WebMD Medical News
Laura J. Martin, MD
Sept. 1, 2011 -- Sept. 11, 2011, will mark the 10-year anniversary of the terror attacks on the World Trade Center in New York City and the Pentagon in Washington, D.C.
For many, the physical and mental scars are still very real. Two new studies in the Lancet show just how real these health effects are for our first responders.
Male firefighters who were at Ground Zero are 19% more likely to develop cancer than firemen who were not at the site.
This finding directly contradicts a federal report released in July that found there was not enough evidence to link toxins from the fallen towers to increased cancer rates among the firefighters. This means that cancer would not be covered as a medical issue under funds set aside to help with the medical bills of first responders and volunteers.
Another study shows that rescue and recovery workers are still experiencing breathing issues and mental health problems one decade after exposure to the toxic dust and debris at Ground Zero.
There were 263 firemen at Ground Zero who were diagnosed with cancer in the first seven years after Sept. 11, 2011. This is more than would be expected in the general population of same-aged men, and more than what is seen among firefighters who were not at the disaster site.
The study only looked at male firefighters. It did not include other groups of people who were also exposed. It also only tracked firemen for seven years. This may not be long enough to get a firm handle on any potential increased risk for cancer, the researchers say.
“Prior to our study, very little was known about the 9/11-cancer connection,” researcher Mayris Webber says in an email. She is a senior epidemiologist at the WTC Medical Monitoring & Treatment Program in New York.
This study comes in the wake of the $4.3 billion James Zadora 9/11 Health and Compensation Act that was passed last December. This bill provides health care to 9/11 first responders for a host of illnesses thought to be related to time spent at Ground Zero. As stated, cancer care was not included in this bill, to great controversy.
Going forward, it may be, Webber says. “The bill requires periodic review of scientific and clinical data to determine if cancer or certain types of cancer should be added to the applicable list of WTC-related health conditions,” she says.
But not everyone is convinced that cancer risk is higher among first responders.
“The firefighter study goes against everything that has been known until this point, including the findings of studies funded by the federal government,” says Jeff Stier, a senior fellow at the National Center for Public Policy Research. His organization is a conservative think tank based in Washington, D.C.
“This is an emotionally driven issue and everyone wants to help the heroes,” he says. But “we should not turn a blind eye to the science just because we have affinity toward the heroes.”
The second Lancet study included 27, 449 people who took part in the WTC Medical Monitoring and Treatment Program.
After nine years, rescue and recovery workers are at risk for:
The more time the responders spent at Ground Zero, the greater their risk for most of these health issues, the study showed.
Jacqueline Moline, MD, chair of population health at North Shore University Hospital in Manhasset, N.Y., was one of the researchers of this study. “We shouldn't have to justify that these people are still sick anymore. They are.”
Furthermore, “We need to keep following these people and keep treating them,” she says.
Another study researcher, Juan P. Wisnivesky, MD, agrees. “We need to continue to periodically follow rescue and recovery workers with physical and mental health examinations to ensure early diagnosis and appropriate treatment of WTC-related conditions,” says Wisnivesky, who serves as the vice chair for research in the department of medicine at Mount Sinai School of Medicine in New York City.
This includes amped-up prevention efforts, he says.
“We should make sure these workers receive state-of-the-art preventive medicine (including screening for cancer) to minimize the potential impact of exposure,” he says. “Many responders have lung function abnormalities, so effective smoking cessation efforts should be key in this population, particularly among those who were exposed the most.”
As far as the controversial cancer-9/11 link, “We need to do more research in this area and continue to follow up rescue and recovery workers,” Wisnivesky says. “It is difficult to assess rates of cancer and find appropriate comparison populations.”
What’s more, “many cancers have a relatively long latency and may not be diagnosed for many years after exposure,” he says. “We need to be vigilant about this potential consequence of exposure.”
Many of the first responders are also still coping with the emotional aftermath of the terror attacks. Depression, anxiety, panic, and other symptoms may stick around for a long time, says Anand Pandya, MD.
Today Pandya is the interim chair of psychiatry at Cedars-Sinai Medical Center in Los Angeles. In 2001, he was working at Ground Zero.
“Some people get better and others don’t,” he says. “We know that a lot of people may have symptoms for years before acknowledging that they really interfere with life.”
PTSD can appear at any time after a trauma, he says. Help is available and this study shows that it is still needed, he says.
E.J. Suh, PhD, assistant professor of clinical psychology at Columbia University School of Medicine in New York, says that she still sees people who need help coping with the lingering effects of the terror attacks. “It is an ongoing recovery in terms of New Yorkers who were affected by 9/11.”
SOURCES:Mayris Webber, senior epidemiologist, WTC Medical Monitoring & Treatment Program, New York.Wisnivesky, J. Lancet, 2011: vol 378: pp 888-897.Mauer, M. Lancet, 2011: vol 378: pp 852-853.Zeig-Owens, R. Lancet, 2011: vol 378: pp 898-905.Melius, J. Lancet, 2011: vol 378: pp 854-855.Jeff Stier, senior fellow, National Center for Public Policy Research, Washington, D.C.Jacqueline Moline, MD, chair, population health, North Shore University Hospital, Manhasset, N.Y.E.J. Suh, PhD, assistant professor of clinical psychology, Columbia University School of Medicine, New York.Anand Pandya, MD, interim chair, psychiatry, Cedars-Sinai Medical Center, Los Angeles.Juan P. Wisnivesky, MD, vice chair for research, department of medicine, Mount Sinai School of Medicine, New York City.
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