Is World Trade Center cleanup site exposure linked to lung cancer?

For weeks and months following the Sept. 11 terrorist attacks, first responders, construction workers and volunteers took part in the search, rescue, recovery and cleanup efforts on the World Trade Center site, inhaling a poorly understood toxic muck in the air and on the ground. For a study published today in JAMA Network Open, researchers looked at the potential long-term risk of lung cancer among World Trade Center responders.

Here are the key takeaways that oncologists and other physicians need to know, as reported in the JAMA Network Open study, “Lung Cancer Incidence After September 11, 2001, Among World Trade Center Responders.”

Question: Is there an association between occupational exposures while working at the World Trade Center (WTC) disaster sites and the incidence of lung cancer over a decade later?

Findings: In this cohort study including 12,334 WTC responders aged 49.3 years at study inclusion, 118 developed incident lung cancer more than a decade after exposure. Compared with minimally exposed responders who reported low dust exposure, responders working on the WTC sites who reported more severe exposures had a nearly threefold higher incidence of lung cancer even after adjusting for demographic factors and smoking.

Meaning: This study suggests that, when compared with the lowest reported exposure levels, a higher level of reported exposure to more particulate dust or debris was significantly associated with an increased incidence of lung cancer.

AMA members can explore a range of peer-reviewed research and clinical information published by the JAMA Network™, which brings JAMA^® together with JAMA Network Open and 11 specialty journals. Published continuously since 1883, JAMA is one of the most widely circulated, peer-reviewed, general medical journals in the world. If you are an AMA member or interested in becoming one, learn how to access these educational materials and innovative tools. 

“Revisiting Minimum Case Volume Recommendations for Complex Surgery in Contemporary Practice,” published in JAMA. Current minimum case volume standards for complex surgical procedures, based on older volume outcome studies, do not align with contemporary practice. These findings demonstrate that volume-outcome curves have changed, with fewer cases needed to meet benchmark 30-day mortality over time.

“Long-Term Continuous Monitoring of New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting,” published in JAMA. Although the incidence of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG) in this study was higher than previously reported, the AF burden in these patients was very low, especially after 30 days. The very low AF burden questions the current guideline recommendations that long-term oral anticoagulation should be considered in patients with new-onset AF after CABG.

“Open-Label Placebos as Adjunct for the Preventive Treatment of Migraine: A Randomized Clinical Trial,” published in JAMA Network Open. In this randomized clinical trial, open-label placebo treatment did not reduce headache frequency but was associated with improvements in quality of life and pain-related disability. Future research should clarify the mechanisms underlying these effects and determine their potential supportive role in migraine care for selected patients.

“Cannabis Use Among Individuals With Psychosis After State-Level Commercial Cannabis Legalization,” published in JAMA Psychiatry. In this study, individuals with psychosis reported a large increase in current cannabis use following legalization and commercialization of cannabis in their state, and by larger amounts than previously reported estimates of the general population. Given how cannabis can negatively affect illness course and health-service utilization in individuals with psychosis, these results should be considered by regulators designing policies around taxation, potency, advertising and health warnings.

The subscription cost of JAMA is included with your AMA membership, plus unlimited digital access to all JAMA Network journals, including: JAMA, JAMA Network Open, JAMA Cardiology, JAMA Dermatology, JAMA Internal Medicine, JAMA Neurology, JAMA Oncology, JAMA Ophthalmology, JAMA Otolaryngology–Head and Neck Surgery, JAMA Pediatrics, JAMA Psychiatry, and JAMA Surgery.

The online journals include many helpful features for students, residents and fellows, including full-text PDFs, clinical challenges, archived editions, audio and video author interviews where authors give their perspectives on a study’s objectives, findings and implications. 

There are several ways physicians can leverage resources from the JAMA Network to help them in their clinical practice:

• Take CME courses and earn AMA PRA Category 1 Credit™.
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• Read concise summaries of clinical guidelines and recommendations in a streamlined format designed for today’s busy physicians.
• Access one-page articles that present key facts in patient-friendly terms to support you and your patients.