There has been increased concern about sarcoidosis and cancer among individuals who were highly exposed during the WTC disaster. The NYC Department of Health and Mental Hygiene, in conjunction with other programs, is closely monitoring these conditions in order to detect any increases in these diseases.
At this time, there is no evidence of an increased rate of cancer among individuals highly exposed to the WTC disaster. Increased rates of sarcoidosis have been documented among fire department personnel ( Izbicki G, Chavko R, Banauch, GI, et al. World Trade Center “Sarcoid-Like” Granulomatous Pulmonary Disease in New York City Fire Department Workers. Chest. 2007;3:131;1414-1423). Rates of sarcoidosis among other groups are currently under investigation.
Sarcoidosis* is an auto-immune disease that can attack any organ of the body, although it often starts in the lungs or lymph nodes. It mainly affects people between 20 and 40 years of age, with African-Americans three times more likely to develop the condition than Caucasians and women twice as likely to develop it as men. While most sarcoidosis patients recover without treatment, less than one-third develop chronic debilitating sarcoidosis and fewer than 5% die from the disease. The exact cause of sarcoidosis is unknown.
Sarcoidosis and World Trade Center (WTC) Dust Exposure
While studies have not definitively linked dust exposure from the WTC disaster to new-onset sarcoidosis among exposed workers, the data does suggest elevated levels of sarcoidosis among firefighters.
There have been a few reported sarcoidosis cases among rescue workers that may be related to Ground Zero dust exposure. In May 2007, the New York City Chief Medical Examiner determined that dust exposure from the disaster contributed to a sarcoidosis death, based on published epidemiologic findings among exposed firefighters.
Sarcoidosis is difficult to verify because NYC providers are not required by law to report sarcoidosis cases to the Health Department. Based on New York City death certificate records over the past 10 years, there have been an average of 32 sarcoidosis deaths per year, with the annual number remaining the same since the WTC attacks. During the same period, there have been between 362 and 439 sarcoidosis-related hospitalizations per year in NYC (five per 100,000 people), with the annual rate remaining the same since the disaster.
* Breathing in beryllium, other metal dust or fumes or moldy materials can cause lung disease, which may resemble sarcoidosis.
For more information about sarcoidosis, see our sarcoidosis fact sheet (PDF).
The collapse and burning of the WTC and neighboring buildings released a complex mixture of irritant dust, smoke and gases. The dust cloud also contained heavy metals, as well as asbestos and other carcinogens. In addition, smoke released from the fires contained hazardous and potentially cancer-causing substances.
Because of these exposures, there has been concern about the possibility of increased cancer rates among WTC-exposed people. The NYC Department of Health and Mental Hygiene, the Fire Department of New York and other researchers are carefully monitoring cancer rates among highly exposed people.
In 2007, the NYC Department of Health and Mental Hygiene brought together a panel of experts, including representatives from FDNY, the Mount Sinai School of Medicine, the New York State Department of Health and the National Institute for Occupational Safety and Health, to discuss the potential impact of the WTC disaster on cancer rates and mortality. For more information, download the Expert Panel/Workshop on Cancer and Mortality Studies with World Trade Center- Exposed Populations (PDF).
In 2010, after beginning the process of confirming cancer diagnoses within their cohorts, the NYC Department of Health and Mental Hygiene and FDNY co-chaired another conference of outside experts, including biostatisticians, environmental health scientists and cancer epidemiologists, to help address the complex methodological questions associated with their preliminary cancer investigations. The conference produced several recommendations which are described in the 2010 WTC Medical Working group annual report (PDF).
Although cancer associated with specific exposures takes a long time to develop, three early cancer studies based on verified diagnoses within their cohorts through 2008 (the latest year for which data was available when these analyses began) have been published:
Cancer analyses continue at FDNY, the WTC Health Registry and at the Mount Sinai School of Medicine.
In 2012, the National Institute for Occupational Safety and Health added many different types of cancers to the list of conditions that can be treated at the World Trade Center Health Program.