Head and neck cancer in the World Trade Center Health Program cohort; elucidating risk factors to reduce incidence and morbidity

Rbhs-School Of Public Health, Piscataway NJ

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Abstract

PROJECT SUMMARY/ABSTRACT Head and neck cancer may be among the increased disease risks incurred from exposure to the toxic debris cloud that formed when the World Trade Center (WTC) buildings collapsed on 9/11, and to the subsequent mix of airborne pollutants during the rescue, recovery, and cleanup. The exposure to these anatomical sites (i.e. mouth, nasal and sinus cavities, and throat) was unique because of the direct exposure to the larger particles. The association between head and neck cancer and WTC-related exposure is also possible because these cancers have previously been causally associated with occupational respiratory exposures (e.g. wood dust). Synergistic interactions have also been observed between occupational exposures and some modifiable risk factors (e.g. tobacco and asbestos) and head and neck cancer incidence. Interaction between WTC-related exposure and other risk factors for head and neck cancers (including tobacco use, alcohol consumption and oral human papillomavirus (HPV) infection) may therefore be important in the etiology of WTC-related cancer. Establishing the risk factor profile for head and neck cancer among WTC responders will contribute to the evidence base for developing improved prevention and control interventions. This is important because people with head and neck cancer have a high risk of primary treatment failure, long-term disability, disfigurement, and death. This innovative study will use a nested case-control study to assess the association between WTC exposures and head and neck cancer while controlling for socio-demographic and behavioral risk factors. For each WTC Health Program (WTC-HP) participant with head and neck cancer, we will select three WTC-HP controls matched by age, sex, and vital status (dead/alive). The proposed project also include a case-case study to explore additive and multiplicative effects of WTC exposure with other head and neck cancer risk factors, including tobacco and alcohol use and infection with the human papilloma virus. Here, for each WTC-HP participant with head and neck cancer we will enroll three non-WTC responders with head and neck cancer from the New Jersey State Cancer Registry, matched by age at diagnosis, year of diagnosis, and vital status. Furthermore, the study will describe risk factor and disease presentation among the WTC-HP members diagnosed with head and neck cancer in order to optimize strategies for risk factor modification and early detection. The relative contribution (population attributable fraction) of modifiable risk factors to head and neck cancer incidence in our patient population will be calculated. Patient chart reviews will be conducted to identify gaps in risk factor assessment and screening. The findings from this study will help to build the evidence base for developing recommendations for prevention of these devastating cancers use among WTC responders.