A $2.76 billion aid program for people sickened by World Trade Center dust should be expanded to include those who have at least some types of cancer, members of a government advisory panel said Thursday.
Congress set aside a huge pot of money last year to compensate and treat people exposed to the clouds of toxic soot released during the collapse of the twin towers on Sept. 11, 2001, but lawmakers concerned about runaway costs and illegitimate health claims also limited the program to people suffering from a relatively short list of illnesses, including asthma, acid reflux and certain chronic sinus problems.
So far, cancer hasn't made that list, mostly because scientists have yet to see strong evidence that people exposed to the dust are getting the disease at higher rates than the general public.
The scientific debate is still in its early stages, but at a meeting Thursday in New York, members of the World Trade Center Health Program Scientific and Technical Advisory Committee said they thought evidence of a cancer link would eventually be found, given the sorts of toxins that were present at the site. They agreed, with near unanimity, that it was reasonable to expand the program now while the research continues.
Waiting for harder evidence that could still be years or decades away could mean that deserving people are denied care when they need it most, said panel member Dr. William Rom, director of the division of pulmonary and critical care medicine at New York University's medical school.
"I just don't think we can wait that long," he said.
The committee was less resolved about which cancers to cover. Tens of thousands of people were exposed to the dust from the trade center's destroyed 110-story towers. Many are now of an age when cancer is common. Some are suffering from types of cancer for which there is "no biological plausibility at all" of a trade center tie, Rom said.
Members of the committee spent much of the day Thursday talking about where to draw the line. Some favored a tailored list that would only include types of cancer for which there was a plausible connection to toxins present on 9/11. Others suggested leaving the decision in the hands of federal administrators, or even individual doctors, who would evaluate patients on a case-by-case basis.
The committee's recommendation, now due by an extended deadline of April 2, is advisory only. It can be accepted, rejected or taken piecemeal by the program's administrator, Dr. John Howard, director of the National Institute for Occupational Safety and Health.
The 17-member committee itself is not purely a scientific panel. Besides doctors with experience treating occupational diseases and injuries, it includes Manhattan neighborhood activists and union officials representing city firefighters, police officers and municipal workers.
One of those union representatives, Valerie Dabas, a human resources analyst for the Patrolmen's Benevolent Association, said she was opposed to putting any limits on what types of cancer are covered because gaps in medical knowledge could lead to someone being denied care.
"I think it would be very dangerous," she said.
Overall, the panel is short on cancer specialists, but its chairwoman, epidemiologist Elizabeth Ward, studied cancer for years for the National Institute for Occupational Safety and Health and is now vice president for intramural research at the American Cancer Society.
The committee's evaluation on the 9/11 cancer issue was prompted by a study published in September of cancer rates among city firefighters. The study identified some small spikes in particular cancer types that were cause for concern, but it generally failed to find a significant increase in cancer rates. Out of the 9,000 firefighters in the study group, researchers found only four more cancer cases than they expected, based on rates in the general public. That increase is small enough to have been caused by chance.
Advisory committee: http://www.cdc.gov/niosh/topics/wtc/stac/