Mesothelioma Cases in the World Trade Center Survivors

Our plain-English summary of Mesothelioma Cases in the World Trade Center Survivors, by M.E. Yilmaz, M. Rashidfarokhi, K. Pollard, et al (Annals of Case Reports, 2024).

The study

• Authors: M.E. Yilmaz, M. Rashidfarokhi, K. Pollard, N. Durmus, S. Keserci, D.H. Sterman, A.A. Arslan, Y. Shao, J. Reibman
• Journal: Annals of Case Reports
• Published: 2024;9(2)
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: The destruction of the World Trade Center (WTC) towers in New York City on September 11, 2001 (9/11), released approximately 1 million tons of pulverized particulate matter throughout southern Manhattan and areas in Brooklyn, exposing community members and responders to high levels of potentially toxic environmental particles. Asbestos exposure was a health concern because of its use in certain sections of the WTC towers. Malignant mesothelioma, originating from the lining cells (mesothelium) of the peritoneal and pleural cavities, is one complication associated with asbestos exposure.

Methods: The WTC Environmental Health Center (WTC EHC) is a treatment and surveillance program for community members (Survivors) exposed to WTC dust and fumes.

Results: In this report, we describe four cases of mesothelioma in the WTC EHC as of July 1st, 2023. Two of our patients have been diagnosed with peritoneal mesothelioma and two patients have been diagnosed with pleural mesothelioma.

Conclusion: Given the known delay in the development of mesotheliomas after asbestos exposure, we provide information on these early mesothelioma cases to enhance the understanding of the adverse health effects of WTC exposures on the local community.

In plain English

This article was a case series. It described four people with mesothelioma enrolled in the World Trade Center Environmental Health Center, a treatment and surveillance program for community members (called Survivors) exposed to dust and fumes from the destruction of the World Trade Center towers on September 11, 2001. None had taken part in rescue or recovery work. The four were diagnosed between September 2012 and July 1, 2023. Two had peritoneal mesothelioma: an 80-year-old woman who worked as an office cleaner in lower Manhattan, and a 38-year-old man who lived several blocks from the site. Two had pleural mesothelioma: a 70-year-old male sanitation worker and a 57-year-old male office worker, both with a smoking history. Time from 9/11 to diagnosis ranged from 15 to 19 years. Both pleural patients died, 18 and 21 months after diagnosis. The authors stated they could not identify any asbestos exposure other than WTC dust. They noted gaps in family and military exposure histories and incomplete tumor testing. They called for watching for more cases in WTC-exposed populations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series (descriptive report of four patients)
• Who was studied: Four community members (Survivors) enrolled in the WTC Environmental Health Center in New York, diagnosed with mesothelioma between September 2012 and July 1, 2023: one woman aged 80 and three men aged 38, 70 and 57 at diagnosis. None were rescue or recovery workers.
• Exposure: Self-reported acute exposure to World Trade Center dust on 9/11/2001 and chronic exposure afterward, as local workers (three cases) or a local resident (one case). No asbestos fiber measurements were made for these patients.
• Main results:
  • Of the four cases, two were peritoneal mesothelioma and two were pleural mesothelioma.
  • Case 1, an 80-year-old woman, had unresectable epithelioid mesothelioma of the peritoneum diagnosed 19 years after initial WTC dust exposure.
  • Case 2, a 38-year-old man, had peritoneal biopsies consistent with well-differentiated papillary mesothelioma. The two peritoneal cases were aged 38 and 80 at diagnosis, with latencies of 15 and 19 years from WTC exposure.
  • The two pleural mesothelioma cases (both epithelioid) were diagnosed 17 and 15 years after 9/11.
  • Both pleural mesothelioma patients died, at ages 72 and 59, at 18 and 21 months after diagnosis.
  • Biomarker profiles were available for three patients. The authors stated that none showed a BAP1 mutation.
  • The authors could not identify asbestos exposure other than WTC dust for these patients.
• The authors' conclusion: The authors reported four peritoneal and pleural mesothelioma cases in the Survivor population and said they could not identify an alternative to WTC dust asbestos exposure. They noted that two patients presented at a young age and all had a relatively short latency, and that two peritoneal cases suggested potential for considerable exposure. They concluded that additional cases in WTC-exposed populations should be watched for closely.
• Limitations the authors state:
  • Immunohistochemistry information was incomplete, and staining protocols varied between patients.
  • No immunohistochemical findings were available for the patient with well-differentiated papillary mesothelioma, because the patient was treated at an outside hospital.
  • There was little information on genetic (mutational) risk in the patients.
  • One pleural patient had served in the army, and the authors had no detailed exposure history from that period.
  • Information on possible asbestos exposure through family members was lacking for at least two patients.
  • There are no data on asbestos fibers in the lungs of WTC-exposed community members.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Mesothelium, Peritoneal Mesothelioma, Pleural Mesothelioma.

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• Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001 — P.J. Lioy, C.P. Weisel, et al. (2002)
• Health and environmental consequences of the world trade center disaster — P.J. Landrigan, P.J. Lioy, et al. (2004)
• Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust — W.N. Rom, M. Weiden, et al. (2002)
• Health effects of World Trade Center (WTC) Dust: An unprecedented disaster's inadequate risk management — M. Lippmann, M.D. Cohen, et al. (2015)
• Case report: Lung disease in World Trade Center responders exposed to dust and smoke: carbon nanotubes found in the lungs of World Trade Center patients and dust samples — M. Wu, R.E. Gordon, et al. (2010)

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