All 9/11 responders put their own lives at risk to save others from the events that occurred at the World Trade Center (WTC) on September 11, 2001, in New York City. Since then, several studies have shown elevated rates of cancers such as multiple myeloma, prostate cancer and thyroid cancer among first responders and those who worked nearby.
Today, a new study published in the journal JNCI Cancer Spectrum adds another cancer to that list, leukemia, which is a cancer of the blood and bone marrow. Researchers of this study examined cancer incidence in nearly 29,000 first responders, including law enforcement, construction, and telecommunications workers who had some level of exposure to the WTC dust.
While the study did not find a clear relationship between length of time or the intensity of exposure in the development of cancer, researchers did identify several risk factors that were linked to a higher risk of developing cancer including age, gender and smoking status.
Some may question why the findings of increased risk of leukemia, specifically, have just come to the forefront now, nearly two decades after 9/11. The study’s author, Susan Teitelbaum, PhD, professor of environmental medicine and public health at the Icahn School of Medicine at Mount Sinai in New York City, said, “Previously the sample size wasn't large enough to detect an association.”
In an interview with Medscape Dr. Gwen Nichols, Chief Medical Officer at The Leukemia & Lymphoma Society, explains, “Associations of older age and smoking are not surprising. Leukemia can take years to develop after exposure to a carcinogen, so past studies may have been completed too early to pick up on a heightened risk. Many earlier studies were also smaller, and since leukemia is relatively rare, these samples may not have included enough patients to conduct a full analysis.”
Dr. Nichols elaborates, “It is also highly unlikely that any one exposure is unifactorial when it comes to leukemia. If someone is at higher risk, such as a smoker or being older, then exposure to environmental toxins may increase the risk more, as opposed to someone without those factors," she said. "What we know about causes of leukemia — from the standpoint of exposure to toxins — is limited. It would be great to learn more, especially in this era of genetic testing, and be able to tell people how to help reduce their risks."
According to Dr. Nichols, ongoing research may shed some light on a "genetic link" between exposure and the development of leukemia. Healthy individuals who are not diagnosed with a blood cancer, but are found to have a group of cells with an acquired gene mutation known as clonal hematopoiesis of indeterminate potential, have been found to be more prone to developing leukemia as they age.
"The Leukemia & Lymphoma Society is currently supporting research that is looking at the development of CHIP over time, for multiple myeloma and leukemia," said Nichols. "This study looked at the development of CHIP in first responders, and they saw an increase in clonal CHIP that was higher than what one would expect, as compared to age matched controls."
The findings reported in this study suggest exposure could be causing increases in mutational changes. "It has a fairly long latency and that may partially explain why we're seeing more leukemia now,” said Dr. Nichols.
The study is ongoing, and Dr. Nichols said she is "hopeful that a paper will published when the research is completed."
LLS also provides resources and information on the risks to fire fighters. Learn more here.
NCI Cancer Spectr. Published January 14, 2020. Full text
Progress in new cancer treatments is accelerating so rapidly that the standard of care for many cancer patients is changing right before our very eyes.
Since 2017, the U.S. Food and Drug Administration (FDA) has approved a remarkable 53 therapies just to treat patients with blood cancers, and The Leukemia & Lymphoma Society (LLS) has helped advance 46 of these treatments.
I have no reason to believe the next few years won’t be as productive and groundbreaking as the last few. With that, here are some of my predictions for 2020:
CAR T-cell Immunotherapy Continues to Amaze
Revolutionary advances in harnessing the body’s immune system to seek out and destroy cancer cells, is creating excitement about chimeric antigen receptor (CAR) T-cell immunotherapy, a treatment that engineers the patient’s own cells to fight cancer. While the treatment is currently FDA approved for two types of cancer - acute lymphoblastic leukemia (ALL) and large B-cell lymphoma - I predict we will see CAR-T approved this year for patients with mantle cell lymphoma and multiple myeloma. Compelling data for both of these blood cancers was presented at the American Society of Hematology meeting in December. I’m especially excited about so called “off-the-shelf immunotherapy” that doesn’t require engineering individual patients’ T cells, making manufacture of these cells less costly and time consuming.
More Precision Medicine/Less Chemotherapy
Precision medicine - giving patients a drug based on their molecular profile rather than taking a one-size-fits-all approach - is showing great promise in acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). While chemotherapy, drugs that directly kill cells, remains an important component of many treatment regimens, I predict we will see less reliance on these types of drugs as more targeted therapies, drugs that work by interfering with molecules that help drive cancer growth, gain approval.
More Help for Children with Cancer
For too long we’ve been treating children with acute leukemia with the same protocols developed more than 30 years ago. While most children with ALL survive with treatment, the harsh chemotherapy combinations leave many with lasting side effects. We can and will do better for these children. With the success of our Beat AML Master Clinical Trial, a precision medicine study for adults with AML, we are now planning a global precision medicine trial for children with AML. To develop new therapies for the 40% of children and young adults who don’t respond to treatment, we aim to launch our trial – LLS PedAL – in the summer of 2020.
As well, we’ve more than doubled our commitment to pediatric research grants, new services for children with cancer and their families, including our best-in-class Information Resource Center and Clinical Trials Support services, with trained medical specialists ready to help patients, families and caregivers navigate a cancer diagnosis and treatment, including enrolling in an appropriate clinical trial.
More Collaborations to Help More Patients
LLS is a global leader in the fight against cancer but we can’t do it alone. Nonprofit, government, industry and the business sector all must work together to solve big problems.
LLS is a trusted convener, and we will continue to facilitate collaboration across partners such as consumer companies such as Walgreens and Burlington, pharma and bio companies such as Bristol-Myers Squibb, Pfizer and Johnson & Johnson, professional organizations such as The American Society of Hematology (ASH) and Milken Faster Cures, and the Paul G. Allen Frontiers Group and The Mark Foundation for Cancer Research, to fund cutting edge research to advance more breakthrough, novel cancer treatments in 2020.
Improving Access to Treatments and Care
All of the scientific progress doesn’t mean a thing if patients can’t access the treatments. One of LLS’s priorities is increasing participation in clinical trials and we will continue to approach this challenge from many directions in 2020.
Our collaboration with ASH will help inform more patients about appropriate clinical trials. As well, we will be awarding grants under a new program called IMPACT (Impactful Medicine Providing Access to Clinical Trials), to expand access to high-quality clinical trials to patients served by community-based sites of care, particularly rural, minority, and/or economically disadvantaged blood cancer patients.
We will continue to collaborate with all of the players in the healthcare ecosystem to attack the high cost of cancer care for patients. Financial toxicity and quality of life will be the focus of new research with patients at the center.
We aim to get two policies on the president’s desk by late May - a cap on out-of-pocket costs to patients in Medicare Part D, along with an initiative known as “smoothing,” which would spread out the cost to patients in Medicare so they are not hit with a very high upfront payment.
On the state level, we are fighting back against “junk plans” in 13 states. These insurance plans don’t adequately provide coverage, particularly for patients with preexisting conditions. We will be issuing a study in February showing the impact of these plans.
As you can see, we’ve got our work cut out for us in 2020 and we’ll all need to stay focused as we deliver our mission for patients and families.
In an interview with Medscape Dr. Gwen Nichols, Chief Medical Officer at The Leukemia & Lymphoma Society, explains, “Associations of older age and smoking are not surprising. Leukemia can take years to develop after exposure to a carcinogen, so past studies may have been completed too early to pick up on a heightened risk. Many earlier studies were also smaller, and since leukemia is relatively rare, these samples may not have included enough patients to conduct a full analysis.”
