Washington, DC: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2012-115, 2012 Feb; :1-53
The James Zadroga 9/11 Health and Compensation Act of 2010, Public Law 111-347, Title XXXIII of the Public Health Service Act, 124 Stat. 3623 (codified at 42 United States Code section 300mm-300mm-61), requires the Administrator of the World Trade Center (WTC) Health Program to "periodically conduct a review of all available scientific and medical evidence, including findings and recommendations of Clinical Centers of Excellence, published in peer-reviewed journals to determine if, based on such evidence, cancer or a certain type of cancer should be added to the applicable list of WTC-related health conditions." 42 U.S.C. sec. 300mm-22(a)(5)(A). The National Institute for Occupational Safety and Health (NIOSH) presented the first periodic review of cancer for the WTC Health Program in July 2011. This review included findings from the peer-reviewed scientific and medical literature about exposures and cancer resulting from the September 11, 2001, terrorist attacks [NIOSH 2011]. The Exposure section of the first periodic review provided an initial list of agents detected in the area around the World Trade Center (WTC) during the disaster response and recovery periods. The Contaminants of Potential Concern (COPC) Committee of the World Trade Center Indoor Air Task Force Working Group developed the initial list from the chemicals identified in air sample testing results included in four databases [COPC Committee 2003]. The committee used this list to select COPCs and set health-based benchmarks for indoor environments. The four data sources were the: 1. Environmental Protection Agency (EPA) Region 2 database of environmental sampling results, which contains more than 200,000 records on sampling results for 137 agents; 2. New York City Department of Health and Mental Hygiene (NYCDOHMH)/Agency for Toxic Substances and Disease Registry (ATSDR) public health investigation database, which includes results from Lower Manhattan samples of six minerals, 354 air samples from residential buildings, and 32 samples of fibers collected outdoors and analyzed by phase contrast microscopy; 3. New York City Department of Education findings from sampling in schools, which involved samples collected both indoors and outdoors from six schools between September 2001 and June 2002 and includes more than 30,000 records of air sampling results for more than 70 agents; and 4. Chatfield and Kominsky's survey of indoor air quality. A total of 287 chemicals or chemical groups were identified from the report [COPC Committee 2003], and each of them was checked against (1) the United States National Toxicology Program (NTP) 12th Report on Carcinogens (RoC) [NTP 2011] and (2) the United Nations International Agency on Research on Cancer (IARC) list of agents and documented in the IARC monographs, Volumes 1-102 [IARC 2006]. The list and cancer designations of these chemicals were provided in Appendix E of the First Periodic Review of Scientific and Medical Evidence Related to Cancer for the World Trade Center Health Program [NIOSH 2011]. In addition to the agents identified by the COPC Committee [COPC 2003], several other agents of potential concern have been included because of the potential for widespread exposure. In particular, the fires at the WTC site produced over an extended period of time substantial amounts of combustion products from building materials, including wood and plastics. Also, a large number of trucks, many of which run on diesel fuels, were used at the WTC site. These trucks likely produced large quantities of diesel particulates, which were discharged into the air at and around the WTC site. Because of the potential exposure of rescue and recovery workers, as well as workers and residents in area buildings, to soot, biomass fuel, and diesel particulates, these are included with the COPC agents identified by EPA. Tables 1, 2, and 3 (Section IV) provide the cancer classifications of NTP and IARC and expand upon the information provided in the first periodic report by providing a summary of the basis for the IARC classification. NTP and IARC do not address decomposition products from plastics as a group; they are addressed only as individual compounds. Therefore, the individual compounds from thermal decomposition of plastics that were identified by the COPC Committee are included in the tables. A summary of the studies cited in the IARC monographs is provided in Section IV. Hyperlinks to the NTP Report on Carcinogens and the IARC monographs are provided as well. The agents identified as COPC and other select agents are grouped according to their IARC designation as Group 1, 2A, or 2B. Agents categorized by IARC as Group 3 or Group 4 are not summarized because they are not expected to contribute to potential cancer outcomes among the rescue and recovery workers and the survivors. Descriptions of uncategorized agents are not available in the IARC Monographs. A total of 63 agents are included from the original list of 287 COPCs, and the additional three agents (soot, biomass fuel, and diesel) have been added.