By Anemona Hartocollis
The New York Times
NORFOLK, VA — A federal health official’s ruling has cleared the way for 50 types of cancer to be added to the list of sicknesses covered by a $4.3 billion fund set up to compensate and treat people exposed to toxic smoke, dust and fumes in the months after the Sept. 11, 2001, terrorist attack on the World Trade Center.
The decision, released Friday afternoon, came as vindication for hundreds of people who have claimed - often in the face of resistance from public health officials - that their cancers were caused by their exposure to the dust cloud and debris from the destruction of the twin towers.
It will allow not only rescue workers, but also volunteers, residents, schoolchildren and passers-by to apply for money to pay for compensation and treatment for cancers developed after the attack. The cancers will not officially be added to the list until after a period of public comment lasting several months.
The decision, by Dr. John Howard, director of the National Institute for Occupational Safety and Health, comes despite a lack of epidemiological evidence linking the attack to cancer.
It also poses a number of logistical challenges: It will be difficult, if not impossible, to separate people who developed cancer as a result of ground zero from those who would have gotten the disease anyway, and many cancer diagnoses are likely to be made years after the fund is exhausted.
But in a lengthy report defending his decision, Howard said a New York Fire Department study published last fall in the British journal The Lancet had provided a strong foundation for a conclusion that some cancers had been caused by exposure to the debris. The study showed that firefighters exposed to toxic substances at ground zero had a 19 percent higher rate of cancer than firefighters who were not exposed.
Beyond the Lancet study, he said, he had relied on recommendations made in late March by a scientific and technical advisory committee consisting of experts from the fields of cancer, environmental medicine, toxicology and epidemiology as well as neighborhood activists and union officials. He fully adopted the committee’s recommendation that 14 broad categories of cancer, encompassing 50 specific types, should be deemed as World Trade Center-related.
Among the cancers Howard approved are some of the most common, including lung, breast, colon, trachea, esophageal, kidney, bladder, skin, thyroid, blood and bone marrow cancers.
The committee had considered but rejected, in a 14-3 vote, the notion of adding all cancers to the list. It had also explicitly rejected pancreas, brain and prostate cancer, for various reasons.
The committee report said 70 known and potential carcinogens had been found in the smoke, dust and fumes from the disaster; that 15 of those were known to cause cancer in people; 37 were “reasonably anticipated” to cause cancer; and others were probable and possible carcinogens. In many cases, the report said, it is believed that “any level of exposure carries some risk.” Some of the substances might act synergistically, the committee said, to produce unexpected health effects.
From the beginning, scientists, doctors and victims of the attack have complained that there was little real-time data collected on toxic substances at ground zero and on levels of exposure. On the contrary, in the early days after 9/11, there were official statements that it was safe to operate at the site.
Many first responders unflinchingly followed orders to report for work downtown for days, weeks, months and years on end, without thinking of the health consequences. Volunteers poured into the site. Schoolchildren at schools in the immediate vicinity were at first evacuated but returned to school while the area was still a wasteland.
A study by an advisory committee said 70 known and potential carcinogens had been found in the smoke, dust and fumes from ground zero. Fifteen of those were known to cause cancer in people; 37 were “reasonably anticipated” to cause cancer; and others were possible carcinogens.
Among the cancers approved are lung, breast, colon, trachea, esophageal, kidney, bladder, skin, thyroid, blood and bone marrow cancers.
The rejected cancers include pancreas, brain and prostate cancers.
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