Short Wave - 9/11 First Responders Have Higher Cancer Risks But Better Survival Rates

Episode Date: September 10, 2021

Twenty years later, first responders during the 9/11 attacks have an increased risk of getting some kinds of cancer. But, research shows that they're also more likely to survive. Host Emily Kwong talks to NPR correspondent Allison Aubrey about why. Read more about Allison's reporting here. You can follow Emily on Twitter @EmilyKwong1234 and Allison @AubreyNPR. Email Short Wave at [e-mail]. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey everyone, Emily Kwong here with NPR health correspondent Alison Aubrey. Hey, Emily, today on the show, we're going to look back at the 9-11 attacks that occurred 20 years ago tomorrow. Rescue workers today continued pouring through the enormous pile of rubble that sits where the trade center used to be. Filling buckets with debris and passing them down a human chain to be carted away. One problem hampering the work this week. has been dust. And focus on the health impacts of what happened in New York City at the World Trade Center, where thousands of first responders, including firefighters and rescue workers, were called to the

scene for weeks. 20 years later, researchers have documented an increased incidence of several types of cancer. But a new study actually offers some reason for optimism. It turns out, first responders appear to be surviving their cancers at significantly higher rates. Now, the question is, is why? You're listening to Shorewave, the Daily Science podcast from NPR. So Allison, I grew up in the New York City area and I remember this period so clearly. Many first responders spent weeks doing rescue and recovery work at the Ground Zero site in the aftermath of September 11th. What were they exposed to? Well, you know, just after the towers collapsed, the air was just filled with smoke, with debris, basically all that had collapsed. And all the concrete, the glass, pipes. I mean, everything kind of pulverized and burning into this ash. It was laden with all kinds of heavy metals, including lead and other toxins. I mean, many of us remember that plume of smoke and debris that could be seen from space on that day.

And Dr. Michael Crane, who was an environmental medicine expert at Mount Sinai, told me that there has never been anything quite like it. The exposure was really dramatic. The dust, I mean, there was all kinds of carcinogens and combustion products and fibers and glass fibers and asbestos fibers. It was really your witch's groove. And, you know, given what was in the air, there was definitely a concern early on that it might increase the risk of certain cancers. And we have research about that now. So how much of an increased risk of cancer is there among first responders?

Well, some of the most recent data suggests that the total number of cancers is only slightly elevated compared to the general population. But scientists have documented, like, significant increases in certain cancers, a 25% increase in prostate cancer, a doubling in the risk of thyroid cancer, and about a 40% increased risk in leukemia. And there are also a number of rare cancers that are linked to the exposure. I spoke to Elizabeth Cassio of the New York City Fire. Department. She was diagnosed a couple of years ago. She told me about her experience on 9-11, arriving on the scene at the World Trade Center, just as the second tower collapsed. You know, we were walking through six to ten inches of concrete sand, and literally the entire dust cloud that was in every direction, we were literally engulfed by it. Now, she spent weeks

at the site, and she breathed all of this in. And when did her health problems start? start to appear. Well, she was one of the first responders who developed a cough. That eventually went away. But then 18 years later, she received a diagnosis that no one wants. You know, when you hear the word cancer, it's a sobering moment. It's a scary moment. And the doctor was like, look, let's not get ahead of ourselves. She was told that she had a tumor in her cervix. It was a rare invasive cervical cancer that could spread quickly. And her doctors told her that her 9-11 exposure was likely a contributing factor. Yeah, that is a really hard diagnosis. And for Elizabeth, what has her treatment been like? Well, she had both radiation and chemotherapy. She had a very aggressive

treatment plan. And she says it was really rough. I mean, she was in a lot of pain, had lots of side effects. But she responded very well to the treatment about halfway through. Her doctors ordered a CAT scan. And she got some unexpected news. Both oncologists were really happy that the tumor had shrunk dramatically, very quickly. And I did feel relieved. That to me was good news. Oh, that's great. Yeah. That's great news. So she finished her treatment. She's now doing very well. She works full time. She's chief of staff of the New York City Fire Department. Okay. And is this kind of experience that Elizabeth had typical? You know, survival rates really vary, and certainly, sadly, some first responders have died,

but Elizabeth is part of this World Trade Center health program. This is a federally funded program that provides monitoring and treatment to first responders for conditions that are linked to their 9-11 exposures. Now, there are thousands of responders and survivors in the program, and though some cancers are elevated, it turns out quite surprisingly, that first responders are significantly more likely to survive their cancers. I spoke to Rachel Zieg Owens of Einstein College of Medicine. She has just published a new paper that details the outcomes for first responders. They were about 35, 36 percent more likely to survive than the general population. And that is a good feeling.

So, Allison, is this because first responders are getting their cancer detected earlier? You know, in some instances, the cancers are detected earlier, so that's likely part of the equation, perhaps due to more screening. And then also, these folks are getting really incredible care. As part of this World Trade Center health program, there's a lot of coordination. They work with nurses who help manage their care. In many cases, they can be driven to and from their appointments. They're getting the best treatments available. And this is a really key point here.

It is all paid for. I mean, so there's no putting off appointments or treatments. due to expense, Elizabeth Casio told me she was incredibly well cared for. There's a tremendous support network. You're not worried about how do I pay for this. You're not worried about how do I get to and from. So there are a lot of stressors that don't exist for us. And she says just being part of the fire department, there's this whole community of people

kind of ready to help. I'm really glad for this chance to check in on those who first responded to the World Trade Center. and also just to acknowledge what they did 20 years ago. And I'm wondering, Alison, 20 years into the future and beyond, how long will this care continue? Oh, well, they'll get this care. It's federally funded the program through the year 1990. So many, many, many more decades. Now, whether or not this benefit, this increased survivability holds up, I think it's a big question.

You know, age plays a role. I mean, the first responders were on average in their late 30s on that day. back September 11th, 2001. Now they're in their late 50s. Firefighters and EMTs tend to be healthier than the population at large. They need to be pretty fit to do their job. So that might explain this early benefit. And as they age, will they continue to beat the odds for surviving their cancers?

You know, it's not really clear. Dr. Michael Crane, who is also the medical director at the World Trade Center Health Program Clinic, says it would be really good to keep this research going, to be able to answer some of these questions. The really exciting thing is to kind of dream now of this study actually continuing on and maybe being done another five years and another five years. And this will really help answer a lot of those questions. You know, it goes without saying, Emily, that cancer is always a really hard diagnosis.

But this evidence that there is an increased chance of survival is pretty encouraging. Yeah, Alison, on the 20th anniversary of 9-11, I feel like there's so many things to talk about. But to focus on this one thing with this one group of people is really good. So thank you for bringing it to us. Thank you. This story was produced by Thomas Liu. It was edited by Giselle Grayson and fact-checked by Indy Kara. I'm Emily Kwong, and you're listening to Shortwave, the Daily Science podcast from NPR.