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Int J Cancer. 2018 Dec 17. doi: 10.1002/ijc.32070. [Epub ahead of print]

Excess HPV-related head and neck cancer in the World Trade Center Health Program General Responder cohort.

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Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, rm. 133 Piscataway, New Jersey, 08854.
Rutgers, The State University of New Jersey, Cancer Institute of New Jersey.
Clinical Research and Occupational Medicine, Rutgers, The State University of New Jersey, Occupational Health Sciences Institute (EOHSI).
Icahn School of Medicine at Mount Sinai, Environmental Medicine and Public Health.
Icahn School of Medicine at Mount Sinai, Environmental Medicine and Public Health Shapiro, Moshe.
Division of General Internal Medicine, Robert Wood Johnson Medical School, Rutgers University.
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Research Institute.
Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell School of Medicine at Hofstra University.
Bellevue Hospital Center/New York University School of Medicine, Environmental Medicine, New York, New York.
Department of Medicine, Stony Brook University Medical Center.
Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai Tisch Cancer Institute.
Environmental and Occupational Medicine, EOHSI Clinical Center & Rutgers.


The World Trade Center (WTC) attacks exposed rescue and recovery workers to a complex mix of toxicants, including carcinogens. This study compared site-specific cancer incidence of head and neck cancers (HNC) from 2003 through 2012 among 33,809 consented WTC General Responder Cohort (GRC) members to the New Jersey State Cancer Registry, using standardized incidence ratios (SIRs). HNC grouped using SEER ICD-O-3 codes into HPV-related (oropharyngeal) and non-related (other oral-nasal; laryngeal) tumors based on anatomical site. For the 73 GRC members identified with HNC, proportional hazard regression assessed the relationship between WTC exposure and other socio-demographic characteristics. An overall excess of HNC was not observed (SIR = 1.00, 95% CI: 0.78, 1.25) but excess cancer was seen in the latest observation period (2009-2012: SIR=1.4; 95% CI: 1.01, 1.89). A similar temporal pattern was seen for HPV-related oropharyngeal cancer and laryngeal cancer, but not for non-HPV-related sites (oral-nasal cancer). HNC was significantly associated with increasing age (8% per year, 95% CI: 5%, 12%), non-Hispanic white race-ethnicity (hazard ratio (HR) = 3.51, 95 CI: 1.49, 8.27); there was a borderline association with the 9/11 occupation of military/protective services vs. others (HR = 1.83 95% CI: 0.99, 3.38; p=0.0504). Caution is needed in interpreting these results given the small number of cases, potential for surveillance bias, and long latency for most cancers. Our findings highlight the need to examine the potentially carcinogenic effects of WTC exposure in the context of other strong risk factors, and the need for continued medical monitoring of WTC responders. This article is protected by copyright. All rights reserved.


HPV; Head and neck cancer; World Trade Center


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