Risk factors for head and neck cancer in the World Trade Center Health Program General Responder Cohort: results from a nested case-control study

Occup Environ Med. 2019 Nov;76(11):854-860. doi: 10.1136/oemed-2019-105890. Epub 2019 Sep 12.


Objectives: Head and neck cancers (HNCs) may be among the health consequences of involvement in the World Trade Center (WTC) response on and after 11 September 2001. We conducted a nested case-control study of WTC Health Program (WTCHP) general responders to examine the effects of WTC exposures and behavioural risk factors on HNC.

Methods: We enrolled 64 cases and 136 controls, matched on age, sex and race/ethnicity within risk sets. We assessed tobacco and alcohol use, sexual activity, and occupational exposures prior to, during and after WTC exposure until case diagnosis via questionnaire. We obtained WTC exposure information (duration (first to last day), total days and location of work) from the WTCHP General Responder Data Center. We assessed associations with HNC, and interaction among exposures, using conditional logistic regression.

Results: Responders in protective services versus other occupations had increased odds (OR: 2.51, 95% CI 1.09 to 5.82) of HNC. Among those in non-protective services occupations, arriving to the WTC effort on versus after 11 September 2001 was significantly associated with HNC (OR: 3.77, 95% CI 1.00 to 14.11). Duration of work was not significantly associated with HNC. Lifetime and post-WTC years of cigarette smoking and post-WTC number of sex partners were positively and significantly associated with HNC, while alcohol consumption was not.

Conclusions: These findings suggest opportunities for HNC risk factor mitigation (eg, smoking cessation, human papillomavirus vaccination) and contribute to a risk factor profile which may assist WTCHP clinicians with identifying high-risk responders and improve detection and treatment outcomes in this population.

Keywords: World Trade Center; head and neck cancer.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Alcohol Drinking
  • Case-Control Studies
  • Cigarette Smoking / adverse effects
  • Cohort Studies
  • Emergency Responders / statistics & numerical data
  • Female
  • Head and Neck Neoplasms / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • New York City
  • Occupational Exposure / statistics & numerical data*
  • Risk Factors
  • September 11 Terrorist Attacks*
  • Sexual Behavior