Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: An observational cohort study

Rachel Zeig-Owens, Mayris P. Webber, Charles B. Hall, Theresa Schwartz, Nadia Jaber, Jessica Weakley, Thomas E. Rohan, Hillel W. Cohen, Olga Derman, Thomas K. Aldrich, Kerry Kelly, David J. Prezant

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Abstract

The attacks on the World Trade Center (WTC) on Sept 11, 2001 (9/11) created the potential for occupational exposure to known and suspected carcinogens. We examined cancer incidence and its potential association with exposure in the first 7 years after 9/11 in firefighters with health information before 9/11 and minimal loss to follow-up. We assessed 9853 men who were employed as firefighters on Jan 1, 1996. On and after 9/11, person-time for 8927 firefighters was classified as WTC-exposed; all person-time before 9/11, and person-time after 9/11 for 926 non-WTC-exposed firefighters, was classified as non-WTC exposed. Cancer cases were confirmed by matches with state tumour registries or through appropriate documentation. We estimated the ratio of incidence rates in WTC-exposed firefighters to non-exposed firefighters, adjusted for age, race and ethnic origin, and secular trends, with the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) reference population. CIs were estimated with overdispersed Poisson models. Additional analyses included corrections for potential surveillance bias and modified cohort inclusion criteria. Compared with the general male population in the USA with a similar demographic mix, the standardised incidence ratios (SIRs) of the cancer incidence in WTC-exposed firefighters was 1·10 (95 CI 0·98-1·25). When compared with non-exposed firefighters, the SIR of cancer incidence in WTC-exposed firefighters was 1·19 (95 CI 0·96-1·47) corrected for possible surveillance bias and 1·32 (1·07-1·62) without correction for surveillance bias. Secondary analyses showed similar effect sizes. We reported a modest excess of cancer cases in the WTC-exposed cohort. We remain cautious in our interpretation of this finding because the time since 9/11 is short for cancer outcomes, and the reported excess of cancers is not limited to specific organ types. As in any observational study, we cannot rule out the possibility that effects in the exposed group might be due to unidentified confounders. Continued follow-up will be important and should include cancer screening and prevention strategies. National Institute for Occupational Safety and Health.

Original languageEnglish (US)
Pages (from-to)898-905
Number of pages8
JournalThe Lancet
Volume378
Issue number9794
DOIs
StatePublished - Sep 3 2011

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Firefighters
Observational Studies
Cohort Studies
Outcome Assessment (Health Care)
Neoplasms
Incidence
National Institute for Occupational Safety and Health (U.S.)
National Cancer Institute (U.S.)
Occupational Exposure
Early Detection of Cancer
Documentation
Carcinogens
Population
Registries
Epidemiology
Demography

ASJC Scopus subject areas

  • Medicine(all)

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Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks : An observational cohort study. / Zeig-Owens, Rachel; Webber, Mayris P.; Hall, Charles B.; Schwartz, Theresa; Jaber, Nadia; Weakley, Jessica; Rohan, Thomas E.; Cohen, Hillel W.; Derman, Olga; Aldrich, Thomas K.; Kelly, Kerry; Prezant, David J.

In: The Lancet, Vol. 378, No. 9794, 03.09.2011, p. 898-905.

Research output: Contribution to journalArticle

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