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Scientific and Medical Evidence Related to Cancer for the World Trade Center Health Program

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Scientific and Medical Evidence Related to Cancer for the World Trade Center Health Program First Periodic Review of Scientific and Medical Evidence Related to Cancer for the World Trade Center Health Program DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Institute for Occupational Safety and Health World Trade Center Health Program This document is in the public domain and may be freely copied or reprinted. Disclaimer Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH). In addition, citations to Web sites external to NIOSH do not constitute NIOSH endorsement of the sponsoring or- ganizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these Web sites. Ordering Information To receive documents or other information about occupational safety and health topics, contact NIOSH at Telephone: 1–800–CDC–INFO TTY: 888–533–8573 E-mail: [email protected] or visit the NIOSH Web site at www.cdc.gov/niosh. For a monthly update on news at NIOSH, subscribe to NIOSH eNews at www.cdc.gov/ niosh/eNews. DHHS (NIOSH) Publication Number 2011–197 July 2011 Safer • Healthier • PeopleTM ii World Trade Center Health Program World Trade Center Health Program iii Preface to First Periodic Review of Scientific and Medical Evidence Related to Cancer for the World Trade Center Health Program The James Zadroga 9/11 Health and Compensation Act of 2010, Public Law 111-347, Title XXXIII of the Public Health Service Act, 124 Stat. 3623 (codified at 42 U.S.C. sec. 300mm—300mm-61), requires the Administrator of the World Trade Center (WTC) Health Program to “periodically conduct a review of all available scientific and medical evidence, in- cluding findings and recommendations of Clinical Centers of Excellence, published in peer-reviewed journals to determine if, based on such evidence, cancer or a cer- tain type of cancer should be added to the applicable list of WTC-related health conditions.” 42 U.S.C. sec. 300mm-22(a)(5)(A). I am pleased to present the first periodic review of cancer for the WTC Health Program. The review is based on three information sources. First, a systematic search was con- ducted for peer-reviewed findings on exposure and cancer resulting from the Septem- ber 11, 2001, terrorist attacks that have been published in the scientific and medical literature between September 11, 2001, and July 1, 2011. Second, findings and recom- mendations related to cancer were solicited from the WTC Clinical Centers of Excel- lence and Data Centers, the WTC Health Registry at the New York City Department of Health and Mental Hygiene, and the New York State Department of Health. Third, information from the public about cancer was solicited through a Request for Informa- tion published in the Federal Register on March 8, 2011, and March 29, 2011. Overall, this inaugural review of cancer presents findings from the peer-reviewed sci- entific and medical literature about exposures and cancer resulting from the September 11, 2001, terrorist attacks. In addition, the review provides the status of planned and ongoing research efforts to address questions about cancer related to the exposures re- sulting from the terrorist attacks. Specifically, Chapter I describes how the bibliographic search of scientific and medical findings was conducted. Chapter II summarizes the information contained in scientific and medical publications about September 11, 2001, exposures. Chapter III cites the very few peer-reviewed study reports that contain any quantitative data about cancer as a health outcome resulting from September 11, 2001, exposures. In Chapter IV, a primer on cancer epidemiology is presented. In Chapter V, input from the public and from the WTC Clinical Centers of Excellence, the WTC Health Registry, and the New ii World Trade Center Health Program World Trade Center Health Program iii York State Department of Health about cancer is presented. Chapter VI discusses the challenge of determining whether an observed association between one or more of the September 11, 2001, exposure variables and the health outcome of cancer is causal. Finally, the review includes updates from researchers about current studies of cancer. It is expected that the second periodic review of cancer will be conducted in early to mid-2012 to capture any emerging findings about exposures and cancer in responders and survivors affected by the September 11, 2001, terrorist attacks. John Howard, MD Administrator, World Trade Center Health Program iv World Trade Center Health Program World Trade Center Health Program v Acknowledgments The first periodic review of cancer for the World Trade Center Health Program was re- searched and developed by the WTC Health Program Cancer Working Group: Kathleen D. Connick, MSLS, MA Division of Library Sciences and Services Office of Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention Paul Enright, MD Consultant, NIOSH Division of Respiratory Disease Studies Professor, School of Medicine University of Arizona Paul J. Middendorf, PhD, CIH National Institute for Occupational Safety and Health Centers for Disease Control and Prevention John Piacentino, MD, MPH National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Dori B. Reissman, MD, MPH National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Tamela Sawyer, MS National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Kerry Souza, ScD, MPH National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Appreciation is expressed to the following individuals for their review of the first peri- odic review of cancer for the WTC Health Program: Sherry Baron Kristin Cummings Gayle DeBord John Decker Frank Hearl Max Kiefer Ken Martinez Richard Niemeier Paul Schulte Teresa Schnorr Mary Schubauer-Berigan Christine Sofge Douglas Trout Kenneth Wallingford David Weissman Elizabeth Whelan iv World Trade Center Health Program World Trade Center Health Program v Contents Preface to First Periodic Review of Scientific and Medical Evidence Related to Cancer for the World Trade Center Health Program.... iii Acknowledgments .................................................... v Abbreviations ......................................................... x Units of Measurement................................................. xii I. Bibliographic Searches .............................................. 1 A. Search Strategies ................................................... 1 B. Exposure Results ................................................... 5 C. Cancer Results . 5 D. Future Periodic Reviews............................................. 5 E. Other Searches ..................................................... 5 II. Review of Exposures ................................................ 7 A. Introduction....................................................... 7 B. Designations for Agents Identified at the WTC ......................... 8 C. Environmental Monitoring .......................................... 9 1. Chrysotile Asbestos............................................... 10 2. Metals .......................................................... 11 3. Polychlorinated Polycyclic Compounds ............................. 11 4. Polycyclic Aromatic Hydrocarbons ................................. 12 5. Volatile Organic Compounds ...................................... 12 6. Crystalline Silica ................................................. 13 7. Fibrous Glass .................................................... 13 8. Particulate Matter (Dust) .......................................... 14 9. Tritiated Water................................................... 14 D. Biomonitoring ..................................................... 15 1. Particles Deposited in the Respiratory Tract.......................... 15 2. Metals .......................................................... 15 3. Polychlorinated Polycyclic Compounds ............................. 16 4. Polycyclic Aromatic Hydrocarbons ................................. 16 5. Volatile Organic Compounds ...................................... 17 E. Use of Personal Protective Equipment—Respirators ..................... 17 F. Limitations of Chemical Exposure Assessment .......................... 17 World Trade Center Health Program vii G. Other Exposures ................................................... 18 H. Toxicological Studies ............................................... 19 III. Review of Cancer .................................................. 21 A. Cancer Publications ................................................ 21 B. Peer-Reviewed Cancer Publications ................................... 21 1. Risk Models ..................................................... 21 2. Cancer Reviews .................................................. 21 3. Case Series of Multiple Myeloma ................................... 21 C. Non-Peer-Reviewed Cancer Publications .............................. 21 1. Letter to the Editor and Author’s Response About Multiple Myeloma .... 21 2. Other........................................................... 22 IV. Cancer Epidemiology .............................................. 25 A. Basic Concepts .................................................... 25 B. Observed Associations and Causal Associations ........................ 25 1. Strength .......................................................
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