Head And Neck Cancer In The World Trade Center Health Program Cohort; Elucidating Risk Factors To Reduce Incidence And Morbidity


Head and neck cancer may be among the increased disease risks incurred from exposure to the toxicdebris cloud that formed when the World Trade Center (WTC) buildings collapsed on 9/11, and to thesubsequent mix of airborne pollutants during the rescue, recovery, and cleanup. The exposure to theseanatomical sites (i.e. mouth, nasal and sinus cavities, and throat) was unique because of the directexposure to the larger particles. The association between head and neck cancer and WTC-relatedexposure is also possible because these cancers have previously been causally associated withoccupational respiratory exposures (e.g. wood dust). Synergistic interactions have also been observedbetween occupational exposures and some modifiable risk factors (e.g. tobacco and asbestos) and headand neck cancer incidence. Interaction between WTC-related exposure and other risk factors for head andneck cancers (including tobacco use, alcohol consumption and oral human papillomavirus (HPV)infection) may therefore be important in the etiology of WTC-related cancer. Establishing the risk factorprofile for head and neck cancer among WTC responders will contribute to the evidence base fordeveloping improved prevention and control interventions. This is important because people with headand neck cancer have a high risk of primary treatment failure, long-term disability, disfigurement, anddeath. This innovative study will use a nested case-control study to assess the association between WTCexposures and head and neck cancer while controlling for socio-demographic and behavioral risk factors.For each WTC Health Program (WTC-HP) participant with head and neck cancer, we will select threeWTC-HP controls matched by age, sex, and vital status (dead/alive). The proposed project also include acase-case study to explore additive and multiplicative effects of WTC exposure with other head and neckcancer risk factors, including tobacco and alcohol use and infection with the human papilloma virus.Here, for each WTC-HP participant with head and neck cancer we will enroll three non-WTC responderswith head and neck cancer from the New Jersey State Cancer Registry, matched by age at diagnosis, yearof diagnosis, and vital status. Furthermore, the study will describe risk factor and disease presentationamong the WTC-HP members diagnosed with head and neck cancer in order to optimize strategies forrisk factor modification and early detection. The relative contribution (population attributable fraction) ofmodifiable risk factors to head and neck cancer incidence in our patient population will be calculated.Patient chart reviews will be conducted to identify gaps in risk factor assessment and screening. Thefindings from this study will help to build the evidence base for developing recommendations forprevention of these devastating cancers use among WTC responders.
Effective start/end date9/1/168/31/18


  • National Institute for Occupational Safety and Health (NIOSH)


Head and Neck Neoplasms
Tobacco Use
Construction Industry