TOPLINE:

Among 12,334 World Trade Center (WTC) responders, 118 developed lung cancer over an 11-year period, with severely exposed individuals showing nearly triple the risk compared with those with mild exposure.

METHODOLOGY:

• A prospective cohort study collected data between July 1, 2012, and December 31, 2023, from WTC responders enrolled in a Long Island, New York, medical monitoring program.
• Analysis included individuals who survived and were followed up for incident lung cancer after a 10-year latency period.
• Exposure assessment utilized detailed questionnaires about on-site work conditions, including work type and duration, environmental conditions, and protective equipment use.
• WTC exposure severity was categorized as mild, moderate, or severe using a validated approach.
• The primary outcome was lung cancer incidence, with diagnoses verified by CDC clinicians.

TAKEAWAY:

• Among 12,334 eligible responders (mean age, 49.3 years; 90.9% men), 118 cases of incident lung cancer were identified (incidence rate, 8.7/10,000 person-years; 95% CI, 7.3-10.5).
• Lung cancer incidence was higher in moderately exposed (adjusted hazard ratio [AHR], 1.86; 95% CI, 1.19-2.91; P = .007) and severely exposed (AHR, 2.90; 95% CI, 1.69-4.99; P < .001) groups than in mildly exposed groups.
• Specific WTC exposures, including smelling fumes (AHR, 1.05; 95% CI, 1.01-1.09; P = .007) or sewage (AHR, 1.03; 95% CI, 1.01-1.05; P = .004), showed higher lung cancer incidence after adjusting for demographics and tobacco use.
• The researchers found lung cancer incidence was consistently higher among those with greater exposure severity.

IN PRACTICE:

“Although increased risk of lung cancer is presumed in this population, this cohort study is the first to establish an association between a measure of WTC exposure severity and the incidence of lung cancer,” the authors of the study wrote. “This study therefore underlines the importance of having an established and long-lasting monitoring program when the public is concerned about exposures whose outcomes are likely to have lengthy latency periods,” added the authors.

SOURCE:

The study was led by Sean A.P. Clouston, PhD, Program in Public Health at Stony Brook University in Stony Brook, New York. It was published online on October 9 in JAMA Network Open.

LIMITATIONS:

The study had several important limitations. The WTC exposure data relied on questionnaires not specifically designed to measure airborne dynamics of fine and ultrafine particulate matter, potentially leading to exposure misclassification. The absence of biomarkers for WTC exposure severity necessitated reliance on retrospectively collected information from responders at study intake. While no evidence of recall bias was found, exposure severity ratings could be enhanced by directly matching exposure questionnaires with biomarkers. Additionally, the study did not explicitly examine behavioral changes or additional exposures occurring after WTC events that may introduce biases.

DISCLOSURES:

Clouston and Frank D. Mann, PhD, reported receiving grants from the National Institute on Occupational Safety and Health during the conduct of the study. Laura Sampson, PhD, reported receiving grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.