The Suit Magazine

Just ten days before Americans turned their attention to the memory of fateful events that took so many lives and changed the course of our nation a decade ago, The Lancet released a long-awaited report acknowledging a connection between cancer and exposure to the toxic elements found at the World Trade Center site following the September 11 terrorist attacks.

This finding comes on the heels of a July report issued by National Institute for Occupational Safety and Health (NIOSH), which did not find sufficient evidence to indicate a cancer connection. NIOSH has been appointed by Congress to monitor cancer for potential inclusion as a covered condition under the James Zadroga 9/11 Health and Compensation Act of 2010.

In accordance with the Zadroga Act, Congress has set aside $4.3 billion to cover healthcare expenses for ailments with a proven link to Ground Zero exposure. The fund also compensates survivors for economic losses incurred by the death of family members who became ill after the original Victim Compensation Fund, established in 2001, closed in 2003.

"There are specific health conditions that are covered," explained NIOSH Public Affairs Officer Fred Blosser. "Congress said that cancer was not included in those conditions, but that NIOSH should review the scientific and medical evidence related to the question of cancer and WTC exposures."

While NIOSH's first periodic review could not find enough peer-reviewed evidence to establish a cancer link at the time, Blosser added, "We also pointed out that the current absence of published scientific and medical findings did not indicate evidence of an absence of an association between the WTC exposures and the occurrence of cancer."

The Lancet report, whose senior author is Dr. David Prezant, a professor at the Albert Einstein College of Medicine, revealed the findings of a comprehensive seven-year study of nearly 9,853 New York firefighters, including some who were exposed to the toxic debris and others who weren't. The results showed a 19 percent increase in the probability that WTC rescue workers would develop cancer, as compared to non-exposed colleagues. Furthermore, study participants showed a 10 percent greater risk for developing cancers than the general population.

In a press release, Dr. Prezant noted the results "support the need to continue monitoring firefighters and others who responded to the World Trade Center disaster or participated in the recovery and cleanup at the site. This monitoring should include cancer screening and efforts to prevent cancer from developing in exposed individuals."

"We will do a second review," Blosser said. "We expect that to be done in early- to mid-2012. In that review, we will incorporate any new peer-reviewed evidence, and that includes the papers published in The Lancet."

According to the Congressional Research Service summary memorandum issued in January 2011, the Zadroga Act grants the appointed administrator, Sheila Birnbaum, authorization to add cancer via regulation if NIOSH presents sufficient evidence supporting a correlation.

Michael Barasch, the attorney who represented James Zadroga himself and was instrumental in advocating for the resultant healthcare act, speculated about likely next steps.  "The New York Fire Department believes the risk of getting certain cancers was caused by exposure,” he said. “Ms. Birnbaum is waiting for NIOSH to decide which, in their opinion, are related. I have a feeling they're going to go along with the fire department [and The Lancet report’s findings], because they have the statistical data. At the end of the day, you have to have the statistical evidence that your illness is related."

At the time the bill was passed, the anticipation was that a cancer link would eventually be proven. But since conclusive evidence was not yet available—and rather than walking the ethically vague line of allowing members of Congress to answer scientific medical questions—the bill was drafted with internal mechanisms allowing for the eventual inclusion of cancer without further Congressional approval.

However, the Act contains no provisions to increase funding should coverage be expanded to cancer-related treatments, losses, or death. The high costs of treating cancer could have untold impact on the availability of allotted funds.

"It sounds like a lot of money," Barasch cautioned. "Nobody knows how many claims are going to be made. And since Ms. Birnbaum expanded the geographical boundaries to include residents up until Canal St., what happens if people on Canal St. start calling and claiming they have asthma? She's going to have to take a very hard look and see when they started developing symptoms. If they say 2003, she's going to say, 'Show me the medical proof.' People are going to have to prove it. Otherwise, you're going to have 50,000 residents making claims, and there's not enough money for that."

For first responders and financial district residents who have since suffered from debilitating respiratory ailments and are now seeing a spike in cancer diagnoses, The Lancet’s report could be the first step toward receiving desperately-needed funding for cancer treatments.

In a 2007 report published by the American Cancer Society, 37 percent of cancer-related deaths could have been prevented with adequate healthcare coverage. For those currently diagnosed but unable to afford treatment, waiting for statistical evidence linking cancer to Ground Zero exposure could prove life-threatening—a sobering reminder for all of us, as we watch footage of the tragic day replay in tribute, that although the site has been cleared, the devastating reality continues to haunt the most heroic among us.

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