10 Years Later: What Have We Learned?

Jacqueline Moline, MD

Not only were nearly 3,000 people killed on 9/11, but the health effects related to the disaster have lingered for thousands who performed rescue and recovery work at the World Trade Center (WTC) site, or who lived or worked in the area.

Both traditional and non-traditional first responders participated in the rescue and recovery effort. Little attention was paid to the exposures at the WTC site, which included massive quantities of dust and fumes, pulverized construction material, asbestos, heavy metals, dioxins, polycholinated biphenyls (PCBs), and polycyclic aromatic hydrocarbons.

Immediate health effects were noted among WTC-exposed individuals, such as upper and lower airway irritation, persistent cough, and severe gastroesophageal reflux.

For years, there have been concerns about increased rates of cancer among those who participated in rescue and recovery work. In 2009, I was the lead author on a paper that described a cluster of young individuals with multiple myeloma. Recently, Rachel Zeig-Owens and colleagues published a study in the Lancet that showed that there is a 19 percent increase in cancer rates among firefighters with WTC exposures, compared to non-exposed firefighters.

Typically, there is a latency period between exposure to carcinogens and when cancer develops. It appears that exposure to the WTC dust and fumes, a complex mixture with more than 150 carcinogens, might have accelerated carcinogenesis (that is, the process by which normal cells transform into cancer cells).

Thousands remain at risk for developing cancers, so it is critical that medical monitoring continues for years, and that we fully cover the care of the men and women who responded during our nation’s time of need. While there might never be absolute certainty regarding the full contribution from the WTC dust and fumes, it makes sense to follow the model set by the Veterans Administration with veterans exposed to Agent Orange: We should care for those who served during the country’s time of need.


Jacqueline Moline, MD,

Vice President/Chair, Population Health
North Shore/LIJ Health System

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