New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA.
New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA.
J Natl Cancer Inst. 2022 Feb 7;114(2):210-219. doi: 10.1093/jnci/djab165.
Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure.
From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk.
Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both.
In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.
据报道，有 3 个世贸中心（WTC）灾难救援和恢复工作人员队列的癌症发病率显著增加。我们对这些队列的数据进行了汇总，以解决公众对 WTC 暴露 14 年后癌症风险的持续关注。
从一个合并的、去重的 69102 名 WTC 救援和恢复工作人员队列中，研究了在 2009 年之前登记并随访至 2015 年的 57402 名工作人员的样本。从 13 个州癌症登记处确定了 2002-2015 年诊断出的侵袭性癌症。使用标准化发病率比（SIR）评估癌症发病率。使用 Cox 回归估计调整后的风险比（aHR），以检查 WTC 暴露与癌症风险之间的关联。
在确定的 3611 例癌症中，有 3236 例报告为首次原发性（FP）癌症，分别有 649724 和 624620 人年的累计随访。合并 FP 癌症的发病率低于预期（SIR=0.96，95%置信区间[CI]为 0.93 至 0.99）。黑色素瘤皮肤（SIR=1.43，95%CI=1.24 至 1.64）、前列腺（SIR=1.19，95%CI=1.11 至 1.26）、甲状腺（SIR=1.81，95%CI=1.57 至 2.09）和扁桃体（SIR=1.40，95%CI=1.00 至 1.91）癌症的 SIR 显著升高。与 2001 年 9 月 17 日后抵达的人员相比，9 月 11 日抵达的人员前列腺（aHR=1.61，95%CI=1.33 至 1.95）和甲状腺（aHR=1.77，95%CI=1.11 至 2.81）癌症的 aHR 显著更高，且两者均呈现出统计学显著的暴露-反应趋势。
在研究过的规模最大的 9/11 救援和恢复工作人员队列中，整体癌症发病率低于预期，WTC 暴露强度与特定癌症部位的风险增加有关，这证明了环境灾难后进行长期随访研究的价值。
