9/11 and Cancer
- Bryan Smith was diagnosed with stage 4 lung cancer, and he attributes his diagnosis to time spent working near Ground Zero after 9/11.
- Smith is one of thousands of people who have linked their illness or cancer to 9/11 events.
- Cancer is the fifth-most common 9/11-related health condition among first responders.
- The U.S. Preventive Services Task Force recommends lung cancer screening with the same level of importance as mammograms for breast cancer.
For 50-year-old Bryan Smith, weeks of experiencing a nagging cough led to a diagnosis he really didn't expect: lung cancer. And Smith says he believes it’s due to the time he spent at Ground Zero after the 9/11 attacks 20 years ago.
"It was completely surprising. I never smoked," Smith told KGTV news.
Read More"I was terrified. My whole world stopped right there," Smith said.
Feeling terrified as Smith did upon after getting an unexpected diagnosis like cancer can bring a slew of other emotions. SurvivorNet doctors recommend not blaming yourself for the disease. One helpful suggestion for warriors beginning their health journeys is to learn more about the disease. Also asking your doctor additional questions and even seeking a second opinion can help ease the initial shock and anxiety associated with a new diagnosis.
"I think it's really important for them to be able to hear it multiple times, take notes," Dr. Heather Yeo, colorectal surgeon at Weill Cornell Medicine said.
What Is Lung Cancer?
Lung cancer is the second most common form of cancer, and the leading cause of cancer deaths in both men and women in the United States. It can be particularly tricky to treat because often, symptoms don't show up until the cancer has spread to other organs.
According to the American Cancer Society, lung cancer is a type of cancer that starts in the lungs and the cells in the body begin to grow out of control.
There are two main types of lung cancer, which doctors group together based on how they act and how they're treated:
- Non-small cell lung cancer (NSCLC) is the most common type and makes up about 85% of cases.
- Small cell lung cancer (SCLC) is less common, but it tends to grow faster than NSCLC and is treated very differently.
Lung cancer, like all cancers is staged into four main groups based upon the tumor size and location, if any lymph nodes are involved, and if the cancer has spread outside of the lung to other parts of the body. Although lung cancer is staged into four main stages there are several substages within each category that your physician may discuss with you. In general, the four stages of lung cancer are:
- Stage 1 – The tumor is less than or equal to 4cm in size and is limited to a single spot of the lung. In Stage I lung cancer there are no lymph nodes involved and the cancer has not spread outside of the lung. Stage I is further divided into Stage IA1, Stage 1A2, Stage 1A3, and Stage 1B depending on the size of the tumor.
- Stage 2 – The tumor is > 4cm and less than or equal to 7cm and no lymph nodes are involved OR the tumor is less than or equal to 5cm and there are certain lymph nodes in the chest involved (known as N1). In Stage II lung cancer the cancer has not spread outside of the lungs. Stage II is further divided into Stage IIA and Stage IIB.
- Stage 3 – The tumor is > 7cm and no lymph nodes are involved or only certain lymph nodes (N1) OR the tumor is less than or equal to 7cm in size and more advance lymph nodes (N2) are involved OR the tumor is >5cm or less than or equal to 7cm and certain lymph nodes are involved (N1). Also, any size tumor with very advanced lymph nodes (N3) involved is Stage III. In Stage III lung cancer the cancer has not spread outside of the lung. Stage III is further divided into Stage IIIA, Stage IIIB, and Stage IIIC.
- Stage 4 – In stage IV lung cancer the cancer has spread outside of the lung and is known as metastatic cancer.
Smith Blames 9/11 and Ground Zero
Smith said after the Sept. 11 terror attacks, he worked as an officer for the Federal Protective Service protecting federal buildings. He was assigned to patrol an area 10 blocks from Ground Zero, the site of the World Trade Center buildings. He says he worked in the area for three months without personal protective equipment.
"Your uniforms could be covered in ashy soot, a short amount of time after your shift had begun, and you're breathing it all in," Smith said.
"I believe there is a strong possibility my diagnosis is linked to my time near Ground Zero…I think we’re seeing the scope of this tragedy from 9/11 is long-term and continues," he added.
Smith is one person among thousands of people to publicly trace an illness or cancer diagnosis to the Sept. 11 attacks. SurvivorNet previously shared John Mormando's story he linked his cancer diagnosis to exposure to toxins in the air following the terrorist attacks.
Mormando was not near the World Trade Centers that fateful morning, but he went back to work at a building in the area soon after., which he said he didn’t feel was safe. Years later in March 2018, a lump in his chest revealed that he had been a victim of the terror attacks after all.
Mormando had bouts with skin cancer in 2015 and 2016. An avid golf player, he attributed them to too much time in the sun. Then, in 2018, he felt a lump in his chest. A needle biopsy revealed he had breast cancer. He knew men could get it, but that it was rare. Mormando had no family history of the condition and, training for an Iron Man, he was in the best shape of his life. The more he researched, the more questions he had.
"So I confided to a friend of mine that worked with me down on the floor at the exchange, and he said, 'Johnny, you know there's a bunch of guys that work on the floor that have cancer,'" he says. The one thing they had in common was where they had worked in September 2001.
WATCH: Understanding cancer risk from 9/11.
While undergoing surgery and chemotherapy at NYU Langone's Perlmutter Cancer Center, Mormando got confirmation that his cancer was considered 9/11-related. He was eligible to enter the September 11th Victims Compensation Fund and the WTC Health Program.
Cancer is the fifth-most common 9/11-related health condition among responders and the fourth among survivors. The most common cancers in these groups are of the skin (non-melanoma), prostate, and breast (in females), melanoma and lymphoma.
"It was a total war zone. Fires were still burning. There was smoke everywhere," Mormando told SurvivorNet. He continued to work in the area for several more years.
The World Trade Center Health Program has tracked the health of and provided medical care to more than 105,000 survivors and responders. They include responders and survivors of the World Trade Center attack and responders to the Pentagon attack and the Pennsylvania plane crash. Among them, 19,150 that's nearly 1 in 5 have had a 9/11-related cancer.
"There has been no other disaster quite like this," Michael Crane, MD, tells SurvivorNet. Crane is Medical Director of the World Trade Center Health Program at Mount Sinai Hospital in New York and an expert in the health consequences of large-scale disasters.
"We are looking at an exposure that was really frightening and whose total extent is unknown."
The 9/11 attacks exposed an estimated 490,000 people to a load of cancer-causing toxins that is impossible to quantify.
"There was the explosion, the collapse, and the enormous release of material," says Crane. "Plus, you had ongoing fires for months. The dust cloud passed, but the air stayed dusty for days. No one will ever know what we inhaled."
The degree and extent of exposure was different for each person.
Lung Cancer Symptoms and Risk Factors
Smoking may be the first cause that comes to mind with lung cancer. And it is true that smoking causes most cases of this cancer. Tobacco smoke contains a mixture of more than 7,000 different chemicals, at least 70 of which are known to cause cancer. If you quit smoking, you can significantly reduce your risk of developing the disease and dying from it.
Yet almost 20% of people who die from lung cancer in the United States each year have never smoked or used any other form of tobacco. SurvivorNet doctors say that anyone with lungs can get lung cancer regardless of if you have smoked or not.
Risk factors for lung cancer include:
- Smoking
- Exposure to secondhand smoke
- History of radiation therapy
- Exposure to radon gas which is "the natural breakdown of uranium in soil, rock and water" according to Mayo Clinic.
- Exposure to asbestos, arsenic, chromium and/or nickel
- Family history of lung cancer
Signs and symptoms of lung cancer may include:
- A new cough that doesn’t go away
- Coughing up blood, even a small amount
- Shortness of breath
- Chest pain
- Hoarseness
- Losing weight without trying
- Bone pain
- Headache
Lung Cancer Treatment
The U.S. Preventive Services Task Force recommends lung cancer screening with the same level of importance as mammograms for breast cancer.
Many lung cancers are found incidentally on tests done for other reasons. Right now, screening is recommended for people who meet all the following criteria:
- You are or were a heavy smoker (who smoked a minimum of 20 pack years)
- You currently smoke or quit within the last 15 years
- You are between 50 and 80 years old
Lung Cancer Treatment and Staging
Treatment varies depending on which type and stage of cancer you have. If the cancer is local meaning just in the lungs surgery may be an option. But if it has spread to the lymph nodes, a combination of radiation with chemotherapy, followed by immunotherapy, may be the best option. Once the cancer has spread outside of the lungs, chemotherapy and/or targeted drugs are used to control its growth as much as possible.
Treating Stage I Lung Cancer
Stage 1 lung cancer means that your cancer is only in your lungs and has not started to spread to your lymph nodes. Surgery to remove the cancer is considered the gold standard for this stage. Although there are subdivisions of stage I lung cancer, everyone who can have surgery should have surgery to remove their tumor. Some doctors or centers may discuss using a targeted drug after surgery depending on specific aspects unique to your tumor.
For anyone who can't have surgery because of underlying health conditions, the current standard of care is stereotactic body radiation therapy (SBRT), which directs extremely high doses of radiation to the tumor. SBRT minimizes the radiation dose to nearby structures, reducing the risk of damage to healthy organs.
Treating Stage 2 Lung Cancer
Stage 2 lung cancer means that your cancer is still in your lung, but it has spread to at least one lymph node. Surgery to remove a lobe of the lung (lobectomy) and the affected lymph node(s) is the first-line treatment. As with stage I lung cancer, there are subdivisions of stage II lung cancer, but these often don't affect the initial treatment decision. Surgery is the gold standard treatment for stage II lung cancer, regardless of what subdivision you have. In some cases, surgery to remove the whole lung (pneumonectomy) may be necessary.
Chemotherapy plus immunotherapy may also be recommended to shrink the tumor before surgery and reduce chances of recurrence after surgery. Some doctors may discuss using a targeted drug after surgery depending on specific aspects unique to your tumor. Surgery could be followed by additional chemo and immunotherapy. In people with stage II disease who are unable to have surgery, meeting with a radiation oncologist is a very important step, because the tumor may be able to effectively be treated with radiation or chemoradiation, a combination of chemotherapy and radiation.
Stage IIIA, IIIB, and IIIC Lung Cancer Treatment
The decision to proceed with surgery for stage IIIA lung cancer is not always black and white, and it's an area where doctors sometimes disagree.
In stage IIIA, surgery can play a role, depending on where the cancer is, how close it is to other structures, and how many lymph nodes are affected. Chemotherapy plus immunotherapy may also be an option before surgery to shrink the tumor and destroy any errant cancer cells. In scenarios where surgery is not ideal, patients are treated with radiation therapy, which is often given together with chemotherapy. Many of those who are treated with radiation and chemotherapy will receive immunotherapy, as well.
In stage IIIB, cancer has spread to the lymph nodes on the opposite side of the chest, or it has invaded another area, such as the veins feeding the heart. This stage is most often treated with radiation therapy and chemotherapy, followed by immunotherapy. Like with stage IIIA disease, radiation serves as the backbone of treatment for patients with stage IIIB disease, and chemotherapy is often given to enhance the effects of radiation. Patients who tolerate chemotherapy and radiation therapy well are also considered for immunotherapy.
In stage IIIC, the primary tumor is large, and the cancer has spread to lymph nodes on the opposite side of the chest, or it has invaded other structures, such as the veins feeding the heart. As with stage IIIA and stage IIIB cancers, radiation therapy is the mainstay of treatment. Chemotherapy is also used to enhance the effect of radiation therapy. Patients who respond to treatment may also receive immunotherapy.
Stage 4 means that your cancer has spread to other organs, which may include your brain, liver and/or bones. The goal of therapy is to treat the entire body to destroy every last remnant of the cancer. In the past, chemotherapy was considered the treatment standard for stage IV lung cancer, but times have changed.
More types of treatment are available for stage IV lung cancer today than ever before. Treatment for late-stage lung cancer may include a combination of surgery, chemotherapy, or radiation. Immunotherapy has also yielded good results.
Your doctor will discuss all your treatment options with you, and you can evaluate them together. The treatments currently available for late-stage lung cancer can help you to live longer and make you feel better by relieving symptoms.
Dealing With 9/11-Linked Disease
Hundreds of thousands of people may have been exposed to toxins and pollution in the air after the attacks on the World Trade Center on Sept. 11, 2001. There are resources available.
- Cancer After 57 Days at Ground Zero: A Retired Firefighter Shares His 9/11 Story
- Hundreds Pay Respects to 9/11 First Responder Luis Alvarez, Who Died of Cancer Linked to the Attacks
- New 9/11 Memorial Honors Heroes Lost Or Still Suffering From Ground Zero-Linked Illness, Including Tragic Cancers
- Everyone Who Was There, Get Screened: 9/11 Responder John Feal’s Story
- He Was a 9/11 Rescue Worker, He Got Cancer, And He Wouldn’t Change a Thing
- Helpful Resources if You’re Worried About 9/11-linked Cancer
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