breast cancer blood samples, and (2) to compare the DNA methylation differences among the WTC EHC breast cancer cases and WTC-exposed cancer-free controls. Gene pathway enrichment analyses were further conducted. There were significant differences in DNA methylation between WTC-exposed breast cancer cases and unexposed prediagnostic breast cancer cases. The top differentially methylated genes were Intraflagellar Transport 74 (IFT74), WD repeat-containing protein 90 (WDR90), and Oncomodulin (OCM), which are commonly upregulated in tumors. Probes associated with established tumor suppressor genes (ATM, BRCA1, PALB2, and TP53) were hypermethylated among WTC-exposed breast cancer cases compared to the unexposed group. When comparing WTC EHC breast cancer cases vs. cancer-free controls, there appeared to be global hypomethylation among WTC-exposed breast cancer cases compared to exposed controls. Functional pathway analysis revealed enrichment of several gene pathways in WTC-exposed breast cancer cases including endocytosis, proteoglycans in cancer, regulation of actin cytoskeleton, axon guidance, focal adhesion, calcium signaling, cGMP-PKG signaling, mTOR, Hippo, and oxytocin signaling. The results suggest potential epigenetic links between WTC exposure and breast cancer in local community members enrolled in the WTC EHC program.
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Affiliation(s)
- Stephanie Tuminello
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (Y.Z.); (A.Z.-J.); (Y.C.); (Y.S.)
- Correspondence: (S.T.); (A.A.A.)
| | - Yian Zhang
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (Y.Z.); (A.Z.-J.); (Y.C.); (Y.S.)
| | - Lei Yang
- Foundation Medicine, Cambridge, MA 02141, USA;
| | - Nedim Durmus
- Department of Medicine, New York University Langone Health, New York, NY 10016, USA; (N.D.); (J.R.)
| | - Matija Snuderl
- Department of Pathology, New York University Langone Health, New York, NY 10016, USA; (M.S.); (A.H.)
| | - Adriana Heguy
- Department of Pathology, New York University Langone Health, New York, NY 10016, USA; (M.S.); (A.H.)
- NYU Langone’s Genome Technology Center, New York, NY 10016, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (Y.Z.); (A.Z.-J.); (Y.C.); (Y.S.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
| | - Yu Chen
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (Y.Z.); (A.Z.-J.); (Y.C.); (Y.S.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
| | - Yongzhao Shao
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (Y.Z.); (A.Z.-J.); (Y.C.); (Y.S.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
| | - Joan Reibman
- Department of Medicine, New York University Langone Health, New York, NY 10016, USA; (N.D.); (J.R.)
| | - Alan A. Arslan
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (Y.Z.); (A.Z.-J.); (Y.C.); (Y.S.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY 10016, USA
- Correspondence: (S.T.); (A.A.A.)
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15
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Sigel K, de la Hoz RE, Markowitz SB, Kong CY, Stone K, Todd AC, Wisnivesky JP. Lung cancer incidence among world trade center rescue and recovery workers. Cancer Med 2022; 11:3136-3144. [PMID: 35343066 PMCID: PMC9385594 DOI: 10.1002/cam4.4672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/20/2022] [Accepted: 02/03/2022] [Indexed: 11/08/2022] Open
Abstract
Background Many World Trade Center disaster (WTC) rescue and recovery workers (WTC RRWV) were exposed to toxic inhalable particles. The impact of WTC exposures on lung cancer risk is unclear. Methods Data from the WTC Health Program General Responders Cohort (WTCGRC) were linked to health information from a large New York City health system to identify incident lung cancer cases. Incidence rates for lung cancer were then calculated. As a comparison group, we created a microsimulation model that generated expected lung cancer incidence rates for a WTC‐ and occupationally‐unexposed cohort with similar characteristics. We also fitted a Poisson regression model to determine specific lung cancer risk factors for WTC RRWV. Results The incidence of lung cancer for WTC RRWV was 39.5 (95% confidence interval [CI]: 30.7–49.9) per 100,000 person‐years. When compared to the simulated unexposed cohort, no significant elevation in incidence was found among WTC RRWV (incidence rate ratio [IRR] 1.34; 95% CI: 0.92–1.96). Predictors of lung cancer incidence included age, smoking intensity, and years since quitting for former smokers. In adjusted models evaluating airway obstruction and individual pre‐WTC occupational exposures, only mineral dust work was associated with lung cancer risk (IRR: 2.03; 95% CI: 1.07–3.86). Discussion In a sample from a large, prospective cohort of WTC RRWV we found a lung cancer incidence rate that was similar to that expected of a WTC‐ and occupationally‐unexposed cohort with similar individual risk profiles. Guideline‐concordant lung cancer surveillance and periodic evaluations of population‐level lung cancer risk should continue in this group.
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Affiliation(s)
- Keith Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rafael E de la Hoz
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven B Markowitz
- Earth and Environmental Sciences, Queens College, City University of New York, Queens, New York, USA
| | - Chung Yin Kong
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kimberly Stone
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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16
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Li J, Yung J, Qiao B, Takemoto E, Goldfarb DG, Zeig-Owens R, Cone JE, Brackbill RM, Farfel MR, Kahn AR, Schymura MJ, Shapiro MZ, Dasaro CR, Todd AC, Kristjansson D, Prezant DJ, Boffetta P, Hall CB. Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up. J Natl Cancer Inst 2022; 114:210-219. [PMID: 34498043 PMCID: PMC8826586 DOI: 10.1093/jnci/djab165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure. METHODS From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk. RESULTS Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both. CONCLUSIONS In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - David G Goldfarb
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Amy R Kahn
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Moshe Z Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
| | - David J Prezant
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Paolo Boffetta
- Medicine Department of Family, Population and Preventive Medicine Health Sciences, Stony Brook University, Stony Brook Cancer Center, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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17
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Wang L, Xu Y, Zhang L, Kang K, Kobryn A, Portman K, Gordon RE, Pan PY, Taioli E, Aaronson SA, Chen SH, Mulholland DJ. World Trade Center dust exposure promotes cancer in PTEN-deficient mouse prostates. CANCER RESEARCH COMMUNICATIONS 2022; 2:518-532. [PMID: 35911788 PMCID: PMC9336209 DOI: 10.1158/2767-9764.crc-21-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/21/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022]
Abstract
During the 9/11 attacks individuals were exposed to World Trade Center (WTC) dust which contained a complex mixture of carcinogens. Epidemiological studies have revealed the increased incidence of prostate and thyroid cancer in WTC survivors and responders. While reports have shown that WTC-dust associates with the increased prevalence of inflammatory related disorders, studies to date have not determined whether this exposure impacts cancer progression. In this study, we have used genetically engineered mouse (GEM) models with prostate specific deletion of the PTEN tumor suppressor to study the impact of WTC-dust exposure on deposition of dust particles, inflammation, and cancer progression. In normal C57/BL6 mice, dust exposure increased cellular expression of inflammatory genes with highest levels in the lung and peripheral blood. In normal and tumor bearing GEM mice, increased immune cell infiltration to the lungs was observed. Pathological evaluation of mice at different time points showed that WTC-dust exposure promoted PI3K-AKT activation, increased epithelial proliferation and acinar invasion in prostates with heterozygous and homozygous Pten loss. Using autochthonous and transplant GEM models of prostate cancer we demonstrated that dust exposure caused reduced survival as compared to control cohorts. Finally, we used imaging mass cytometry (IMC) to detect elevated immune cell infiltration and cellular expression of inflammatory markers in prostate tumors isolated from human WTC survivors. Collectively, our study shows that chronic inflammation, induced by WTC dust exposure, promotes more aggressive cancer in genetically predisposed prostates and potentially in patients.
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Affiliation(s)
- Lin Wang
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yitian Xu
- Center for Immunotherapy Research, Cancer Center of Excellence, Houston Methodist Research Institute, Houston, Texas
| | - Licheng Zhang
- Center for Immunotherapy Research, Cancer Center of Excellence, Houston Methodist Research Institute, Houston, Texas
| | - Kyeongah Kang
- Center for Immunotherapy Research, Cancer Center of Excellence, Houston Methodist Research Institute, Houston, Texas
| | - Andriy Kobryn
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kensey Portman
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronald E Gordon
- Department of Pathology, Icahn School of Medicine, New York, New York
| | - Ping-Ying Pan
- Center for Immunotherapy Research, Cancer Center of Excellence, Houston Methodist Research Institute, Houston, Texas
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, New York, New York
| | - Stuart A Aaronson
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, New York, New York
| | - Shu-Hsia Chen
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Center for Immunotherapy Research, Cancer Center of Excellence, Houston Methodist Research Institute, Houston, Texas
| | - David J Mulholland
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, New York, New York
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18
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Cleven KL, Rosenzvit C, Nolan A, Zeig-Owens R, Kwon S, Weiden MD, Skerker M, Halpren A, Prezant DJ. Twenty-Year Reflection on the Impact of World Trade Center Exposure on Pulmonary Outcomes in Fire Department of the City of New York (FDNY) Rescue and Recovery Workers. Lung 2021; 199:569-578. [PMID: 34766209 PMCID: PMC8583580 DOI: 10.1007/s00408-021-00493-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022]
Abstract
After the terrorist attacks on September 11, 2001 (9/11), many rescue/recovery workers developed respiratory symptoms and pulmonary diseases due to their extensive World Trade Center (WTC) dust cloud exposure. Nearly all Fire Department of the City of New York (FDNY) workers were present within 48 h of 9/11 and for the next several months. Since the FDNY had a well-established occupational health service for its firefighters and Emergency Medical Services workers prior to 9/11, the FDNY was able to immediately start a rigorous monitoring and treatment program for its WTC-exposed workers. As a result, respiratory symptoms and diseases were identified soon after 9/11. This focused review summarizes the WTC-related respiratory diseases that developed in the FDNY cohort after 9/11, including WTC cough syndrome, obstructive airways disease, accelerated lung function decline, airway hyperreactivity, sarcoidosis, and obstructive sleep apnea. Additionally, an extensive array of biomarkers has been identified as associated with WTC-related respiratory disease. Future research efforts will not only focus on further phenotyping/treating WTC-related respiratory disease but also on additional diseases associated with WTC exposure, especially those that take decades to develop, such as cardiovascular disease, cancer, and interstitial lung disease.
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Affiliation(s)
- Krystal L Cleven
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Carla Rosenzvit
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anna Nolan
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.,Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Rachel Zeig-Owens
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sophia Kwon
- Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael D Weiden
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary, Critical Care and Sleep Medicine Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.,Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Molly Skerker
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA
| | - Allison Halpren
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA
| | - David J Prezant
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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19
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Chiao JW. What causes prostate cancer-learning from a tragedy. Carcinogenesis 2021; 42:1221-1222. [PMID: 34431987 DOI: 10.1093/carcin/bgab078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jen Wei Chiao
- Department of Medicine, New York Medical College, Valhalla, NY, USA
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20
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Gerwen M, Cerutti JM, Rapp J, Genden E, Riggins GJ, Taioli E. Post-9/11 excess risk of thyroid cancer: Surveillance or exposure? Am J Ind Med 2021; 64:881-884. [PMID: 34157150 DOI: 10.1002/ajim.23268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/03/2021] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
An excess risk of thyroid cancer has been reported in different World Trade Center (WTC)-dust exposed cohorts. Increased surveillance of these cohorts has been suggested as a potential explanation of this reported excess thyroid cancer risk leading to an increased diagnosis of earlier-stage thyroid cancers. However, the uncertainty to what extent surveillance or physician bias may be contributing to the reported incidence of thyroid cancer in WTC-dust exposed populations remains, highlighting the need to investigate a potential causal link between WTC dust exposure and thyroid cancer. Future studies are therefore indicated to investigate potential consequences of WTC dust exposure on the thyroid gland. Studies of the heavily exposed populations offer the possibility to better understand the mechanisms behind the exposure to a variety of environmental contaminants, and may provide useful insights into exposures harmful to the thyroid. These can be used in risk stratification when implementing screening in high-risk populations and may inform shared decision-making regarding the extent of thyroid cancer treatment.
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Affiliation(s)
- Maaike Gerwen
- Department of Otolaryngology‐Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
- Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Janete M. Cerutti
- Division of Genetics Universidade Federal de São Paulo São Paulo Brazil
| | - Joseph Rapp
- Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York New York USA
- Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York New York USA
| | - Eric Genden
- Department of Otolaryngology‐Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Gregory J. Riggins
- Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York New York USA
- Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York New York USA
- Tisch Cancer Institute Icahn School of Medicine at Mount Sinai New York New York USA
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21
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Goldfarb DG, Colbeth HL, Skerker M, Webber MP, Prezant DJ, Dasaro CR, Todd AC, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Boffetta P, Hall CB, Zeig-Owens R. Impact of healthcare services on thyroid cancer incidence among World Trade Center-exposed rescue and recovery workers. Am J Ind Med 2021; 64:861-872. [PMID: 34275137 PMCID: PMC8796202 DOI: 10.1002/ajim.23277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND A recent study of World Trade Center (WTC)-exposed firefighters and emergency medical service workers demonstrated that elevated thyroid cancer incidence may be attributable to frequent medical testing, resulting in the identification of asymptomatic tumors. We expand on that study by comparing the incidence of thyroid cancer among three groups: WTC-exposed rescue/recovery workers enrolled in a New York State (NYS) WTC-medical monitoring and treatment program (MMTP); WTC-exposed rescue/recovery workers not enrolled in an MMTP (non-MMTP); and the NYS population. METHODS Person-time began on 9/12/2001 or at enrollment in a WTC cohort and ended at death or on 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. We used Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for MMTP and non-MMTP participants. NYS rates were used as the reference. To estimate potential changes over time in WTC-associated risk, change points in RRs were estimated using profile likelihood. RESULTS The thyroid cancer incidence rate among MMTP participants was more than twice that of NYS population rates (RR = 2.31; 95% CI = 2.00-2.68). Non-MMTP participants had a risk similar to NYS (RR = 0.96; 95% CI = 0.72-1.28). We observed no change points in the follow-up period. CONCLUSION Our findings support the hypothesis that no-cost screening (a benefit provided by WTC-MMTPs) is associated with elevated identification of thyroid cancer. Given the high survival rate for thyroid cancer, it is important to weigh the costs and benefits of treatment, as many of these cancers were asymptomatic and may have been detected incidentally.
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Affiliation(s)
- David G. Goldfarb
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Hilary L. Colbeth
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
| | - Molly Skerker
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P. Webber
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J. Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Robert M. Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Mark R. Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - James E. Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Amy R. Kahn
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Maria J. Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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22
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Daniels RD, Kubale TL, Reissman DB, Howard J. The World Trade Center Health Program: Twenty years of health effects research. Am J Ind Med 2021; 64:797-802. [PMID: 34558722 PMCID: PMC9631716 DOI: 10.1002/ajim.23273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022]
Abstract
It has been 20 years since the devastating terrorist attacks on September 11, 2001. Thousands were injured or killed during the attacks and many more are at risk of adverse health stemming from physical, psychological, and emotional stressors born out of the attacks. Private, federal, state, and local resources were gathered soon after the attacks to address impacts to the community, including the health and well-being of both responders and survivors. Many of these efforts are now largely consolidated under the federally mandated World Trade Center (WTC) Health Program. This program provides medical monitoring and treatment of qualifying conditions among the 9/11-exposed population and supports related physical and mental health research. In this commentary, we describe the WTC Health Program, with emphasis on the health-effects research it has funded since inception in 2011. We describe sentinel research publications, and how science has impacted the program. We provide examples relating studies in this special issue to important roles in the WTC Health Program research agenda. Finally, we provide a perspective on future research needs.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - Travis L. Kubale
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - Dori B. Reissman
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - John Howard
- Office of the Director National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
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23
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Webber MP, Singh A, Zeig-Owens R, Salako J, Skerker M, Hall CB, Goldfarb DG, Jaber N, Daniels RD, Prezant DJ. Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the US adult male population: 2001-2016. Occup Environ Med 2021; 78:707-714. [PMID: 34507965 PMCID: PMC8458058 DOI: 10.1136/oemed-2021-107570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare cancer incidence in Fire Department of the City of New York (FDNY) firefighters who worked at the World Trade Center (WTC) site to incidence in a population of non-WTC-exposed firefighters, the Career Firefighter Health Study (CFHS) cohort, and to compare rates from each firefighter cohort to rates in demographically similar US males. METHODS FDNY (N=10 786) and CFHS (N=8813) cohorts included male firefighters who were active on 11 September 2001 (9/11) and were followed until death or 31 December 2016. Cases were identified from 15 state cancer registries. Poisson regression models assessed cancers in each group (FDNY and CFHS) versus US males, and associations between group and cancer rates; these models estimated standardised incidence ratios (SIRs) and adjusted relative rates (RRs), respectively. Secondary analyses assessed surveillance bias and smoking history. RESULTS We identified 915 cancer cases in 841 FDNY firefighters and 1002 cases in 909 CFHS firefighters. FDNY had: higher rates for all cancers (RR=1.13; 95% CI 1.02 to 1.25), prostate (RR=1.39; 95% CI 1.19 to 1.63) and thyroid cancer (RR=2.53; 95% CI 1.37 to 4.70); younger median ages at diagnosis (55.6 vs 59.4; p<0.001, all cancers); and more cases with localised disease when compared with CFHS. Compared with US males, both firefighter cohorts had elevated SIRs for prostate cancer and melanoma. Control for surveillance bias in FDNY reduced most differences. CONCLUSIONS Excess cancers occurred in WTC-exposed firefighters relative to each comparison group, which may partially be explained by heightened surveillance. Two decades post-9/11, clearer understanding of WTC-related risk requires extended follow-up and modelling studies (laboratory or animal based) to identify workplace exposures in all firefighters.
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Affiliation(s)
- Mayris P Webber
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Ankura Singh
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joke Salako
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Molly Skerker
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - David G Goldfarb
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Robert D Daniels
- World Trade Center Health Program, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - David J Prezant
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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24
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Goldfarb DG, Zeig‐Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Kahn AR, Qiao B, Schymura MJ, Webber MP, Dasaro CR, Lucchini RG, Todd AC, Prezant DJ, Hall CB, Boffetta P. Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study. Am J Ind Med 2021; 64:815-826. [PMID: 34288025 PMCID: PMC8515734 DOI: 10.1002/ajim.23278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated. METHODS This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016. RESULTS From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64-0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58-0.72). The cancer-specific HR was 0.94 (95% CI = 0.78-1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. CONCLUSIONS WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.
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Affiliation(s)
- David G. Goldfarb
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Environmental, Occupational and Geospatial Health SciencesCity University of New York Graduate School of Public Health and Health PolicyNew YorkNew YorkUSA
| | - Rachel Zeig‐Owens
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Dana Kristjansson
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Department of Genetics and BioinformaticsNorwegian Institute of Public HealthOsloNorway
- Center of Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Jiehui Li
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Robert M. Brackbill
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Mark R. Farfel
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - James E. Cone
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Amy R. Kahn
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Baozhen Qiao
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Maria J. Schymura
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Mayris P. Webber
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David J. Prezant
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Charles B. Hall
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Paolo Boffetta
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew YorkUSA
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
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25
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Health Trends among 9/11 Responders from 2011-2021: A Review of World Trade Center Health Program Statistics. Prehosp Disaster Med 2021; 36:621-626. [PMID: 34550060 DOI: 10.1017/s1049023x21000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. METHODS The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. RESULTS A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. DISCUSSION Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. CONCLUSION Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.
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Abstract
OBJECTIVE To date, nearly 10,000 World Trade Center (WTC) responders have been diagnosed with at least one type of WTC-related cancer, and over 70 types of cancer have been related to WTC occupational exposure. Due to the observed latency period for malignancies, the WTC Health Program anticipates increases in rates of new cancer diagnoses. Given the growing number of cancer diagnoses in this population, there is an urgent need to develop a novel intervention to address the psychosocial needs of WTC responders with cancer. Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention originally developed to help patients with advanced cancer find and sustain meaning in life despite illness-related limitations. Existential distress and loss of meaning are critical and understudied elements of psychological health that have been widely overlooked among WTC responders with cancer. METHOD We have adapted MCP for WTC responders (MCP-WTC) for the treatment of WTC responders who have been diagnosed with WTC-certified cancers. MCP-WTC aims to target the complex crisis in meaning faced by those responders who responded to the 9/11 attacks and subsequently were diagnosed with cancer as a result of their service. RESULTS We describe the adaptation of MCP-WTC and the application of this intervention to meet the unique needs of those exposed to the terrorist attacks of September 11, 2001 (9/11), participated in the rescue, recovery, and clean-up effort at Ground Zero, and were diagnosed with WTC-related cancer. We highlight the novel aspects of this intervention which have been designed to facilitate meaning-making in the context of the patient's response to 9/11 and subsequent diagnosis of cancer. SIGNIFICANCE OF RESULTS This work provides a rationale for MCP-WTC and the potential for this intervention to improve the quality of life of WTC responders and help these patients navigate life after 9/11 and cancer.
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Stein CR, Cooney ML, Frank B, Bender HA, Winkel G, Lucchini RG. Mental health mediators of subjective cognitive concerns among World Trade Center responders. J Psychiatr Res 2021; 140:187-196. [PMID: 34118636 DOI: 10.1016/j.jpsychires.2021.05.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Decline in cognitive functioning among rescue and recovery workers who responded in the aftermath of the September 11, 2001, World Trade Center (WTC) attacks is of emerging interest. Responders are vulnerable to cognitive decline from exposure to airborne toxins present at the WTC site, as well as from WTC-related mental and physical health conditions. To better understand the relationship between occupational WTC exposure, mental health, physical health and subjective cognitive functioning, we examined the mediating role of health status in the association between exposure and subjective cognitive concerns in a multi-site, longitudinal investigation of the WTC General Responder cohort (n = 16,380 responders; n = 58,575 visits) for the period 2002-2015. Through latent class analyses, we identified a four-level marker of cognitive concerns based on information from a Self-Administered Mental Health Questionnaire. Using generalized linear mixed models with random intercepts, we observed that a higher intensity WTC exposure composite was associated with greater cognitive concerns, and that this association was operating almost entirely through mental health comorbidities, not physical health comorbidities. In fully adjusted models, the inclusion of probable depression, anxiety, PTSD and use of psychotropic medications attenuated the association between highest WTC exposure and greatest cognitive concerns. Physical health did not appear to be on the pathway between WTC exposure and cognitive concerns. Understanding the underlying sources of cognitive concerns may help identify vulnerable members of the General Responder cohort and potentially aid clinical decision-making, such as treatment choice and enhanced screening options. Earlier diagnosis and symptom treatment may help preserve functional independence.
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Affiliation(s)
- Cheryl R Stein
- Hassenfeld Children's Hospital at NYU Langone, Department of Child and Adolescent Psychiatry, Child Study Center, One Park Avenue 7th Floor, New York, NY, 10016, USA.
| | - Michael L Cooney
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Brandon Frank
- Clinical and Health Psychology, University of Florida, 1225 Center Dr, Gainesville, FL, 32603, USA
| | - Heidi A Bender
- Weill Cornell Medicine/New York Presbyterian, Weill Cornell Brain and Spine, 525 East 68 Street, Box 99, New York, NY, 10028, USA
| | - Gary Winkel
- Icahn School of Medicine at Mount Sinai, Population Health Science and Policy, 1425 Madison Avenue, 3rd Floor, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Roberto G Lucchini
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 1 Gustave L. Levy Place, New York, NY, 10029, USA
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Zeig-Owens R, Singh A, Triplett S, Salako J, Skerker M, Napier A, Peele E, Stanley M, Sattaluri S, Prezant D, Webber MP. Assembling the Career Firefighter Health Study cohort: A methods overview. Am J Ind Med 2021; 64:680-687. [PMID: 34114224 DOI: 10.1002/ajim.23266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies of World Trade Center (WTC)-exposed rescue/recovery workers report the increased occurrence of health conditions after work at the WTC disaster site. However, the extent to which these associations are due to WTC exposure is unclear, in part due to the lack of suitable comparison groups. Accordingly, we identified a previously assembled National Institute for Occupational Safety and Health (NIOSH) cohort of career firefighters from three US cities (n = 29,992). Here, we document the challenges in establishing this non-WTC-exposed firefighter cohort for the goal of tracking and comparing cancer and chronic health conditions in WTC-exposed and non-WTC-exposed firefighters. METHODS Follow-up process included institutional review board applications, data use agreements, state cancer registry linkages and vital status determination for the NIOSH firefighter cohort. After completion of these steps, we undertook outreach to the three original city fire departments and union officials, before contact tracing and direct recruitment of 14,566 living firefighters to complete a confidential health survey. We staggered recruitment efforts by the city, using letters, postcards, emails, videos, and telephone outreach. Participants who completed the survey received $10. RESULTS A total of 4962 of 14,566 alive firefighters responded to the baseline survey (34.1% response rate). Respondents were older and more likely to be non-Hispanic white than nonrespondents. CONCLUSIONS We provide an overview of the process for the first survey to collect information on physical and mental health conditions among US firefighters. The data collected will have an important impact on studies of WTC rescue/recovery work, firefighting, and related health conditions.
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Affiliation(s)
- Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ankura Singh
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Suzanne Triplett
- Survey Research Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Joke Salako
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Molly Skerker
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Ariana Napier
- Survey Research Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Eric Peele
- Survey Research Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Marshica Stanley
- Survey Research Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Sridevi Sattaluri
- Survey Research Division, RTI International, Research Triangle Park, North Carolina, USA
| | - David Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Division of Epidemiology, Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Breast Cancer Characteristics in the Population of Survivors Participating in the World Trade Center Environmental Health Center Program 2002-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147555. [PMID: 34300003 PMCID: PMC8306152 DOI: 10.3390/ijerph18147555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
The destruction of World Trade Center on 11 September 2001 exposed local community members to a complex mixture of known carcinogens and potentially carcinogenic substances. To date, breast cancer has not been characterized in detail in the WTC-exposed civilian populations. The cancer characteristics of breast cancer patients were derived from the newly developed Pan-Cancer Database at the WTC Environmental Health Center (WTC EHC). We used the Surveillance, Epidemiology, and End Results (SEER) Program breast cancer data as a reference source. Between May 2002 and 31 December 2019, 2840 persons were diagnosed with any type of cancer at the WTC EHC, including 601 patients with a primary breast cancer diagnosis (592 women and 9 men). There was a higher proportion of grade 3 (poorly differentiated) tumors (34%) among the WTC EHC female breast cancers compared to that of the SEER-18 data (25%). Compared to that of the SEER data, female breast cancers in the WTC EHC had a lower proportion of luminal A (88% and 65%, respectively), higher proportion of luminal B (13% and 15%, respectively), and HER-2-enriched (5.5% and 7%, respectively) subtypes. These findings suggest considerable differences in the breast cancer characteristics and distribution of breast cancer intrinsic subtypes in the WTC-exposed civilian population compared to that of the general population. This is important because of the known effect of molecular subtypes on breast cancer prognosis.
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Bello GA, Ornstein KA, Lucchini RG, Hung WW, Ko FC, Colicino E, Taioli E, Crane MA, Todd AC. Development and Validation of a Clinical Frailty Index for the World Trade Center General Responder Cohort. J Aging Health 2021; 33:531-544. [PMID: 33706594 DOI: 10.1177/0898264321997675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: To develop and validate a clinical frailty index to characterize aging among responders to the 9/11 World Trade Center (WTC) attacks. Methods: This study was conducted on health monitoring data on a sample of 6197 responders. A clinical frailty index, WTC FI-Clinical, was developed according to the cumulative deficit model of frailty. The validity of the resulting index was assessed using all-cause mortality as an endpoint. Its association with various cohort characteristics was evaluated. Results: The sample's median age was 51 years. Thirty items were selected for inclusion in the index. It showed a strong correlation with age, as well as significant adjusted associations with mortality, 9/11 exposure severity, sex, race, pre-9/11 occupation, education, and smoking status. Discussion: The WTC FI-Clinical highlights effects of certain risk factors on aging within the 9/11 responder cohort. It will serve as a useful instrument for monitoring and tracking frailty within this cohort.
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Affiliation(s)
- Ghalib A Bello
- Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,5450Florida International University, School of Public Health, Miami, FL, USA.,University of Brescia, Brescia, Italy
| | - William W Hung
- Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, New York, NY, USA
| | - Fred C Ko
- Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, New York, NY, USA
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Population Health Science and Policy, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Thoracic Surgery, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael A Crane
- Department of Environmental Medicine and Public Health, World Trade Center Health Program Clinical Center of Excellence at Mount Sinai, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, World Trade Center Health Program General Responder Data Center, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Shao Y, Durmus N, Zhang Y, Pehlivan S, Fernandez-Beros ME, Umana L, Corona R, Addessi A, Abbott SA, Smyth-Giambanco S, Arslan AA, Reibman J. The Development of a WTC Environmental Health Center Pan-Cancer Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041646. [PMID: 33572220 PMCID: PMC7916067 DOI: 10.3390/ijerph18041646] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/23/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
(1) Background: Recent studies have reported elevated risks of multiple cancers in the World Trade Center (WTC) affected community members (also called WTC “Survivors”). The large variety of WTC-cancers created a need to develop a comprehensive cancer database. This paper describes the development of a pan-cancer database at the WTC Environmental Health Center (EHC) Data Center. (2) Methods: A new REDCap-based pan-cancer database was created using the pathology reports and available biomarker data of confirmed cancer cases after review by a cancer epidemiologist, a pathologist, physicians and biostatisticians. (3) Results: The WTC EHC pan-cancer database contains cancer characteristics and emerging biomarker information for cancers of individuals enrolled in the WTC EHC and diagnosed after 11 September 2001 and up to 31 December 2019 obtained from WTC EHC clinical records, pathological reports and state cancer registries. As of 31 December 2019, the database included 3440 cancer cases with cancer characteristics and biomarker information. (4) Conclusions: This evolving database represents an important resource for the scientific community facilitating future research about the etiology, heterogeneity, characteristics and outcomes of cancers and comorbid mental health conditions, cancer economics and gene–environment interaction in the unique population of WTC survivors.
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Affiliation(s)
- Yongzhao Shao
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York University, New York, NY 10016, USA; (Y.Z.); (A.A.A.)
- Department of Environmental Medicine, NYUG-SOM, New York University, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
- Correspondence: (Y.S.); (J.R.)
| | - Nedim Durmus
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Yian Zhang
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York University, New York, NY 10016, USA; (Y.Z.); (A.A.A.)
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
| | - Sultan Pehlivan
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Maria-Elena Fernandez-Beros
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Lisette Umana
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Rachel Corona
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Adrienne Addessi
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
| | - Sharon A. Abbott
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
| | - Sheila Smyth-Giambanco
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
| | - Alan A. Arslan
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine (NYUGSOM), New York University, New York, NY 10016, USA; (Y.Z.); (A.A.A.)
- Department of Environmental Medicine, NYUG-SOM, New York University, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
- Department of Obstetrics and Gynecology, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
| | - Joan Reibman
- Department of Environmental Medicine, NYUG-SOM, New York University, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.); (L.U.); (R.C.); (A.A.); (S.A.A.); (S.S.-G.)
- Division of Pulmonary Medicine, School of Medicine (SOM), NYUG-SOM, New York University, New York, NY 10016, USA
- Correspondence: (Y.S.); (J.R.)
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Brackbill RM, Kahn AR, Li J, Zeig-Owens R, Goldfarb DG, Skerker M, Farfel MR, Cone JE, Yung J, Walker DJ, Solomon A, Qiao B, Schymura MJ, Dasaro CR, Kristjansson D, Webber MP, Lucchini RG, Todd AC, Prezant DJ, Boffetta P, Hall CB. Combining Three Cohorts of World Trade Center Rescue/Recovery Workers for Assessing Cancer Incidence and Mortality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1386. [PMID: 33546187 PMCID: PMC7913216 DOI: 10.3390/ijerph18041386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 02/02/2023]
Abstract
Three cohorts including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC), each funded by the World Trade Center Health Program have reported associations between WTC-exposures and cancer. Results have generally been consistent with effect estimates for excess incidence for all cancers ranging from 6 to 14% above background rates. Pooling would increase sample size and de-duplicate cases between the cohorts. However, pooling required time consuming steps: obtaining Institutional Review Board (IRB) approvals and legal agreements from entities involved; establishing an honest broker for managing the data; de-duplicating the pooled cohort files; applying to State Cancer Registries (SCRs) for matched cancer cases; and finalizing analysis data files. Obtaining SCR data use agreements ranged from 6.5 to 114.5 weeks with six states requiring >20 weeks. Records from FDNY (n = 16,221), WTCHR (n = 29,372), and GRC (n = 33,427) were combined de-duplicated resulting in 69,102 unique individuals. Overall, 7894 cancer tumors were matched to the pooled cohort, increasing the number cancers by as much as 58% compared to previous analyses. Pooling resulted in a coherent resource for future research for studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.
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Affiliation(s)
- Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Amy R. Kahn
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Jiehui Li
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Rachel Zeig-Owens
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - David G. Goldfarb
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
| | - Molly Skerker
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Mark R. Farfel
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - James E. Cone
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Janette Yung
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Deborah J. Walker
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Adrienne Solomon
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (J.L.); (M.R.F.); (J.E.C.); (J.Y.); (D.J.W.); (A.S.)
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Maria J. Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY 12237, USA; (A.R.K.); (B.Q.); (M.J.S.)
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, 0456 Oslo, Norway;
| | - Mayris P. Webber
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.R.D.); (R.G.L.); (A.C.T.)
| | - David J. Prezant
- Fire Department of the City of New York (FDNY), Brooklyn, NY 11201, USA; (R.Z.-O.); (D.G.G.); (M.S.); (M.P.W.); (D.J.P.)
- Department of Medicine, Montefiore Medical Center, New York, NY 10467, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA;
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
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Mental Healthcare Needs in World Trade Center Responders: Results from a Large, Population-Based Health Monitoring Cohort. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:427-434. [PMID: 31776767 DOI: 10.1007/s10488-019-00998-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nearly two decades after the 9/11 attacks on the World Trade Center (WTC), the prevalence of mental disorders remains elevated among traditional (e.g., police) and non-traditional (e.g., construction workers) responders who were involved in the WTC rescue, recovery, and clean-up efforts. To date, however, scarce research has examined factors associated with perceived need for mental health care, which is critical to promoting engagement in mental health treatment in this population. Data were analyzed from 16,170 WTC responders, including 8881 police responders and 7289 non-traditional responders, who completed their first annual health monitoring visit with the WTC Health Program an average of 6.5 years after September 11, 2001. Predisposing, enabling, and need-based factors associated with perceived need for mental health care were examined using multivariable logistic regression analyses. Nearly half (48.7%) of non-traditional responders and a fifth (20.6%) of police responders reported a need for mental health care. The most common perceived needs were for psychotropic medication, individual psychotherapy, and stress management counseling. Predisposing (e.g., female gender) and need-based factors (e.g., WTC-related posttraumatic stress disorder) predicted perceived need for mental health care in both groups. Among non-traditional responders, Hispanic ethnicity and current suicidal ideation were additionally associated with this outcome. Non-traditional WTC responders are substantially more likely than police WTC responders to perceive a need for mental health treatment. Characterization of factors associated with perceived need for treatment can help inform population-based outreach and monitoring efforts designed to promote engagement in mental health treatment in WTC responders.
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Maura F, Diamond B, Maclachlan KH, Derkach A, Yellapantula VD, Rustad EH, Hultcrantz M, Shah UA, Hong J, Landau HJ, Iacobuzio-Donahue CA, Papaemmanuil E, Irby S, Crowley L, Crane M, Webber MP, Goldfarb DG, Zeig-Owens R, Giricz O, Verma A, Prezant DJ, Dogan A, Shah SP, Zhang Y, Landgren O. Initial Whole-Genome Sequencing of Plasma Cell Neoplasms in First Responders and Recovery Workers Exposed to the World Trade Center Attack of September 11, 2001. Clin Cancer Res 2021; 27:2111-2118. [PMID: 33504553 DOI: 10.1158/1078-0432.ccr-20-2245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/21/2020] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The World Trade Center (WTC) attack of September 11, 2001 created an unprecedented environmental exposure to known and suspected carcinogens. High incidence of multiple myeloma and precursor conditions has been reported among first responders to the WTC disaster. To expand on our prior screening studies, and to characterize the genomic impact of the exposure to known and potential carcinogens in the WTC debris, we were motivated to perform whole-genome sequencing (WGS) of WTC first responders and recovery workers who developed a plasma cell disorder after the attack. EXPERIMENTAL DESIGN We performed WGS of nine CD138-positive bone marrow mononuclear samples from patients who were diagnosed with plasma cell disorders after the WTC disaster. RESULTS No significant differences were observed in comparing the post-WTC driver and mutational signature landscapes with 110 previously published WGSs from 56 patients with multiple myeloma and the CoMMpass WGS cohort (n = 752). Leveraging constant activity of the single-base substitution mutational signatures 1 and 5 over time, we estimated that tumor-initiating chromosomal gains were windowed to both pre- and post-WTC exposure. CONCLUSIONS Although limitations in sample size preclude any definitive conclusions, our findings suggest that the observed increased incidence of plasma cell neoplasms in this population is due to complex and heterogeneous effects of the WTC exposure that may have initiated or contributed to progression of malignancy.
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Affiliation(s)
- Francesco Maura
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Benjamin Diamond
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kylee H Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Venkata D Yellapantula
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Even H Rustad
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica Hong
- Center for Hematological Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Elli Papaemmanuil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shani Irby
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Mayris P Webber
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - David G Goldfarb
- Mount Sinai School of Medicine, New York, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Orsi Giricz
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Amit Verma
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Division of Pulmonary Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York
| | - Ahmet Dogan
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sohrab P Shah
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yanming Zhang
- Cytogenetics Laboratory, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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Bover Manderski MT, Black K, Udasin IG, Black TM, Steinberg MB, Giuliano AR, Luft BJ, Harrison D, Crane MA, Moline J, Passannante MR, Ohman Strickland P, Dasaro CR, Lucchini RG, Todd AC, Graber JM. Retrospective Assessment of Risk Factors for Head and Neck Cancer Among World Trade Center General Responders. Front Public Health 2020; 8:488057. [PMID: 33330296 PMCID: PMC7734028 DOI: 10.3389/fpubh.2020.488057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/04/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: To assess the reliability of a questionnaire designed to reconstruct risk factors for head and neck cancer relative to the 9/11 World Trade Center (WTC) response and over the lifetime. Methods: As part of a nested case-control study, 200 WTC Health Program (WTCHP) General Responder Cohort (GRC) members completed a newly-developed study questionnaire via telephone (with a trained interviewer) or online (self-administered). We assessed agreement between measures of tobacco and alcohol use in our questionnaire results and data collected previously during WTCHP-GRC monitoring visits using Cohens Kappa (κ) and intraclass correlation coefficient (ICC) for categorical and continuous measures, respectively. We compared agreement by disease status, survey mode, and year of WTCHP enrollment. Results: We observed high agreement between measures of lifetime, pre-WTC, and post-WTC smoking prevalence (all κ > 0.85) and smoking duration (all ICC > 0.84). There was moderate agreement between measures of smoking frequency (ICC: 0.61-0.73). Agreement between measures of smoking frequency, but not duration, differed by disease status, and agreement between smoking measures was higher for participants who completed our survey by phone than by web. Among cases, there were no differences based on enrollment in the WTCHP before or after diagnosis. Conclusion: Agreement between measures was generally high, although potential reporting bias and a mode effect that should be considered when interpreting analyses of self-reported data in this population; however differential misclassification appears to be minimal. Our questionnaire may be useful for future studies examining similar behavioral risk factors among disaster-exposed populations.
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Affiliation(s)
- Michelle T. Bover Manderski
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Kathleen Black
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Iris G. Udasin
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Taylor M. Black
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Michael B. Steinberg
- Division of General Internal Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States
| | - Benjamin J. Luft
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Denise Harrison
- Department of Environmental Medicine, Bellevue Hospital Center/New York University School of Medicine, New York, NY, United States
| | - Michael A. Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jacqueline Moline
- Department of Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY, United States
| | - Marian R. Passannante
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Judith M. Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
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36
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World Trade Center Health Program: First Decade of Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197290. [PMID: 33036199 PMCID: PMC7579473 DOI: 10.3390/ijerph17197290] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Abstract
The terrorist attacks on 11 September 2001 placed nearly a half million people at increased risk of adverse health. Health effects research began shortly after and continues today, now mostly as a coordinated effort under the federally mandated World Trade Center (WTC) Health Program (WTCHP). Established in 2011, the WTCHP provides medical monitoring and treatment of covered health conditions for responders and survivors and maintains a research program aimed to improve the care and well-being of the affected population. By 2020, funds in excess of USD 127 M had been awarded for health effects research. This review describes research findings and provides an overview of the WTCHP and its future directions. The literature was systematically searched for relevant articles published from 11 September 2001 through 30 June 2020. Synthesis was limited to broad categories of mental health, cancer, respiratory disease, vulnerable populations, and emerging conditions. In total, 944 WTC articles were published, including peer-reviewed articles funded by the WTCHP (n = 291) and other sources. Research has focused on characterizing the burden and etiology of WTC-related health conditions. As the program moves forward, translational research that directly enhances the care of individuals with chronic mental and physical health conditions is needed.
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Durmus N, Shao Y, Arslan AA, Zhang Y, Pehlivan S, Fernandez-Beros ME, Umana L, Corona R, Smyth-Giambanco S, Abbott SA, Reibman J. Characteristics of Cancer Patients in the World Trade Center Environmental Health Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7190. [PMID: 33019547 PMCID: PMC7578998 DOI: 10.3390/ijerph17197190] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022]
Abstract
The destruction of the World Trade Center (WTC) towers on 11 September 2001 released many tons of aerosolized dust and smoke with potential for carcinogenic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members ("Survivors"), including local residents and workers, present in the NYC disaster area on 9/11 or in the days or weeks following. We report a case series of cancers identified in the WTC EHC as of 31 December 2019. Descriptive characteristics are presented for 2561 cancer patients (excluding non-melanoma skin cancer) and 5377 non-cancer WTC-EHC participants who signed informed consent. We identified a total of 2999 cancer diagnoses in 2561 patients: 2534 solid tumors (84.5%) and 465 lymphoid and hematopoietic tissue cancers (15.5%) with forty-one different cancer types. We describe the distribution, frequency, median age of cancer diagnosis and median latency from 9/11 by cancer site. In addition to common cancer types, rare cancers, including male breast cancers and mesotheliomas have been identified. The current study is the first report on cancer characteristics of enrollees at WTC EHC, a federally designated treatment and surveillance program for local community members affected by the 9/11 terrorist attack on the WTC.
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Affiliation(s)
- Nedim Durmus
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.)
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.S.); (A.A.A.); (Y.Z.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (L.U.); (R.C.); (S.S.-G.); (S.A.A.)
| | - Alan A. Arslan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.S.); (A.A.A.); (Y.Z.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY 10016, USA
- Perlmutter Comprehensive Cancer Center, NYU Langone Health, New York, NY 10016, USA
| | - Yian Zhang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.S.); (A.A.A.); (Y.Z.)
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (L.U.); (R.C.); (S.S.-G.); (S.A.A.)
| | - Sultan Pehlivan
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.)
| | - Maria-Elena Fernandez-Beros
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.)
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (L.U.); (R.C.); (S.S.-G.); (S.A.A.)
| | - Lisette Umana
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (L.U.); (R.C.); (S.S.-G.); (S.A.A.)
| | - Rachel Corona
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (L.U.); (R.C.); (S.S.-G.); (S.A.A.)
| | - Sheila Smyth-Giambanco
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (L.U.); (R.C.); (S.S.-G.); (S.A.A.)
| | - Sharon A. Abbott
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (L.U.); (R.C.); (S.S.-G.); (S.A.A.)
| | - Joan Reibman
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.-E.F.-B.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.S.); (A.A.A.); (Y.Z.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (L.U.); (R.C.); (S.S.-G.); (S.A.A.)
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Arslan AA, Tuminello S, Yang L, Zhang Y, Durmus N, Snuderl M, Heguy A, Zeleniuch-Jacquotte A, Shao Y, Reibman J. Genome-Wide DNA Methylation Profiles in Community Members Exposed to the World Trade Center Disaster. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155493. [PMID: 32751422 PMCID: PMC7432006 DOI: 10.3390/ijerph17155493] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 12/17/2022]
Abstract
The primary goal of this pilot study was to assess feasibility of studies among local community members to address the hypothesis that complex exposures to the World Trade Center (WTC) dust and fumes resulted in long-term epigenetic changes. We enrolled 18 WTC-exposed cancer-free women from the WTC Environmental Health Center (WTC EHC) who agreed to donate blood samples during their standard clinical visits. As a reference WTC unexposed group, we randomly selected 24 age-matched cancer-free women from an existing prospective cohort who donated blood samples before 11 September 2001. The global DNA methylation analyses were performed using Illumina Infinium MethylationEpic arrays. Statistical analyses were performed using R Bioconductor package. Functional genomic analyses were done by mapping the top 5000 differentially expressed CpG sites to the Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway database. Among cancer-free subjects, we observed substantial methylation differences between WTC-exposed and unexposed women. The top 15 differentially methylated gene probes included BCAS2, OSGIN1, BMI1, EEF1A2, SPTBN5, CHD8, CDCA7L, AIDA, DDN, SNORD45C, ZFAND6, ARHGEF7, UBXN8, USF1, and USP12. Several cancer-related pathways were enriched in the WTC-exposed subjects, including endocytosis, mitogen-activated protein kinase (MAPK), viral carcinogenesis, as well as Ras-associated protein-1 (Rap1) and mammalian target of rapamycin (mTOR) signaling. The study provides preliminary data on substantial differences in DNA methylation between WTC-exposed and unexposed populations that require validation in further studies.
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Affiliation(s)
- Alan A. Arslan
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY 10016, USA
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (S.T.); (L.Y.); (Y.Z.); (A.Z.-J.); (Y.S.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
- Correspondence:
| | - Stephanie Tuminello
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (S.T.); (L.Y.); (Y.Z.); (A.Z.-J.); (Y.S.)
| | - Lei Yang
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (S.T.); (L.Y.); (Y.Z.); (A.Z.-J.); (Y.S.)
| | - Yian Zhang
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (S.T.); (L.Y.); (Y.Z.); (A.Z.-J.); (Y.S.)
| | - Nedim Durmus
- Department of Medicine, New York University Langone Health, New York, NY 10016, USA; (N.D.); (J.R.)
| | - Matija Snuderl
- Department of Pathology, New York University Langone Health, New York, NY 10016, USA; (M.S.); (A.H.)
| | - Adriana Heguy
- Department of Pathology, New York University Langone Health, New York, NY 10016, USA; (M.S.); (A.H.)
- NYU Langone’s Genome Technology Center, New York, NY 10016, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (S.T.); (L.Y.); (Y.Z.); (A.Z.-J.); (Y.S.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
| | - Yongzhao Shao
- Department of Population Health, New York University Langone Health, New York, NY 10016, USA; (S.T.); (L.Y.); (Y.Z.); (A.Z.-J.); (Y.S.)
- NYU Perlmutter Comprehensive Cancer Center, New York, NY 10016, USA
| | - Joan Reibman
- Department of Medicine, New York University Langone Health, New York, NY 10016, USA; (N.D.); (J.R.)
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Colbeth HL, Genere N, Hall CB, Jaber N, Brito JP, El Kawkgi OM, Goldfarb DG, Webber MP, Schwartz TM, Prezant DJ, Zeig-Owens R. Evaluation of Medical Surveillance and Incidence of Post-September 11, 2001, Thyroid Cancer in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers. JAMA Intern Med 2020; 180:888-895. [PMID: 32310290 PMCID: PMC7171583 DOI: 10.1001/jamainternmed.2020.0950] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Elevated incidence rates of thyroid cancer among World Trade Center (WTC)-exposed individuals may be associated with the identification of asymptomatic cancers during medical surveillance. OBJECTIVE To examine the association between WTC exposure and thyroid cancer among Fire Department of the City of New York (hereafter, Fire Department) rescue/recovery workers as well as the association with medical surveillance. DESIGN, SETTING, AND PARTICIPANTS This closed-cohort study classified the method of detection (asymptomatic and symptomatic) of thyroid cancers in 14 987 men monitored through the Fire Department-WTC Health Program diagnosed from September 12, 2001, to December 31, 2018. Age-, sex-, and histologic-specific Fire Department incidence rates were calculated and compared with demographically similar men in Olmsted County, Minnesota, from the Rochester Epidemiology Project using age-standardized rates, relative rates (RRs), and 95% CIs. The secondary analysis was restricted to papillary carcinomas. EXPOSURES World Trade Center exposure was defined as rescue/recovery work at the WTC site from September 11, 2001, to July 25, 2002. MAIN OUTCOMES AND MEASURES The outcomes evaluated comprised (1) number of incident thyroid cancers and their detection method categorizations in the Fire Department and Rochester Epidemiology Project cohorts; (2) Fire Department, Rochester Epidemiology Project, and Surveillance, Epidemiology, and End Results-21 age-standardized incidence rates of thyroid cancer; and (3) RRs comparing Fire Department and Rochester Epidemiology Project overall and by detection method categorization. RESULTS Seventy-two post-9/11 Fire Department cases of thyroid cancer were identified. Among the 65 cases (90.3%) with a categorized detection method, 53 cases (81.5%) were asymptomatic and 12 cases (18.5%) were symptomatic. Median (interquartile range) age at diagnosis was 50.2 (44.0-58.6) vs 46.6 (43.9-52.9) years for asymptomatic vs symptomatic cases. Associated primarily with asymptomatic cancers, the overall age-standardized incidence of Fire Department thyroid cancers (24.7; 95% CI, 17.4-52.3) was significantly higher than the Rochester Epidemiology Project (10.4; 95% CI, 8.5-12.7) and Surveillance, Epidemiology, and End Results-21 (9.1; 95% CI, 9.0-9.1) per 100 000 person-years. Furthermore, the RR of thyroid cancer among symptomatic men in Fire Department cases was not significantly different from that of men in the Rochester Epidemiology Project (0.8; 95% CI, 0.4-1.5); however, the rate of asymptomatic cancers was more than 3-fold that of the Rochester Epidemiology Project rate (RR, 3.1; 95% CI, 2.1-4.7). CONCLUSIONS AND RELEVANCE Excess asymptomatic thyroid cancer in Fire Department WTC-exposed rescue/recovery workers is apparently attributable to the identification of occult lesions during medical surveillance. Among WTC-exposed cohorts and the general population, these findings appear to have important implications for how thyroid cancer incidence rates are interpreted and how diagnoses should be managed.
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Affiliation(s)
- Hilary L Colbeth
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - Natalia Genere
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota
| | - Charles B Hall
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York.,Albert Einstein College of Medicine, Saul R. Korey Department of Neurology, Bronx, New York
| | - Nadia Jaber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York
| | - Juan P Brito
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota.,Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, Minnesota
| | - Omar M El Kawkgi
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Rochester, Minnesota.,Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, Minnesota
| | - David G Goldfarb
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - Mayris P Webber
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York.,Montefiore Medical Center, Department of Epidemiology and Population Health, Bronx, New York
| | - Theresa M Schwartz
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Albert Einstein College of Medicine, Department of Medicine, Pulmonology Division, Bronx, New York
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York.,Montefiore Medical Center, Pulmonology Division, Department of Medicine, Bronx, New York.,Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York
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40
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Sigel KM, Xu D, Weber J, Wisnivesky JP, Celedón JC, de la Hoz RE. Prevalence of Pulmonary Nodules Detected by Computed Tomography in World Trade Center Rescue and Recovery Workers. Ann Am Thorac Soc 2020; 17:125-128. [PMID: 31499008 PMCID: PMC6944347 DOI: 10.1513/annalsats.201907-517rl] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Keith M. Sigel
- Icahn School of Medicine at Mount SinaiNew York, New York
| | - Dongming Xu
- Icahn School of Medicine at Mount SinaiNew York, New York
| | - Jonathan Weber
- St. Francis Hospital – The Heart CenterRoslyn, New Yorkand
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Clouston SAP, Kuan P, Kotov R, Mukherjee S, Thompson-Carino P, Bromet EJ, Luft BJ. Risk factors for incident prostate cancer in a cohort of world trade center responders. BMC Psychiatry 2019; 19:389. [PMID: 31822278 PMCID: PMC6902605 DOI: 10.1186/s12888-019-2383-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/29/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite a relatively young average age and no routine screening, prostate cancer is one of the most common cancers in men who worked at the World Trade Center (WTC) following the 9/11/2001 disaster. This study evaluated whether re-experiencing stressful memories of a traumatic event was associated with prostate cancer incidence. METHODS Participants were males from one clinical center that monitors the health of first-responders (N = 6857). Monitoring began in July 2002 and occurs annually but does not include prostate cancer screening. Severity of physical exposures and of re-experiencing memories and stress responses were measured at study enrollment using standardized and validated methods in all participants. The outcome was incidence of diagnosed prostate cancer after enrollment (n = 68). Bivariate analyses provided age-adjusted incidence rates (aIR). Cox proportional hazards modeling was used to calculate incidence; hazards ratios (HR) were reported. RESULTS The mean age of responders on 9/11/2001 was 37.9 years. Prostate cancer incidence was lowest in responders with no re-experiencing stress (aIR = 250.83/100,000 person-years, [233.41-268.25]) and highest in responders with severe re-experiencing stress (aIR = 818.49/100,000 person-years, [801.07-835.91]). Cox proportional hazards regression revealed that re-experiencing the stressful events of 9/11/2001 was associated with increased prostate cancer incidence (HR = 1.96 [1.26-3.05], P = 0.003), even upon adjusting for confounders. CONCLUSIONS This is the first study to identify a positive association between re-experiencing a traumatic event and prostate cancer incidence. Our results are consistent with recent rodent model evidence demonstrating a direct biological link between stress pathways and prostate tumorigenesis and offer new hypotheses in the causality of prostate cancer.
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Affiliation(s)
- Sean A. P. Clouston
- 0000 0004 0437 5731grid.412695.dDepartment of Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook Medicine, Health Sciences Center, #3-071, Nichols Rd., Stony Brook, NY 11794-8338 USA
| | - Peifen Kuan
- 0000 0001 2216 9681grid.36425.36Department of Applied Mathematics, Stony Brook University, Stony Brook, NY USA
| | - Roman Kotov
- grid.459987.eDepartment of Psychiatry, Stony Brook Medicine, Stony Brook, NY USA
| | - Soumyadeep Mukherjee
- grid.459987.eProgram in Public Health, Stony Brook Medicine, Stony Brook, NY USA
| | | | - Evelyn J. Bromet
- grid.459987.eDepartment of Psychiatry, Stony Brook Medicine, Stony Brook, NY USA
| | - Benjamin J. Luft
- grid.459987.eWorld Trade Center Health and Wellness Program, Department of Medicine, Stony Brook Medicine, Stony Brook, NY USA
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Shapiro MZ, Wallenstein SR, Dasaro CR, Lucchini RG, Sacks HS, Teitelbaum SL, Thanik ES, Crane MA, Harrison DJ, Luft BJ, Moline JM, Udasin IG, Todd AC. Cancer in General Responders Participating in World Trade Center Health Programs, 2003-2013. JNCI Cancer Spectr 2019; 4:pkz090. [PMID: 32337498 PMCID: PMC7050150 DOI: 10.1093/jncics/pkz090] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/04/2019] [Accepted: 10/30/2019] [Indexed: 01/31/2023] Open
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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Affiliation(s)
- Moshe Z Shapiro
- 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
| | - Sylvan R Wallenstein
- 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
| | - Christopher R Dasaro
- 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
| | - Roberto G Lucchini
- 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
| | - Henry S Sacks
- 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
| | - Susan L Teitelbaum
- 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
| | - Erin S Thanik
- 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
| | - Michael A Crane
- 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
| | - Denise J Harrison
- World Trade Center Health Program Clinical Center of Excellence, NYU Langone Medical Center, New York University School of Medicine, New York, NY
| | - Benjamin J Luft
- World Trade Center Health Program Clinical Center of Excellence, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY
| | - Jacqueline M Moline
- 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
| | - Iris G Udasin
- World Trade Center Health Program Clinical Center of Excellence, Environmental and Occupational Health Sciences Institute, Robert Wood Johnson Medical Center, Piscataway, NJ
| | - Andrew C Todd
- 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
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Risk of Stroke Among Survivors of the September 11, 2001, World Trade Center Disaster. J Occup Environ Med 2019; 60:e371-e376. [PMID: 29851739 DOI: 10.1097/jom.0000000000001361] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between 9/11-related posttraumatic stress disorder (PTSD), dust cloud exposure, and subsequent development of stroke among 42,527 enrollees in the World Trade Center (WTC) Health Registry. METHODS Using four waves of longitudinal data from the WTC Health Registry surveys, we employed Cox proportional hazards regression models to assess the associations. RESULTS Incidence of stroke was higher among those with PTSD or intense dust cloud exposure than those without, and it was even higher for those who had experienced both. In fully adjusted models, participants with PTSD had an increased risk of developing stroke [adjusted hazards ratio (AHR) 1.69, 95% confidence interval (95% CI) 1.42 to 2.02], as did those with intense dust exposure (AHR 1.29, 95% CI 1.09 to 1.53). CONCLUSION We found that individuals with 9/11-related PTSD and/or intense dust exposure may have an increased risk of developing stroke.
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The Physical and Mental Health Challenges Experienced by 9/11 First Responders and Recovery Workers: A Review of the Literature. Prehosp Disaster Med 2019; 34:625-631. [DOI: 10.1017/s1049023x19004989] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AbstractIntroduction:In the years following the September 11, 2001 terrorist attacks in New York (USA), otherwise known as 9/11, first responders and recovery workers began experiencing a range of physical and mental health challenges. Publications documenting these provide an important evidence-base identifying exposure-related health challenges associated with environmental exposures from the World Trade Center (WTC) site and describe the key lessons learned regarding both physical and mental health challenges (including symptoms and defined conditions) from the 9/11 disaster response.Methods:A systematic literature review was conducted using the MEDLINE, PubMed, CINAHL, and PsychInfo databases (September 11, 2001 to September 11, 2018) using relevant search terms, truncation symbols, and Boolean combination functions. Publications were limited to journal articles that documented the physical or mental health challenges of 9/11 on first responders or recovery workers.Results:A total of 156 publications were retrieved by the search strategy. The majority (55%) reported a quantitative methodology, while only seven percent reported the use of a qualitative research methodology. Firefighters were the group of responders most frequently reported in the literature (35%), while 37% of publications reported on research that included a mix of first responders and recovery workers. Physical health was the focus of the majority of publications (57%). Among the challenges, respiratory issues were the physical health condition most frequently reported in publications, while posttraumatic stress disorder (PTSD) was the most frequent mental health condition reported on. Publications were published in a broad range of multi-disciplinary journals (n = 75).Discussion:These findings will go some way to filling the current gap in the 9/11 evidence-base regarding the understanding of the long-term health challenges for first responders and recovery workers.
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Lieberman-Cribbin W, Tuminello S, Gillezeau C, van Gerwen M, Brody R, Mulholland DJ, Horton L, Sisco M, Prophete C, Zelikoff J, Lee HW, Park SH, Chen LC, Cohen MD, Taioli E. Complementary biobank of rodent tissue samples to study the effect of World Trade Center exposure on cancer development. J Transl Med 2019; 17:342. [PMID: 31601237 PMCID: PMC6788109 DOI: 10.1186/s12967-019-2089-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/29/2019] [Indexed: 02/03/2023] Open
Abstract
World Trade Center (WTC) responders were exposed to mixture of dust, smoke, chemicals and carcinogens. New York University (NYU) and Mount Sinai have recreated WTC exposure in rodents to observe the resulting systemic and local biological responses. These experiments aid in the interpretation of epidemiological observations and are useful for understanding the carcinogenesis process in the exposed human WTC cohort. Here we describe the implementation of a tissue bank system for the rodents experimentally exposed to WTC dust. NYU samples were experimentally exposed to WTC dust via intratracheal inhalation that mimicked conditions in the immediate aftermath of the disaster. Tissue from Mount Sinai was derived from genetically modified mice exposed to WTC dust via nasal instillation. All processed tissues include annotations of the experimental design, WTC dust concentration/dose, exposure route and duration, genetic background of the rodent, and method of tissue isolation/storage. A biobank of tissue from rodents exposed to WTC dust has been compiled representing an important resource for the scientific community. The biobank remains available as a scientific resource for future research through established mechanisms for samples request and utilization. Studies using the WTC tissue bank would benefit from confirming their findings in corresponding tissues from organs of animals experimentally exposed to WTC dust. Studies on rodent tissues will advance the understanding of the biology of the tumors developed by WTC responders and ultimately impact the modalities of treatment, and the probability of success and survival of WTC cancer patients.
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Affiliation(s)
- Wil Lieberman-Cribbin
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, 10029, USA
| | - Stephanie Tuminello
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, 10029, USA
| | - Christina Gillezeau
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, 10029, USA
| | - Maaike van Gerwen
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, 10029, USA
| | - Rachel Brody
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David J Mulholland
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lori Horton
- Nelson Institute of Environmental Medicine, New York University, Tuxedo Park, NY, USA
| | - Maureen Sisco
- Nelson Institute of Environmental Medicine, New York University, Tuxedo Park, NY, USA
| | - Colette Prophete
- Nelson Institute of Environmental Medicine, New York University, Tuxedo Park, NY, USA
| | - Judith Zelikoff
- Nelson Institute of Environmental Medicine, New York University, Tuxedo Park, NY, USA
| | - Hyun-Wook Lee
- Nelson Institute of Environmental Medicine, New York University, Tuxedo Park, NY, USA
| | - Sung-Hyun Park
- Nelson Institute of Environmental Medicine, New York University, Tuxedo Park, NY, USA
| | - Lung-Chi Chen
- Nelson Institute of Environmental Medicine, New York University, Tuxedo Park, NY, USA
| | - Mitchell D Cohen
- Nelson Institute of Environmental Medicine, New York University, Tuxedo Park, NY, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, 10029, USA.
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Landgren O, Zeig-Owens R, Giricz O, Goldfarb D, Murata K, Thoren K, Ramanathan L, Hultcrantz M, Dogan A, Nwankwo G, Steidl U, Pradhan K, Hall CB, Cohen HW, Jaber N, Schwartz T, Crowley L, Crane M, Irby S, Webber MP, Verma A, Prezant DJ. Multiple Myeloma and Its Precursor Disease Among Firefighters Exposed to the World Trade Center Disaster. JAMA Oncol 2019; 4:821-827. [PMID: 29710195 PMCID: PMC6145680 DOI: 10.1001/jamaoncol.2018.0509] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Question Are environmental exposures from the World Trade Center disaster site associated with multiple myeloma and its precursor disease, monoclonal gammopathy of undetermined significance (MGUS), in New York City firefighters? Findings In this case series, 16 participants were diagnosed with multiple myeloma after September 11, 2001, with a median age of disease onset of 57 years, and in subsets with relevant data, a high proportion of the cases had light-chain myeloma, and plasma cells were CD20 positive. In the screening study, World Trade Center exposure was found to be statistically significantly associated with light-chain MGUS and overall MGUS. Meaning World Trade Center disaster exposures are associated with myeloma precursor disease (MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age. Importance The World Trade Center (WTC) attacks on September 11, 2001, created an unprecedented environmental exposure to known and suspected carcinogens suggested to increase the risk of multiple myeloma. Multiple myeloma is consistently preceded by the precursor states of monoclonal gammopathy of undetermined significance (MGUS) and light-chain MGUS, detectable in peripheral blood. Objective To characterize WTC-exposed firefighters with a diagnosis of multiple myeloma and to conduct a screening study for MGUS and light-chain MGUS. Design, Setting, and Participants Case series of multiple myeloma in firefighters diagnosed between September 11, 2001, and July 1, 2017, together with a seroprevalence study of MGUS in serum samples collected from Fire Department of the City of New York (FDNY) firefighters between December 2013 and October 2015. Participants included all WTC-exposed FDNY white, male firefighters with a confirmed physician diagnosis of multiple myeloma (n = 16) and WTC-exposed FDNY white male firefighters older than 50 years with available serum samples (n = 781). Exposures WTC exposure defined as rescue and/or recovery work at the WTC site between September 11, 2001, and July 25, 2002. Main Outcomes and Measures Multiple myeloma case information, and age-adjusted and age-specific prevalence rates for overall MGUS (ie, MGUS and light-chain MGUS), MGUS, and light-chain MGUS. Results Sixteen WTC-exposed white male firefighters received a diagnosis of multiple myeloma after September 11, 2001; median age at diagnosis was 57 years (interquartile range, 50-68 years). Serum/urine monoclonal protein isotype/free light-chain data were available for 14 cases; 7 (50%) had light-chain multiple myeloma. In a subset of 7 patients, myeloma cells were assessed for CD20 expression; 5 (71%) were CD20 positive. In the screening study, we assayed peripheral blood from 781 WTC-exposed firefighters. The age-standardized prevalence rate of MGUS and light-chain MGUS combined was 7.63 per 100 persons (95% CI, 5.45-9.81), 1.8-fold higher than rates from the Olmsted County, Minnesota, white male reference population (relative rate, 1.76; 95% CI, 1.34-2.29). The age-standardized prevalence rate of light-chain MGUS was more than 3-fold higher than in the same reference population (relative rate, 3.13; 95% CI, 1.99-4.93). Conclusions and Relevance Environmental exposure to the WTC disaster site is associated with myeloma precursor disease (MGUS and light-chain MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age, particularly the light-chain subtype.
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Affiliation(s)
- Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Orsolya Giricz
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - David Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Kaznouri Murata
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katie Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lakshmi Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Dogan
- Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - George Nwankwo
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Ulrich Steidl
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Kith Pradhan
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Charles B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Nadia Jaber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - Theresa Schwartz
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | | | | | - Shani Irby
- Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mayris P Webber
- Department of Medicine, Montefiore Medical Center, Bronx, New York.,Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Amit Verma
- Division of Hemato-Oncology, Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - David J Prezant
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York.,Department of Medicine, Division of Pulmonary Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York
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Bover Manderski MT, Black K, Udasin IG, Giuliano AR, Steinberg MB, Ohman Strickland P, Black TM, Dasaro CR, Crane M, Harrison D, Moline J, Luft BJ, Passannante MR, Lucchini RG, Todd AC, Graber JM. Risk factors for head and neck cancer in the World Trade Center Health Program General Responder Cohort: results from a nested case-control study. Occup Environ Med 2019; 76:854-860. [PMID: 31515248 DOI: 10.1136/oemed-2019-105890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Head and neck cancers (HNCs) may be among the health consequences of involvement in the World Trade Center (WTC) response on and after 11 September 2001. We conducted a nested case-control study of WTC Health Program (WTCHP) general responders to examine the effects of WTC exposures and behavioural risk factors on HNC. METHODS We enrolled 64 cases and 136 controls, matched on age, sex and race/ethnicity within risk sets. We assessed tobacco and alcohol use, sexual activity, and occupational exposures prior to, during and after WTC exposure until case diagnosis via questionnaire. We obtained WTC exposure information (duration (first to last day), total days and location of work) from the WTCHP General Responder Data Center. We assessed associations with HNC, and interaction among exposures, using conditional logistic regression. RESULTS Responders in protective services versus other occupations had increased odds (OR: 2.51, 95% CI 1.09 to 5.82) of HNC. Among those in non-protective services occupations, arriving to the WTC effort on versus after 11 September 2001 was significantly associated with HNC (OR: 3.77, 95% CI 1.00 to 14.11). Duration of work was not significantly associated with HNC. Lifetime and post-WTC years of cigarette smoking and post-WTC number of sex partners were positively and significantly associated with HNC, while alcohol consumption was not. CONCLUSIONS These findings suggest opportunities for HNC risk factor mitigation (eg, smoking cessation, human papillomavirus vaccination) and contribute to a risk factor profile which may assist WTCHP clinicians with identifying high-risk responders and improve detection and treatment outcomes in this population.
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Affiliation(s)
- Michelle T Bover Manderski
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kathleen Black
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Iris G Udasin
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Michael B Steinberg
- Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Taylor M Black
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Denise Harrison
- Department of Environmental Medicine, Bellevue Hospital Center, New York City, New York, USA
| | - Jacqueline Moline
- Department of Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Marian R Passannante
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Roberto G Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Judith M Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.,Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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Editorial for "Long-Term Health Effects of the 9/11 Disaster" in International Journal of Environmental Research and Public Health, 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183289. [PMID: 31500226 PMCID: PMC6765956 DOI: 10.3390/ijerph16183289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 12/17/2022]
Abstract
The call for articles on the long term health effects of the 11 September 2001 terrorist attacks (9/11) has resulted in twenty-three papers that add a significant amount of information to the growing body of research on the effects of the World Trade Center (WTC) disaster almost two decades later [...].
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Enhanced exposure assessment and genome-wide DNA methylation in World Trade Center disaster responders. Eur J Cancer Prev 2019; 28:225-233. [PMID: 30001286 DOI: 10.1097/cej.0000000000000460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
DNA methylation has emerged as a promising target linking environmental exposures and cancer. The World Trade Center (WTC) responders sustained exposures to potential carcinogens, resulting in an increased risk of cancer. Previous studies of cancer risk in WTC-exposed responders were limited by the deficiency in quantitative and individual information on exposure to carcinogens. The current study introduces a new exposure-ranking index (ERI) for estimating cancer-related acute and chronic exposures, which aimed to improve the ability of future analyses to estimate cancer risk. An epigenome-wide association study based on DNA methylation and a weighted gene co-expression network analysis were carried out to identify cytosine-phosphate-guanosine (CpG) sites, modules of correlated CpG sites, and biological pathways associated with the new ERI. Methylation was profiled on blood samples using Illumina 450K Beadchip. No significant epigenome-wide association was found for ERI at a false discovery rate of 0.05. Several cancer-related pathways emerged in pathway analyses for the top ranking genes from epigenome-wide association study as well as enriched module from the weighted gene co-expression network analysis. The current study was the first DNA methylation study that aimed to identify methylation signature for cancer-related exposure in the WTC population. No CpG sites survived multiple testings adjustment. However, enriched gene sets involved in cancer, were identified in both acute and chronic ERIs, supporting the view that multiple genes play a role in this complex exposure.
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50
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van Gerwen MAG, Tuminello S, Riggins GJ, Mendes TB, Donovan M, Benn EKT, Genden E, Cerutti JM, Taioli E. Molecular Study of Thyroid Cancer in World Trade Center Responders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1600. [PMID: 31067756 PMCID: PMC6539993 DOI: 10.3390/ijerph16091600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Maaike A G van Gerwen
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Stephanie Tuminello
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Gregory J Riggins
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA.
| | - Thais B Mendes
- Division of Genetics, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil.
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Emma K T Benn
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Eric Genden
- Department of Otolaryngology- Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Janete M Cerutti
- Division of Genetics, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil.
| | - Emanuela Taioli
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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