‘The Clock Has Not Stopped Running’ on 9/11-Related Cancer Incidence 20 Years Later

This year marks the 20-year anniversary of the September 11 attacks, when two planes were flown into the Twin Towers in Lower Manhattan, killing nearly 3,000 people. Two decades later, the impact of that fateful day remains; exposure to the air around ground zero in the weeks and months after the attacks increased many people’s long-term risk for cancer.

In 2011, the World Trade Center Health Program was created to monitor and treat survivors and first responders who developed health conditions related to their ground zero air exposure. An estimated 105,000 members enrolled in the health program as of June 30, 2020. Of note, 13% of conditions certified within the World Trade Center Health Program include cancer of several types including non-melanoma skin cancer, prostate cancer and lung cancer, among others.

First responders and survivors of the Sept. 11 attacks have an increased risk for cancer because of the combustion and pulverization of two large buildings.

“In the first place, it was the collapse of (two) large (buildings) with lots and lots of building materials in it, other parts of plastics and metals, etc. and parts of computers that we don’t even know about,” said Dr. Michael A. Crane, a medical director of the World Trade Center Health Program Clinical Center at Mount Sinai in New York City, in an interview with CURE®. “All of that was ground to pulverized dust. On top of that, it was on fire, and nearly combusting products, particularly of some building materials, can throw off an awful toxic exposure.”

Crane explained that the toxic dust particles that surrounded ground zero could easily enter into a person’s body. According to a study assessing the World Trade Center Health Program, the dust surrounding ground zero consisted of a complex mixture of organic (ie, pesticides, etc.) and inorganic materials (asbestos, metals, calcite glass fibers, etc.) and included many known carcinogens and toxins.

“There are greater predispositions (of cancer) because if, for example, you breathe certain types of particles, the particles of a certain size may lay around in the lung and they may go no further, or they may migrate to the lining of the lung like asbestos does sometimes,” Crane said. “But yes, it can be absorbed into the body, it can stay in the lungs, it can be eaten and swallowed and get out through the digestive tract. The physical properties of the dust mixed with fumes and vapors from fires made this an extraordinarily dangerous exposure.”

It is unknown how long the effects of this exposure can impact first responders and survivors, Crane added, although it is known that the effects of asbestos can be felt beyond 20 years. In addition, the extent of which people were exposed to the toxic air may be difficult to estimate because the dust entered air conditioning vents, inside people’s windows, surfaces within offices and on clothes, in addition to other areas.

“Also, all the people who live in the community around (ground zero), anyone who had an open window, a broken window or open ventilation duct, which was practically everybody in the warm September afternoon, was exposed to this material,” Crane said. “And for the community, folks who went to school down there, worked down there, the candy store or dry cleaner down there, that was felt to be most of Lower Manhattan or going over to Brooklyn, and that was like 400,000 people, so a huge population.”

‘It Was a Matter of Timing’

In 2001, Judy Meyers was a commercial real estate paralegal on Water Street in Lower Manhattan and had commuted through the World Trade Center for over 20 years that she worked downtown. On Sept. 11, Meyers was commuting to work on New Jersey Transit from Rockland County, New York, looked out the window and saw that the World Trade Center was on fire. In an interview with CURE®, Meyers said she didn’t get to Manhattan that day since the trains were at a standstill at the Hoboken, New Jersey stop, but she recalled seeing victims coming onto the train before it headed back towards her home.

“New Jersey Transit made the decision quickly to turn the trains around and get us the heck out of there, but we had to wait for victims to come,” said Meyers, now 68 and currently living in San Diego, California, with her husband. “Looking out the train window, I was (thinking), these people are all so dirty. We didn’t have cell phones like we do today, so we didn’t know what was going on from minute to minute like other people did who were watching TV. We were kind of in the dark.”

Meyers didn’t know exactly what occurred to the World Trade Center until she got home and turned on the news.

She was unable to go back to work for about a week since lower Manhattan was closed. After speaking with some of her colleagues who were in the office the day of the attack, Meyers realized how critical timing was in her life.

“I have to say, I am a very lucky person, I am one of the very lucky ones, because I would have been right in the middle of it. It was a matter of timing, basically. That’s all it was for me. So I am very fortunate. And it was just an awful, awful time in New York at that time. The smell, I’ll never forget that. That smell was everywhere inside, outside and it was just a horrific time.”

Despite the smell that encompassed Lower Manhattan, Meyers added that the Environmental Protection Agency assured everyone that the area was safe. Her job required her to go to meetings in several buildings close by, so she was often walking around and inhaling the particulate matter, and she recalled seeing uncovered trucks hauling debris from the World Trade Center site.

Fast-forward to June 2019, Meyers suddenly lost her voice, so she went to the doctor where she was misdiagnosed with allergies then acid reflux. After treating both of those ailments, her voice was still gone and she developed a minor cough. Meyers said she lost weight over several months but attributed it to being on the keto diet since the beginning of that year. She went back to her primary care doctor in October 2019, when her doctor heard crackling in her lungs, so she was sent for a chest X-ray, which led to a chest CT scan and then she got the news.

“She called me into her office at 5:00 (p.m.) on a Friday to deliver the news to me: You have lung cancer,” Meyers said. “A total shock out of nowhere. … But she said to me, ‘It’s not a death sentence anymore.’”

After undergoing a biopsy a couple weeks later, she received a diagnosis of stage 3 non-small cell adenocarcinoma, and biomarker testing determined she had an EGFR mutation. Although she was reassured that, that mutation is the best news she could have, she had to undergo aggressive treatment with six rounds of chemotherapy and 30 rounds of chest radiation.

“That was difficult because the radiation gave me esophagitis big time,” Meyers explained. “I could not swallow. I couldn’t eat. Drinking an Ensure would take me an hour, that’s how painful it was.”

She then experienced severe abnormal pain in February 2020, when she asked her husband to take her to the emergency room. Meyers had a perforated bowel and sepsis infection, which required emergency surgery and a 10-day hospital stay, with a good part of it spent in the ICU.

“I felt so horrible in the ICU that my sister came to support me,” Meyers said. “I said to her, ‘I can die. I can’t go through this. I’m OK if I die. I’m at peace with it.’ (My sister) was so horrified.”

After Meyers’ hospital stay, she went into a rehabilitation center for 10 days and was discharged on March 7, 2021, at a time when the COVID-19 pandemic was starting.

“The timing was unbelievably good. Again, I was lucky with timing.”

With further treatment and taking precautions because of the pandemic, she started to recover day by day, and feeling stronger by August 2020. Meyers was considered to have no evidence of disease in April 2021.

Long-Term Impact of 9/11

Crane also remembered vividly where he was on Sept. 11, 2001. At the time, he was the medical director of Con Edison, and he was driving to work on the Long Island Expressway near the Midtown Tunnel when suddenly everything stopped. People started exiting their cars to walk around the standstill traffic, listening to their radios trying to figure out what was happening downtown. Crane was able to take an exit for Long Island City where there was a company headquarters. He spoke with his colleagues and then went to the rooftop, where he saw 2 World Trade Center collapse.

“I see it today,” Crane said. “I can see it in my mind’s eye. It’s right there, a little bit off to the right, watching it balloon out into fire and then disappear. And that was it. That was a really emotional moment for me. And I promised that I would do anything to make this situation better.”

And that’s exactly what he did while working at Con Edison, where he established a monitoring and treatment program for employees who aided in recovery efforts at the World Trade Center site. Later, he joined Mount Sinai, where he continues his mission at the Selikoff Centers for Occupational Health and the World Trade Center Health Program Clinical Center of Excellence.

“People (like Dr. Irving Selikoff and his team) who have training in this area really were able to see right away that this was going to be a terrible, terrible event requiring a long-term response,” Crane said.

Although many programs and centers are in place to aid in the care of first responders and survivors of the Sept. 11 attacks, Crane continues to be concerned about this unique set of patients.

“The clock has not stopped running,” he said. “The biggest fear that I had, … I was very concerned about that 20-year timeframe for asbestos causing cancer in asbestos workers. There was tons of asbestos released when the towers came down. From that point of view alone, I was really terrified that there’s going to be an epidemic, literally an epidemic of lung cancer among the responders and among the community people, and that has not happened. When we look at the data, the incidence and prevalence of lung cancer are not greater in responders — in fact, a bit lower in responders than in the regular population of New York State, not just New York City.”

Looking back, Meyers did not have a family history of cancer, and her doctors could not pinpoint anything else in her history that contributed to her cancer diagnosis. She made the connection from her cancer diagnosis to her Sept. 11 exposure somewhat immediately.

“It didn’t occur to me to do anything special,” Meyers noted. “It never occurred to me that I should do an annual CT screening. … I was not considered an at-risk type of person. … According to the legislation, your lung cancer is presumed to have been caused by the 9/11 toxic exposure even if you were a smoker, even if you were a heavy smoker, your lung cancer is still presumed to have been caused by that toxic exposure because not everybody who smoked gets lung cancer.”

Although Meyers considers herself a “very fortunate nobody,” she participates in online support forums established by the LUNGevity Foundation and advocates for increased funding for cancer research in this area.

“It’s important that we be a part of the research because the victim toll didn’t stop on 9/11,” she added. “It continues, and it continues 20 years later. It’s important for everyone to be counted. Get that (information) into your medical records. Some doctors understand (and) some do not. I think it’s up to us to educate the doctors sometimes. Get your regular screening because annual screening can really save your life.”

To hear more of Meyer’s story, listen to her episode on the “CURE® Talks Cancer” podcast.

To hear more of Crane's story, listen to his episode on the "CURE® Talks Cancer" podcast.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.