The federally funded World Trade Center Program at the Mount Sinai School of Medicine in New York offers WTC responders free medical surveillance examinations and targeted treatment for health conditions related to WTC work exposures.
The wreckage of the World Trade Center still smolders as recovery operations continue, October 10, 2001. (Photo by Michael Rieger courtesy FEMA)
Of the estimated 40,000 men and women who were exposed to products of combustion and particulate matter following the attacks on September 11, 2001, more than 27,000 responders have been medically screened under the Mount Sinai program.
Post 9/11 asthma attacks or episodes were reported by as many as eight percent of 20,843 workers and volunteers who provided rescue and recovery, essential service restoration, and cleanup efforts after two terrorist-controlled planes struck the twin towers, releasing caustic dust and toxic pollutants, according to a Mount Sinai study published in November.
Asthma is typically seen in only four percent of the population.
"Although previous WTC studies have shown significant respiratory problems, this is the first study to directly quantify the magnitude of asthma among WTC responders," said Hyun Kim, ScD, instructor of Preventive Medicine at Mount Sinai School of Medicine and lead author of the analysis.
"Eight years after 9/11 the WTC Program is still observing responders affected by asthma episodes and attacks at rates more than twice that of people not exposed to WTC dust," he said.
Of the study's rescue and recovery workers, 86 percent were men and the average duration of work at World Trade Center sites was 80 days. The study followed uniformed and other law enforcement and protective service workers, who made up 42 percent of subjects, as well as construction workers and other responders.
Dr. Philip Landrigan (Photo courtesy NIEHS)
"It is important to note that this report focused on findings from baseline or initial visit examinations," said Philip Landrigan, MD, who chairs Mount Sinai School of Medicine's Department of Preventive Medicine and serves as principal investigator of the WTC Program Data and Coordination Center.
"The data show an increasing percentage of responders reporting asthmatic episodes, rising to double that seen in the general population," Dr. Landrigan said. "It is clearly vital that we continue to track responders' health and look further into the medical outcomes of this population."
In addition, a study by Mount Sinai researchers published in February 2009 found that 24 percent of World Trade Center responders continued to have impairment of their lung function after their second exams at Mount Sinai's World Trade Center Medical Monitoring and Treatment Program.
Led by Gwen Skloot, MD, associate professor of medicine and pulmonary, critical care and sleep medicine at Mount Sinai, analyzed the changes in spirometry results between the first exam and the second exam of WTC responders, which occurred an average of 32 months after the first exam.
Spirometry, the most widely used measurement of lung function, is a 15-minute breathing test that Mount Sinai offers to all WTC Program participants. "The majority of individuals did not have an excessive decline in lung function between examinations," said Dr. Skloot. "We are now intensively studying the subgroup with excessive change in lung function in order to identify important predictors of change."
"We believe that these persistent abnormalities were due to a combination of persistent asthma, restrictive disorders such as lung scarring or chest wall abnormalities, as well as unknown factors, " said Paul Enright, MD, research professor of medicine at University of Arizona College of Public Health and adjunct professor of community and preventive medicine at Mount Sinai.
Rescue workers at the World Trade Center, October 5, 2001. (Photo by Andrea Booher courtesy FEMA)
"We think that it is important for us to continue to examine the responders to determine the possible causes," Dr. Enright said.
Medical experts agree it is important to continue close monitoring of the 9/11 responders for emerging health problems.
"Asthma and other chronic lung conditions remain a significant burden for rescue and recovery workers responding to the attacks on the World Trade Center," said Kalpalatha Guntupalli, MD, president of the American College of Chest Physicians.
"The significant chronic health problems associated with the WTC attacks only reinforces the need for stronger disaster preparedness plans as well as long-term medical follow-up for 9/11 responders and individuals who respond to disaster-related events," said Dr. Guntupalli.
In addition, multiple myeloma, a form of cancer whose time of onset is usually after 50, has been detected in a small but significant number of World Trade Center responders under age 45, Mount Sinai researchers reported in August 2009.
They believe is too early to say whether a higher cancer risk exists among personnel who worked at Ground Zero.
"While it is too soon, and the numbers are too small at this juncture, to state unequivocally that a risk of multiple myeloma is truly increased among WTC responders, the program felt it important to report these cases, particularly since this type of cancer is unusual in persons under 45," said lead author Jacqueline Moline, MD, director of the WTC MMTP Clinical Center at Mount Sinai.
"Physicians who may be caring for 9/11 responders should be alert for diseases occurring at unusual ages or other emerging conditions among WTC responders," said Dr. Moline.
There are no other published studies evaluating the potentially carcinogenic effects of exposure to a complex mixture of substances comparable to that sustained by WTC responders. But it is known that many of the potential exposures at the World Trade Center, including benzene, paint and solvent vapors, aromatic hydrocarbons, polychlorinated biphenyls, dioxin, pesticides, engine exhaust and metals, have been associated with increased rates of multiple myeloma in other studies.
"This finding also underscores the importance of regular, ongoing medical monitoring for this highly exposed population, including surveillance for cancer and other emerging diseases," said Dr. Landrigan. He said Mount Sinai's WTC Program is establishing linkages with the New York State Cancer Registry.
Copyright Environment News Service (ENS) 2010. All rights reserved.