Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the US adult male population: 2001–2016

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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.

Related collections

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Author and article information

Journal

Journal ID (nlm-ta): Occup Environ Med

Journal ID (iso-abbrev): Occup Environ Med

Journal ID (hwp): oemed

Journal ID (publisher-id): oem

Title: Occupational and Environmental Medicine

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 1351-0711

ISSN (Electronic): 1470-7926

Publication date (Print): October 2021

Publication date (Electronic): 10 September 2021

Volume: 78

Issue: 10

Pages: 707-714

Affiliations

[1 ]departmentDivision of Epidemiology, Department of Epidemiology and Population Health , Montefiore Medical Center and Albert Einstein College of Medicine , Bronx, New York, USA

[2 ]departmentBureau of Health Services , Fire Department of the City of New York , Brooklyn, New York, USA

[3 ]departmentPulmonary Medicine Division, Department of Medicine , Montefiore Medical Center and Albert Einstein College of Medicine , Bronx, New York, USA

[4 ]departmentDivision of Biostatistics, Department of Epidemiology and Population Health , Montefiore Medical Center and Albert Einstein College of Medicine , Bronx, New York, USA

[5 ]departmentWorld Trade Center Health Program , Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) , Cincinnati, Ohio, USA

Author notes

[Correspondence to ] Dr Mayris P Webber, Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY 11201, USA; mayris.webber@ 123456fdny.nyc.gov

Author information

Mayris P Webber http://orcid.org/0000-0002-8322-4573

Ankura Singh http://orcid.org/0000-0002-8495-4850

Rachel Zeig-Owens http://orcid.org/0000-0002-8679-2306

Joke Salako http://orcid.org/0000-0003-2417-9810

Molly Skerker http://orcid.org/0000-0002-7511-610X

Charles B Hall http://orcid.org/0000-0001-9982-8120

David G Goldfarb http://orcid.org/0000-0002-8679-2306

Robert D Daniels http://orcid.org/0000-0002-3915-7991

David J Prezant http://orcid.org/0000-0001-9562-0330

Article

Publisher ID: oemed-2021-107570

DOI: 10.1136/oemed-2021-107570

PMC ID: 8458058

PubMed ID: 34507965

SO-VID: beb14e08-5788-410e-9a8d-b8b41477d2a3

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.