Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
The Bureau of Health Services and Office of Medical Affairs, Fire Department of the City of New York, Brooklyn, New York.
JAMA Oncol. 2018 Jun 1;4(6):828-831. doi: 10.1001/jamaoncol.2018.0504.
Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers.
To project the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence.
DESIGN, SETTING, AND PARTICIPANTS: A total of 14 474 WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12 374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNY WTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data.
World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002.
(1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers.
On January 1, 2012, the cohort was 96.8% male, 87.1% white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95% CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95% CI, 2638-2786] vs 2596 [95% CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95% CI, 1383-1495] vs 863 [95% CI, 816-910]), thyroid (73 [95% CI, 60-86] vs 57 [95% CI, 44-69]), and melanoma cases (201 [95% CI, 179-223] vs 131 [95% CI, 112-150), but fewer lung (237 [95% CI, 212-262] vs 373 [95% CI, 343-405]), colorectal (172 [95% CI, 152-191] vs 267 [95% CI, 241-292]), and kidney cancers (66 [95% CI, 54-80] vs 132 [95% CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235 835 412 (95% CI, $187 582 227-$284 088 597).
We project that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.
有报道称，暴露于世界贸易中心（WTC）灾难的个体癌症发病率较高，包括纽约市消防局（FDNY）的救援和恢复人员。
通过估计 20 年的癌症发病率，预测 WTC 暴露的 FDNY 救援和恢复人员未来的癌症负担。
设计、地点和参与者：共有 14474 名 WTC 暴露的 FDNY 员工在 2012 年 1 月 1 日时无癌症；对队列的白人男性人群（n=12374）进行了亚组分析。在这项封闭队列研究中，我们预测了 2012 年 1 月 1 日至 2031 年 12 月 31 日期间的癌症发病率。使用每个个体的纽约市（NYC）特定的人口统计学癌症和全国死亡率对每个个体进行模拟，对整个队列进行求和，并进行 1000 次模拟以产生平均值估计值。在白人男性的亚组中进行了额外的分析，比较了使用 2007-2011 年 FDNY WTC 健康计划（FDNY-WTCHP）癌症率与 NYC 率产生的病例数。使用索赔数据估算了第一年癌症治疗的平均和 20 年总费用。
暴露于世界贸易中心灾难的定义为在 2001 年 9 月 11 日至 2002 年 7 月 25 日期间在 WTC 现场的任何时间进行的救援和恢复工作。
（1）根据 NYC 癌症率，预测整个队列的新发癌症病例数；（2）使用 FDNY-WTCHP 与 NYC 率预测亚组的癌症发病率估计值；（3）估计新发癌症的第一年治疗费用。
在 2012 年 1 月 1 日，队列中 96.8%为男性，87.1%为白人，平均（SD）年龄为 50.2（9.2）岁。预计新发癌症病例数为 2960 例（95%CI，2883-3037）。在使用 FDNY-WTCHP 与 NYC 癌症率进行的亚组分析中，白人男性的预计新病例数增加（2714 [95%CI，2638-2786] vs 2596 [95%CI，2524-2668]）。因此，我们预计会有更多的前列腺癌（1437 [95%CI，1383-1495] vs 863 [95%CI，816-910]）、甲状腺癌（73 [95%CI，60-86] vs 57 [95%CI，44-69]）和黑色素瘤病例（201 [95%CI，179-223] vs 131 [95%CI，112-150]），但肺癌（237 [95%CI，212-262] vs 373 [95%CI，343-405]）、结直肠癌（172 [95%CI，152-191] vs 267 [95%CI，241-292]）和肾癌（66 [95%CI，54-80] vs 132 [95%CI，114-152]）的病例会减少（P<.001 用于所有比较）。第一年治疗的 20 年成本估计为 235835412 美元（95%CI，18758227-284088597 美元）。
我们预测 FDNY-WTCHP 队列将经历比人口统计学相似的人群更高的癌症负担。这强调了在 WTC 暴露的救援和恢复人员中进行癌症预防工作和常规筛查的重要性。
