The aftermath of the September 11 attack on the World Trade Center in New York City has extended beyond the war on terror and related efforts aimed at promoting the national security of the United States. Immediately and several years after the terrorist attack that caught the world by surprise, first responders and survivors who were in the ground zero vicinity fell ill and developed respiratory-related illnesses, most notably lung cancer.
A layer of dust and debris enveloped Manhattan after the collapse of the Twin Towers. Veiled within the cloudy air and inhaled by first responders and survivors were particles and chemicals—pulverised concrete, asbestos, fibreglass, mercury, and benzene, among others.
The World Trade Cough: Lung diseases and the aftermath of WTC collapse
Pulmonary disease specialist Dr. David Prezant of the New York City Fire Department or FDNY coined the term “World Trade Cough” in 2002 after firefighters developed chronic respiratory ailments. In his research co-authored with colleagues, findings revealed that 8 percent of the FDNY firefighter workforce who first responded during and immediately after the terrorist attack developed disabling persistent cough associated with reduced forced vital capacity and forced expiratory volume in one second.
Another 23 percent had bronchial hyperresponsiveness as indicated by the result of methacholine challenge. Overall, those who developed the so-called “World Trade Cough” had reduced lung function as determined by spirometry.
Prezant et al concluded that intense albeit short-term exposure to materials generated during the collapse of the World Trade Center was associated with bronchial responsiveness and the development of cough. Furthermore, clinical and physiological severity was related to the intensity of exposure.
At the time of Prezant et al study, researchers were unaware of what environmental constituents at the World Trade Center site caused the respiratory ailments. Nonetheless, the first periodic review from the World Trade Center Health Program that involved assessing peer-reviewed literatures identified 287 chemicals and chemical groups.
Toxic chemicals and human carcinogens from WTC debris
Categories of the identified chemicals include asbestos and glass fibres, crystalline silica, various metals, volatile organic compounds, polychlorinated polycyclic compounds, and polycyclic aromatic hydrocarbons.
Some of these chemicals are known or at least reasonably anticipated as human carcinogen. Thus, exposure to any of these chemicals have been associated with the development of several types of cancer, such as lung cancer including mesothelioma; skin cancer; bladder cancer; hematopoietic cancers; testicular cancer; prostate cancer; and liver and biliary cancer.
Another study conducted by Samara Solan et al investigated and evaluate cancer incidence during the first seven years after the September 11 terrorist attack. Among 20,984 consented participants, 575 cancers were diagnosed in 552 individuals. These cancers include thyroid cancers, prostate cancer, combined hematopoietic and lymphoid cancers, and soft tissue cancer.
However, Solan et al noted that the results of their study should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. Nonetheless, they still concluded that the findings highlighted the need to for continued medical monitoring and surveillance among responders and survivors.
But apart from respiratory ailments and cancer, another study by M. P. Webber et al has established an association between 9/11 WTC rescue and recovery operations and the development of systemic autoimmune diseases.
The Weber et al research involved a nested case-control study performed in rescue and recovery workers. Results revealed that rheumatoid arthritis was the most common autoimmune diagnosis, about 37 percent of subjects; followed by spondyloarthritis with 22 percent; inflammatory myositis with 14 percent; systemic lupus erythematosus with 12 percent; systemic sclerosis with 5 percent; Sjögren’s syndrome with 5 percent; antiphospholipid syndrome with 3 percent; and granulomatosis with polyangiitis with 2 percent.
Weber et al concluded that prolonged work at the WTC site, independent of exposure, was an important indicator for the development of systemic autoimmune diseases. The researchers called for expanded surveillance efforts for those with extended exposures in order to provide them with necessary medical attention.
WTC collapse and health effects on pregnant women and children
Exposure to the chemicals from the dust and debris generated by the collapse of WTC also had an effect on pregnant women and their unborn children, as well as in children.
Researchers P. J. Landrigan et al reviewed several clinical and epidemiological studies. Their assessment mentioned a study conducted by Mount Sinai School of Medicine researchers that revealed a doubling in incidence of intrauterine growth retardation among infants born to exposed mothers as compared to infants born to unexposed mothers.
Another result from a study conducted by Columbia research team revealed that exposed pregnant women gave birth to infants with significantly lower birth weight and shorter length than women living at greater distances from WTC site. Researchers from the New York University documented increased numbers of new asthma cases and aggravations of pre-existing asthma in children living in lower Manhattan.
Researchers Landrigan et al noted that children are uniquely sensitive to toxic exposures in the environment. This sensitivity demonstrates not only disproportionately heavy exposure but also the biologic vulnerability of children who are undergoing complex transitions of early development.
Aftermath: The link between 9/11 Terrorist Attack and cancer, other diseases
The rising incidence of respiratory ailments and other diseases, particularly cancer among firefighters, respondents, and survivors prompted the U.S. government, particularly the Department of Health and Human Services, to launch the World Trade Center Health Program under the Zadroga 9/11 Health and Compensation Act of 2010. This program has provided medical monitoring and treatment for individuals exposed to the dust and debris arising from the collapse of the Twin Towers in New York as well as in Pentagon and in Shanksville, Pennsylvania.
Further readings: (1) Prezant et al. 2002. “Cough and bronchial responsiveness in firefighters at the World Trade Center site.” The New England Journal of Medicine. (2) World Trade Center Health Program. 2011. “First periodic review of scientific and medical evidence related to cancer for the World Trade Center Health Program.” published by the U.S. Department of Health and Human Services. (3) Solan et. 2013. “Cancer incidence in World Trade Center rescue and recovery workers, 2011-2008.” Environmental Health Perspectives. (4) Landrigan et al. 2008. “Impact of September 11 World Trade Center disaster on children and pregnant women.” The Mount Sinai Journal of Medicine. (5) Webber at al. 2015. “Nested case-control study of selected systemic autoimmune diseases in World Trade Center rescue/recovery workers.” Arthritis & Rheumatology.