Experts: Prostate cancer emerges as WTC malady


Prostate cancer, premature stiffening of the heart and thyroid malignancies are emerging as key medical research concerns, according to health experts who this week will present new data on World Trade Center-related disorders at a Manhattan symposium.

Newly identified biomarkers — specific proteins in the blood — are helping doctors better understand prostate malignancies in first responders and others who worked at Ground Zero, said Dr. Michael A. Crane, director of the World Trade Center Health Program at The Mount Sinai Hospital, sponsor of Wednesday’s event at the New York Academy of Medicine.

The research also reveals that other disorders, such as heart stiffening, are occurring at younger ages among first responders, recovery workers and some residents of lower Manhattan who are part of the WTC monitoring program. This cardiac problem, which involves how effectively the organ pumps blood, usually is diagnosed in elderly patients, doctors said.

The increased incidence of prostate cancer appears to have roots in trade center exposures, doctors said.

“We are seeing some very young men with prostate cancer. The youngest one is 34,” Crane said. “Some guys have walked through the door of our center with very advanced-stage disease, and I can tell you this is something that is very rough on their families.”

The symposium is to feature reports on a range of health effects that have emerged over the past 15 years. Among the speakers are Dr. John Howard, administrator of the World Trade Center Health Program and director of the National Institute for Occupational Safety and Health, and Dr. David Prezant, the FDNY’s chief medical officer who defined “World Trade Center cough,” the first condition to develop from exposure to Ground Zero debris.

Prostate cancer has turned up in three consecutive studies as a malignancy prevalent in unexpected rates in men who worked at and around Ground Zero.

Crane, who noted that research has shown “rates of several cancers are elevated in this population,” said Mount Sinai scientists are studying whether their statistical discovery of increased prostate cancer is genuine or an artifact of over-diagnosis because of enhanced medical surveillance of people in World Trade Center health programs.

Nearly 6,000 people who were at or near Ground Zero have developed cancers of all kinds, according to World Trade Center Health Program statistics. The latest tally was completed on June 30.

Among the broad range of documented cancers, doctors have identified mesothelioma as one type seen among Ground Zero workers. Others include blood-cell malignancies, such as lymphomas, multiple myeloma and leukemias. Doctors also have diagnosed a higher-than-expected rate of thyroid cancers.

Toxic exposures occurred through the most direct routes: swallowing, inhaling and absorption via the skin, Crane said. Mercury, lead and polynuclear aromatic hydrocarbons were detected in Ground Zero air. The dust, meanwhile, lingered for weeks.

The prostate, part of the male reproductive system, is a small gland about the size and shape of a walnut that encircles a portion of the urethra, a tubelike structure that carries urine to the bladder. It secretes fluid that nourishes and protects sperm.

In the general population, prostate cancer is the most prevalent malignancy in men throughout the United States. This year, it will be diagnosed in about 180,890 men, and 26,120 will die of it, according to American Cancer Society estimates.

A study reported this month in the American Journal of Industrial Medicine, which devoted its entire issue to World Trade Center health concerns, showed that among 24,000 trade center responders and workers, 223 men developed prostate cancer. It was the highest number for any form of cancer listed in the research.

Doctors recorded 685 cancers of all kinds among the 24,000 study participants. Prostate cancer accounted for nearly 33 percent of all malignancies.

Tony Cruz, 65, chief of Smithtown’s volunteer fire department and a retired FDNY firefighter, spent weeks at Ground Zero.

He said he’s not surprised that scientists are seeing higher than usual numbers of prostate cancers among first responders and others who labored at the site. Members of his profession have long had high rates of the disease, he said.

“We are two-and-a-half times more likely to come down with any form of cancer than the general public,” said Cruz, New York’s director of the Firefighter Cancer Support Network, which counsels recently diagnosed firefighters about prostate tumors and other malignancies. The group’s aim is to help men understand their diagnoses, he said.

Cruz and experts in occupational medicine said several studies have demonstrated an elevated cancer risk among firefighters.

“When you are fighting fires, you are in a cloud of carcinogens,” Cruz said, referring to hydrogen cyanide, molten plastics and other superheated petroleum products, Fiberglas, benzene and other toxic substances. Multiply the toxic substances and their hazardous byproducts by orders of magnitude, he said, and it’s easy to see how the quantity of Twin Tower debris is inducing long-running health problems and cancers across a broad spectrum.

“I had prostate cancer, and yes, I am certain it was occupational,” said Cruz, though he noted that his tumor was diagnosed about a year before the terror attacks of Sept. 11, 2001. He has not had a recurrence, but said he has chronic respiratory problems because of exposures in the aftermath of the towers’ collapse.

Highly engineered firefighting gear is not a barrier to cancer-causing toxins, he said.

“Even in our bunker pants we are not fully protected,” said Cruz, referring to the heat- and fire-resistant trousers that firefighters wear.

Dr. Mary Ann McLaughlin, a professor of cardiology at Mount Sinai, is studying another anomaly that might afflict first responders and other workers who were at Ground Zero.

Some have demonstrated a sleep-related problem — obstructive sleep apnea — that is linked to cardiac deterioration, she said.

In addition, some participants in the World Trade Center health programs have evidence of early stiffening of the heart muscle, a condition usually associated with advanced age or exposure to air pollution, McLaughlin said.

“We’re trying to make sure they are treated now so that this problem doesn’t develop into a future risk,” she said.

 

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