Cancer Expert Shares Troubling Research on World Trade Center Exposure

Police officers and construction workers who responded on September 11, 2001, to the World Trade Center disaster in New York City and worked in its aftermath had at least twice the risk of developing the precursor for multiple myeloma compared to the general population, a new study by Sylvester Comprehensive Cancer at the University of Miami Miller School of Medicine researchers reveals.

C. Ola Landgren, M.D., Ph.D., chief of Sylvester’s Myeloma Program

The study, published in the high-impact Nature publication Blood Cancer Journal, provides mounting evidence that environmental exposure — particularly from a disaster like the one at the World Trade Center (WTC) — is a risk factor for developing multiple myeloma, according to world-renowned cancer expert and study author C. Ola Landgren, M.D., Ph.D., chief of Sylvester’s Myeloma Program.

Multiple myeloma is the second most common blood cancer in adults in the U.S. Each year, about 35,000 new cases are diagnosed and, today, more than 150,000 adults are living with multiple myeloma.

There is not yet an established curative therapy for the disease.

“Unlike most cancers, multiple myeloma has a known precursor condition, called monoclonal gammopathy. It is a protein that can be found in the blood. If you screen people over the age of 40, you will find that about 2% of people have this protein. If you have this protein in your blood, you are at risk for developing the cancer,” Dr. Landgren said. “Not everyone who has the protein gets multiple myeloma, but you need to have the protein in order to develop the blood cancer.”

That’s in the general population. All those risks are at least doubled in those who responded and worked in the aftermath of the WTC disaster.

Confirms Prior Findings

The paper in Blood Cancer Journal confirms findings from the research team’s prior study on WTC responders from the Fire Department of the City of New York (FDNY). In that study, published in 2018 in JAMA Oncology, Dr. Landgren and colleagues reported on nearly 800 firefighters who responded to the 9/11 WTC disaster. They found that there was a doubling of the firefighters’ rate of the precursor, meaning they were at twice the risk of developing multiple myeloma.

“We, along with our colleagues at FDNY’s World Trade Center Health program, found that firefighters who worked at the World Trade Center during and after 9/11 developed multiple myeloma about 10 years earlier than in the general population and tended to have more aggressive disease,” said Dr. Landgren, who also is leader of the Experimental Therapeutics Program and Paul J. DiMare Endowed Chair in Immunotherapy at Sylvester.

Rachel Zeig-Owens, DrPH, director of epidemiology for the WTC Health Program at the FDNY

The challenge was that the researchers could not establish whether the disaster triggered the increased risk, or if it was a risk of the firefighting profession in general.

“In this study, we added more than 1,000 police officers and construction workers who were part of the World Trade Center disaster and aftermath,” Dr. Landgren said. “What this study shows is that the risk of multiple myeloma precursor disease is between two and three times higher in both police officers and construction workers, which is what we saw in firefighters.”

The research, in essence, adds to evidence that the increased risk of multiple myeloma among first responders and construction workers can be linked to having worked at the WTC disaster site.

Understanding Future Risk

Rates of the multiple myeloma precursor and multiple myeloma diagnosis in firefighters, police, and construction workers deployed to the disaster were also two to three times higher than previous studies of multiple myeloma in the general U.S. population by Dr. Landgren and other researchers. Implications of this work are far-reaching.

“If you can find a cause of disease, it tells you that you should protect people from these types of exposures. So, firefighters, police officers, other people that have to respond to basically burn pits or fire pits or these types of dust clouds, they need to have appropriate protection devices,” Dr. Landgren said.

“Our current study supports our initial findings of an association between World Trade Center environmental exposures and monoclonal gammopathy of undetermined significance (MGUS),” said study author Rachel Zeig-Owens, DrPH, director of epidemiology for the WTC Health Program at the FDNY and assistant professor in the Department of Epidemiology and Population Health at Albert Einstein College of Medicine. “Not all patients with MGUS will develop multiple myeloma, but it is important that we continue to follow this population to understand their future multiple myeloma risk.”

Further Implications

The study has implications from a cancer perspective, according to Dr. Landgren.

David Prezant, M.D., chief medical officer, FDNY

“We, in clinics, see patients when they have multiple myeloma and when they have the precursor to multiple myeloma. If we knew there were certain things that actually triggered disease onset and could eradiate those risk factors, then we could then minimize the burden for individuals and the burden for society. There would be fewer of these cancers. It’s much like lung cancer and smoking: If we reduce smoking, that reduces lung cancer,” Dr. Landgren said.

The work also has implications for drug discovery.

“Hopefully, if you can mechanistically understand in future research how this happens, step by step, maybe this could also provide new avenues for drug targets,” Dr. Landgren said.

“These studies emphasize the need to include this blood test as part of regular cancer screening for all World Trade Center responders,” said David Prezant, M.D., chief medical officer, FDNY, special advisor to the fire commissioner for health policy, and co-director of FDNY’s WTC Health Program.

Sylvester researchers collaborated for the Blood Cancer Journal study with researchers from Montefiore Einstein Cancer Center; the Bureau of Health Services, FDNY; Albert Einstein College of Medicine; Renaissance School of Medicine at Stony Brook University; Memorial Sloan Kettering Cancer Center; and The Leukemia & Lymphoma Society.