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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-R; Webber-MP; Hall-CB; Schwartz-T; Jaber-N; Weakley-J; Rohan-TE; Cohen-HW; Derman-O; Aldrich-TK; Kelly-K; Prezant-DJ
Lancet 2011 Sep; 378(9794):898-905
Background: 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. Methods: 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. Findings: 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 110 (95% CI 098-125). When compared with non-exposed firefighters, the SIR of cancer incidence in WTC-exposed firefighters was 119 (95% CI 096-147) corrected for possible surveillance bias and 132 (107-162) without correction for surveillance bias. Secondary analyses showed similar effect sizes. Interpretation: 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.
Cancer-rates; Carcinogens; Demographic-characteristics; Diagnostic-tests; Emergency-responders; Exposure-assessment; Exposure-methods; Fire-fighters; Health-care; Health-hazards; Health-services; Health-surveys; Mathematical-models; Medical-examinations; Medical-monitoring; Medical-screening; Occupational-exposure; Occupational-hazards; Occupational-health; Physiological-effects; Physiological-response; Rescue-workers; Risk-analysis; Risk-factors; Work-areas; Work-environment; Worker-health; Work-operations; Workplace-studies
Dr Mayris Webber, Bureau of Health Services, Fire Department of the City of New York, 9 Metrotech Center, Brooklyn, NY 11201
Publication Date
Document Type
Journal Article
Email Address
Funding Type
Cooperative Agreement
Fiscal Year
NTIS Accession No.
NTIS Price
Identifying No.
Cooperative-Agreement-Number-U10-OH-008242; Cooperative-Agreement-Number-U10-OH-008243; B09282011
Issue of Publication
Priority Area
Source Name
Performing Organization
New York City Fire Department