Estimation of future cancer burden among rescue and recoveryworkers exposed to theworld trade center disaster

Ankura Singh, Rachel Zeig-Owens, William Moir, Charles B. Hall, Theresa Schwartz, Madeline Vossbrinck, Nadia Jaber, Mayris P. Webber, Kerry J. Kelly, Viola Ortiz, Ellen Koffler, David J. Prezant

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

IMPORTANCE Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers. OBJECTIVE To project the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence. DESIGN, SETTING, AND PARTICIPANTS A total of 14 474WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12 374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNYWTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data. EXPOSURES World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002. MAIN OUTCOMES AND MEASURES (1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers. RESULTS On January 1, 2012, the cohort was 96.8%male, 87.1% white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95%CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95%CI, 2638-2786] vs 2596 [95% CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95%CI, 1383-1495] vs 863 [95%CI, 816-910]), thyroid (73 [95%CI, 60-86] vs 57 [95%CI, 44-69]), and melanoma cases (201 [95%CI, 179-223] vs 131 [95%CI, 112-150), but fewer lung (237 [95%CI, 212-262] vs 373 [95%CI, 343-405]), colorectal (172 [95%CI, 152-191] vs 267 [95%CI, 241-292]), and kidney cancers (66 [95%CI, 54-80] vs 132 [95%CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235 835 412 (95%CI, $187 582 227-$284 088 597). CONCLUSIONS AND RELEVANCE We project that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.

Original languageEnglish (US)
Pages (from-to)828-831
Number of pages4
JournalJAMA oncology
Volume4
Issue number6
DOIs
StatePublished - Jun 1 2018

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Disasters
Neoplasms
Rescue Work
Incidence
Costs and Cost Analysis
Kidney Neoplasms
Health Care Costs
Population

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Estimation of future cancer burden among rescue and recoveryworkers exposed to theworld trade center disaster. / Singh, Ankura; Zeig-Owens, Rachel; Moir, William; Hall, Charles B.; Schwartz, Theresa; Vossbrinck, Madeline; Jaber, Nadia; Webber, Mayris P.; Kelly, Kerry J.; Ortiz, Viola; Koffler, Ellen; Prezant, David J.

In: JAMA oncology, Vol. 4, No. 6, 01.06.2018, p. 828-831.

Research output: Contribution to journalArticle

Singh, A, Zeig-Owens, R, Moir, W, Hall, CB, Schwartz, T, Vossbrinck, M, Jaber, N, Webber, MP, Kelly, KJ, Ortiz, V, Koffler, E & Prezant, DJ 2018, 'Estimation of future cancer burden among rescue and recoveryworkers exposed to theworld trade center disaster', JAMA oncology, vol. 4, no. 6, pp. 828-831. https://doi.org/10.1001/jamaoncol.2018.0504
Singh, Ankura ; Zeig-Owens, Rachel ; Moir, William ; Hall, Charles B. ; Schwartz, Theresa ; Vossbrinck, Madeline ; Jaber, Nadia ; Webber, Mayris P. ; Kelly, Kerry J. ; Ortiz, Viola ; Koffler, Ellen ; Prezant, David J. / Estimation of future cancer burden among rescue and recoveryworkers exposed to theworld trade center disaster. In: JAMA oncology. 2018 ; Vol. 4, No. 6. pp. 828-831.
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abstract = "IMPORTANCE Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers. OBJECTIVE To project the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence. DESIGN, SETTING, AND PARTICIPANTS A total of 14 474WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12 374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNYWTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data. EXPOSURES World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002. MAIN OUTCOMES AND MEASURES (1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers. RESULTS On January 1, 2012, the cohort was 96.8{\%}male, 87.1{\%} white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95{\%}CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95{\%}CI, 2638-2786] vs 2596 [95{\%} CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95{\%}CI, 1383-1495] vs 863 [95{\%}CI, 816-910]), thyroid (73 [95{\%}CI, 60-86] vs 57 [95{\%}CI, 44-69]), and melanoma cases (201 [95{\%}CI, 179-223] vs 131 [95{\%}CI, 112-150), but fewer lung (237 [95{\%}CI, 212-262] vs 373 [95{\%}CI, 343-405]), colorectal (172 [95{\%}CI, 152-191] vs 267 [95{\%}CI, 241-292]), and kidney cancers (66 [95{\%}CI, 54-80] vs 132 [95{\%}CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235 835 412 (95{\%}CI, $187 582 227-$284 088 597). CONCLUSIONS AND RELEVANCE We project that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.",
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TY - JOUR

T1 - Estimation of future cancer burden among rescue and recoveryworkers exposed to theworld trade center disaster

AU - Singh, Ankura

AU - Zeig-Owens, Rachel

AU - Moir, William

AU - Hall, Charles B.

AU - Schwartz, Theresa

AU - Vossbrinck, Madeline

AU - Jaber, Nadia

AU - Webber, Mayris P.

AU - Kelly, Kerry J.

AU - Ortiz, Viola

AU - Koffler, Ellen

AU - Prezant, David J.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - IMPORTANCE Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers. OBJECTIVE To project the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence. DESIGN, SETTING, AND PARTICIPANTS A total of 14 474WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12 374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNYWTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data. EXPOSURES World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002. MAIN OUTCOMES AND MEASURES (1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers. RESULTS On January 1, 2012, the cohort was 96.8%male, 87.1% white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95%CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95%CI, 2638-2786] vs 2596 [95% CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95%CI, 1383-1495] vs 863 [95%CI, 816-910]), thyroid (73 [95%CI, 60-86] vs 57 [95%CI, 44-69]), and melanoma cases (201 [95%CI, 179-223] vs 131 [95%CI, 112-150), but fewer lung (237 [95%CI, 212-262] vs 373 [95%CI, 343-405]), colorectal (172 [95%CI, 152-191] vs 267 [95%CI, 241-292]), and kidney cancers (66 [95%CI, 54-80] vs 132 [95%CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235 835 412 (95%CI, $187 582 227-$284 088 597). CONCLUSIONS AND RELEVANCE We project that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.

AB - IMPORTANCE Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers. OBJECTIVE To project the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence. DESIGN, SETTING, AND PARTICIPANTS A total of 14 474WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12 374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNYWTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data. EXPOSURES World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002. MAIN OUTCOMES AND MEASURES (1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers. RESULTS On January 1, 2012, the cohort was 96.8%male, 87.1% white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95%CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95%CI, 2638-2786] vs 2596 [95% CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95%CI, 1383-1495] vs 863 [95%CI, 816-910]), thyroid (73 [95%CI, 60-86] vs 57 [95%CI, 44-69]), and melanoma cases (201 [95%CI, 179-223] vs 131 [95%CI, 112-150), but fewer lung (237 [95%CI, 212-262] vs 373 [95%CI, 343-405]), colorectal (172 [95%CI, 152-191] vs 267 [95%CI, 241-292]), and kidney cancers (66 [95%CI, 54-80] vs 132 [95%CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235 835 412 (95%CI, $187 582 227-$284 088 597). CONCLUSIONS AND RELEVANCE We project that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.

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