Six months ago, cancer was added to the list of illnesses covered by the $3.4 billion World Trade Center fund. Now, as reported on December 19th in the New York Times, the New York City Health Department has completed a study that compares cancer rates among 9/11 responders with overall cancer rates for New York State. Myeloma is at the top of the list of cancers occurring at a statistically higher rate in 9/11 responders. Myeloma is occurring at a 3-fold increased rate: the rate being +185% versus the average for New York State. Thyroid cancer was at +102% and prostate cancer at +43%. All others were not statistically increased in this study.

The findings are controversial in part because it is very early to be assessing the ultimate risks--and therefore much too soon to be drawing conclusions for most cancers, the occurrence of which will increase over time. However, the early increase in myeloma cases is quite remarkable and suggests a particular susceptibility to the exposures at 9/11 sites.

The specific chemical identified by the Zadroga Act reviewers (6 months ago) was 1-3 butadiene, a chemical linked to rubbers and other  fumes present at the 9/11 sites.  The chemical 1-3 butadiene is metabolized in the body via an epoxy mechanism. A study which I published in 2009 (Leukemia article on DNA SNP) showed that myeloma patients are more likely to have a defect in this epoxy metabolism, and, therefore, are potentially more susceptible to the toxic effects.

So it seems that a story is coming together linking exposure, susceptibility, and early onset of myeloma in the 9/11 setting. More studies and follow-ups are needed, but these findings are plausible and satisfy elements of what are called the "Bradford Hill Criteria," used to link toxic exposures and the development of cancer such as myeloma. There is already "proof of principle" that several toxic chemicals can cause myeloma, including pesticides, solvents, and chemicals such as 1-3 butadiene.

With this knowledge, there is now an opportunity for early screening to diagnose any case as soon as possible and look toward even curative intervention.  Every cloud has a silver lining--in this case, the ability to understand the process and intervene early.

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