Impact of healthcare services on thyroid cancer incidence among World Trade Center-exposed rescue and recovery workers.

Autor: Goldfarb DG; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.; Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA.; Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA., Colbeth HL; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.; Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA., Skerker M; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.; Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA., Webber MP; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA., Prezant DJ; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.; Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA.; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA., Dasaro CR; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Todd AC; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Kristjansson D; Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway.; Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway., Li J; New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA., Brackbill RM; New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA., Farfel MR; New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA., Cone JE; New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA., Yung J; New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA., Kahn AR; New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA., Qiao B; New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA., Schymura MJ; New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA., Boffetta P; Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA.; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy., Hall CB; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA., Zeig-Owens R; Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.; Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA.; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Jazyk: angličtina
Zdroj: American journal of industrial medicine [Am J Ind Med] 2021 Oct; Vol. 64 (10), pp. 861-872. Date of Electronic Publication: 2021 Jul 18.
DOI: 10.1002/ajim.23277
Abstrakt: 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.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
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