Firefighters in World Trade Center Attacks Have Increased Risk of Multiple Myeloma

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Environmental factors, such as those associated with the WTC attacks, may be linked to increased cancer risk.
Environmental factors, such as those associated with the WTC attacks, may be linked to increased cancer risk.

Firefighters exposed to environmental carcinogens during the World Trade Center (WTC) attacks on September 11, 2001, have a higher prevalence of multiple myeloma (MM) precursor disease and may have a higher chance of developing multiple myeloma, according to a study published in JAMA Oncology.

Although the causes of MM and its precursors, such as monoclonal gammopathy of undetermined significance (MGUS) and light-chain MGUS, are not fully understood, environmental factors such as those released during the WTC attacks and subsequent rescue/recovery efforts may be associated with increased risk.

For this case series, researchers assessed the prevalence of MM among WTC-exposed white firefighters between September 1, 2001, and July 1, 2017, and also evaluated a seroprevalence study of MGUS based on serum samples collected from 781 firefighters between December 2013 and October 2015.

Sixteen firefighters had MM diagnosed at the median age of 57 years; the mean age of myeloma diagnosis in the general population is between 65 and 74 years. Of the 14 patients who had evaluable serum/urine monoclonal protein isotype/free light-chain data, half had light-chain multiple myeloma.

A subgroup analysis of 7 patients showed that 5 (71%) were positive for CD20 expression.

The prevalence rate of MGUS and light-chain MGUS combined once standardized for age was 7.63 per 100, which represents a 1.8-fold higher rate compared with the reference population from Olmsted County, Minnesota (the only available screening study that included both MGUS and light-chain MGUS). The age-standardized rate for light-chain MGUS only was more than 3-fold higher compared with the same reference population.

The authors concluded that “that environmental exposure due to the WTC attacks is associated with myeloma precursor disease (MGUS and light-chain MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age, particularly the light-chain subtype.”

Reference

Landgren O, Zeig-Owens R, Giricz O, et al. Multiple myeloma and its precursor disease among firefighters exposed to the World Trade Center Disaster [published online April 26, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.0509

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