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Statement from the World Trade Center (WTC) Health Program on the Notice of Proposed Rulemaking to Add Uterine Cancer to the List of WTC-Related Health Conditions

May 10, 2022

The rulemaking published in the Federal Register on May 10, 2022 proposes the addition of uterine cancer to the List of WTC-Related Health Conditions (List). The rulemaking is available for public review and comment for 45 days beginning on May 10, 2022 and ending on June 24, 2022. The WTC Health Program welcomes all comments on the proposed rule.

This proposed rule is not a final determination. After the receipt and consideration of comments from the public and reviews by independent peer reviewers, the Administrator will make a final determination about whether to add uterine cancer to the List and will publish a final rule responding to the comments and peer reviews.

The WTC Health Program is committed to an open and transparent decision-making process.

The press release is available in the NIOSH Newsroom

Frequently Asked Questions

What is being proposed with this notice of proposed rulemaking (NPRM)?

The Administrator of the WTC Health Program is proposing to add uterine cancer to the List of WTC-Related Health Conditions (List). The term “uterine cancer” in this proposal refers to all types of uterine cancer, including endometrial cancer.

Where can I find the Federal Register publication of this NPRM?

The Federal Register publication of the World Trade Center (WTC) Health Program: Addition of Uterine Cancer to the List of WTC-Related Health Conditions proposing the addition of uterine cancer to the List is available at https://www.federalregister.gov/d/2022-09708

Why is the WTC Health Program moving to add this condition now?

Uterine cancer is currently the only type of cancer not covered by the WTC Health Program. After thorough review of the available evidence, the Administrator now believes that the low representation of women in occupational cohorts makes it unlikely that a definitive association between 9/11 exposure and uterine cancer can be identified during the lifetimes of even the most exposed Program members.

When other cancer types were added to the List in 2012 and subsequent years, insufficient evidence was found to support the addition of uterine cancer under the WTC Health Program’s Policy and Procedures for Adding Types of Cancer to the List of WTC-Related Health Conditions.

Since then, the Administrator of the WTC Health Program received a request from several of the directors of the WTC Health Program's Clinical Centers of Excellence (CCEs), as well as requests from WTC responders and survivors (including Petition 023), to consider adding uterine cancer to the List.

After receipt of the requests, the Administrator directed the WTC Health Program’s Science Team to review the available scientific evidence of an association between uterine cancer and 9/11 exposures.

A white paper [PDF, 38 pages 2 MB] issued by the Program in September 2021 found that the available scientific evidence provided sufficient support to add uterine cancer to the List, but only for those Program members who already have certified WTC-related estrogen-secreting tumors. (Note: Program members who have a certified WTC-related estrogen-secreting tumor can already have their uterine cancer certified as a health condition medically associated with the certified WTC-related estrogen-secreting tumor, assuming all other certification requirements, such as latency and exposure duration, are met.) Therefore, the Administrator asked the WTC Health Program Scientific/Technical Advisory Committee (STAC) for a recommendation on whether a reasonable basis exists for adding uterine cancer to the List.

STAC Recommendation to the Administrator
Between September and November 2021, the STAC reviewed the White Paper and other available scientific information, considered public comment, and deliberated on whether there is a reasonable basis to recommend the addition of uterine cancer to the List. Ultimately, the STAC recommended that uterine cancer be added to the List and provided the Administrator with its recommendation and rationale.

Administrator Determination
Based on the STAC’s recommendation and the scientific literature, including the White Paper, the Administrator has determined that the available information provides a sufficient evidentiary basis to propose the addition of uterine cancer to the List.

Is this a final determination?

No, this is a proposed rule and is not a final determination. The notice of proposed rulemaking is subject to peer-review and public comment during a 45-day comment period (the peer-review occurs during the first 30 days of the 45-day comment period). Once the peer-review and public comments are received, the Administrator will consider and address those comments as appropriate before issuing a final rule.

If uterine cancer is added to the List in a final rule, the WTC Health Program can begin to certify cases of uterine cancer in eligible members on or after the effective date of that final rule.

How long do I have to submit comments on this notice of proposed rulemaking?

The proposed rule will be available for public comment until June 24, 2022.

How do I submit comments?

You can submit written comments through the following channels:

Federal eRulemaking Portal: https://www.regulations.gov . Search for CDC-2022-0052 and follow the instructions for submitting comments;
Mail: NIOSH Docket Office, 1090 Tusculum Avenue, MS C-34, Cincinnati, OH 45226-1998.

All written submissions must include the agency name and docket number (CDC–2022-0052; NIOSH–347) for this action. All relevant comments, including any personal information provided, will be posted without change to https://www.regulations.gov . Do not submit comments by email. CDC does not accept comments by email.

What types of cancer are being proposed to be added to the List? How does this differ from what the Program currently covers?

The Administrator is proposing that all types of uterine cancer be added to the List, including malignant neoplasms of isthmus uteri (ICD code C54.0), endometrium (C54.1), myometrium (C54.2), fundus uteri (C54.3), overlapping sites of corpus uteri (C54.8), and corpus uteri, unspecified (C54.9); and malignant neoplasm of uterus, part unspecified (ICD-10 code C55).

Uterine cancer is the only type of cancer not found on the List. Malignant neoplasms of the cervix uteri (invasive cervical cancer) and uterine sarcomas are already eligible for certification by the WTC Health Program under the definition of “Rare cancers.”1

This NPRM proposes that all types of uterine cancer, including endometrial cancer, be added to the List and certified by the Administrator, assuming the WTC Health Program member meets the applicable certification requirements, such as latency and exposure duration.

What is the process for adding new conditions to the current List of WTC-Related Health Conditions?

Consideration of an addition to the List of WTC-Related Health Conditions may be initiated at the Administrator's discretion2 or following receipt of a petition by an interested party.3 Pursuant to § 3312(a)(6)(D) of Title XXXIII of the PHS Act and 42 C.F.R. § 88.16, the Administrator is required to publish a notice of proposed rulemaking, seek independent peer review, and allow interested parties a minimum of 30 days to comment on the proposed rule.

The Administrator has also established a methodology for evaluating whether to add cancer health conditions to the List of WTC-Related Health Conditions; the current version, as well as past versions, is published online in the Policies and Procedures section of the WTC Health Program website.


1 To learn more about rare cancers in the WTC Health Program, see
https://www.cdc.gov/wtc/pdfs/policies/WTCHP_PP_RareCancers05052014-508.pdf.
2 PHS Act, sec. 3312(a)(6)(A); 42 CFR § 88.16(b).
3 PHS Act, sec. 3312(a)(6)(B); 42 CFR§ 88.16(a).