@article{d7f65860ab124d8384faf26f100ab9cb,
title = "Impact of healthcare services on thyroid cancer incidence among World Trade Center-exposed rescue and recovery workers",
abstract = "Background: A recent study of World Trade Center (WTC)-exposed firefighters and emergency medical service workers demonstrated that elevated thyroid cancer incidence may be attributable to frequent medical testing, resulting in the identification of asymptomatic tumors. We expand on that study by comparing the incidence of thyroid cancer among three groups: WTC-exposed rescue/recovery workers enrolled in a New York State (NYS) WTC-medical monitoring and treatment program (MMTP); WTC-exposed rescue/recovery workers not enrolled in an MMTP (non-MMTP); and the NYS population. Methods: Person-time began on 9/12/2001 or at enrollment in a WTC cohort and ended at death or on 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. We used Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for MMTP and non-MMTP participants. NYS rates were used as the reference. To estimate potential changes over time in WTC-associated risk, change points in RRs were estimated using profile likelihood. Results: The thyroid cancer incidence rate among MMTP participants was more than twice that of NYS population rates (RR = 2.31; 95% CI = 2.00–2.68). Non-MMTP participants had a risk similar to NYS (RR = 0.96; 95% CI = 0.72–1.28). We observed no change points in the follow-up period. Conclusion: Our findings support the hypothesis that no-cost screening (a benefit provided by WTC-MMTPs) is associated with elevated identification of thyroid cancer. Given the high survival rate for thyroid cancer, it is important to weigh the costs and benefits of treatment, as many of these cancers were asymptomatic and may have been detected incidentally.",
keywords = "World Trade Center, longitudinal cohort, occupational epidemiology, surveillance, thyroid cancer",
author = "Goldfarb, {David G.} and Colbeth, {Hilary L.} and Molly Skerker and Webber, {Mayris P.} and Prezant, {David J.} and Dasaro, {Christopher R.} and Todd, {Andrew C.} and Dana Kristjansson and Jiehui Li and Brackbill, {Robert M.} and Farfel, {Mark R.} and Cone, {James E.} and Janette Yung and Kahn, {Amy R.} and Baozhen Qiao and Schymura, {Maria J.} and Paolo Boffetta and Hall, {Charles B.} and Rachel Zeig-Owens",
note = "Funding Information: We thank the 13 state cancer registries for providing record linkages: Bureau of Cancer Epidemiology, New York State Department of Health (DOH); Arizona Cancer Registry Department of Health Services (DOHS); California Cancer Registry, Department of Public Health (DPH); Connecticut Tumor Registry, Connecticut DPH; Florida Cancer Registry, Florida DOH; Massachusetts Cancer Registry, Massachusetts DPH; New Jersey State Cancer Registry, New Jersey DOH and Rutgers Cancer Institute of New Jersey; North Carolina Central Cancer Registry, State Center for Health Statistics; Ohio Cancer Incidence Surveillance System, Ohio DOH; Bureau of Health Statistics and Research, Pennsylvania DOH; Texas Cancer Registry, Texas Department of State Health Services, Virginia Cancer Registry, Virginia DOH, and Washington State Cancer Registry, Washington DOH. This study was supported through the National Institute for Occupational Safety and Health (NIOSH) cooperative agreements (U01 OH011681, U01 OH011931, U01OH011315, U01 OH011932, U01 OH011480, and U50/OH009739) and contracts (200‐2011‐39378, 200‐2011‐39383, 200‐2017‐93325, and 200‐2017‐93326). Additionally, this study was supported cooperative agreement 6NU58DP006309 awarded to the New York State Department of Health by the Centers for Disease Control and Prevention (CDC) and by Contract 75N91018D00005 (Task Order: 75N91018F00001) from the National Cancer Institute (NCI), National Institutes of Health, Department of Health and Human Services. This study was also supported by cooperative agreement U50/ATU272750 from the Agency for Toxic Substances and Disease Registry (ATSDR), CDC, which included support from the National Center for Environmental Health, CDC; and by the New York City Department of Health and Mental Hygiene (NYC DOHMH). This study was also supported by grant P30 CA013330 from the National Cancer Institute (NCI), NIH. Funding Information: We thank the 13 state cancer registries for providing record linkages: Bureau of Cancer Epidemiology, New York State Department of Health (DOH); Arizona Cancer Registry Department of Health Services (DOHS); California Cancer Registry, Department of Public Health (DPH); Connecticut Tumor Registry, Connecticut DPH; Florida Cancer Registry, Florida DOH; Massachusetts Cancer Registry, Massachusetts DPH; New Jersey State Cancer Registry, New Jersey DOH and Rutgers Cancer Institute of New Jersey; North Carolina Central Cancer Registry, State Center for Health Statistics; Ohio Cancer Incidence Surveillance System, Ohio DOH; Bureau of Health Statistics and Research, Pennsylvania DOH; Texas Cancer Registry, Texas Department of State Health Services, Virginia Cancer Registry, Virginia DOH, and Washington State Cancer Registry, Washington DOH. This study was supported through the National Institute for Occupational Safety and Health (NIOSH) cooperative agreements (U01 OH011681, U01 OH011931, U01OH011315, U01 OH011932, U01 OH011480, and U50/OH009739) and contracts (200-2011-39378, 200-2011-39383, 200-2017-93325, and 200-2017-93326). Additionally, this study was supported cooperative agreement 6NU58DP006309 awarded to the New York State Department of Health by the Centers for Disease Control and Prevention (CDC) and by Contract 75N91018D00005 (Task Order: 75N91018F00001) from the National Cancer Institute (NCI), National Institutes of Health, Department of Health and Human Services. Funding Information: The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. The Connecticut Department of Public Health Human Investigations Committee approved this research project, which used data obtained from the Connecticut Department of Public Health. The Connecticut Department of Public Health does not endorse or assume any responsibility for any analyses, interpretations or conclusions based on the data. The authors assume full responsibility for all such analyses, interpretations, and conclusions. The Florida cancer incidence data used in this report were collected by the Florida Cancer Data System (FCDS), the statewide cancer registry funded by the Florida Department of Health (DOH), and the Centers for Disease Control and Preventions National Program of Cancer Registries (CDC‐NPCR). The views expressed herein are solely those of the author(s) and do not necessarily reflect those of the DOH or CDC‐NPCR. Cancer incidence data used in these analyses were obtained from the Ohio Cancer Incidence Surveillance System (OCISS), Ohio Department of Health (ODH), a cancer registry partially supported by the National Program of Cancer Registries at the Centers for Disease Control and Prevention (CDC) through cooperative agreement Number NU58DP006284. The use of these data does not imply that ODH or CDC agrees or disagrees with the analyses, interpretations, or conclusions in this report (or publication/presentation). These data were supplied by the Bureau of Health Statistics & Registries, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations, or conclusions. Additional Acknowledgments and Disclaimers from Individual State Cancer Registries: Publisher Copyright: {\textcopyright} 2021 Wiley Periodicals LLC",
year = "2021",
month = oct,
doi = "10.1002/ajim.23277",
language = "English (US)",
volume = "64",
pages = "861--872",
journal = "American Journal of Industrial Medicine",
issn = "0271-3586",
publisher = "Wiley-Liss Inc.",
number = "10",
}
