ASPO Abstracts
Use of World Trade Center Health Program Data to Assess Risk Factors for Head and Neck Cancer; Preliminary findings
Category: Lifestyles Behavior, Energy Balance & Chemoprevention, Early Detection & Risk Prediction
Conference Year: 2018
Abstract Body:
Purpose: Excess cancer has been reported among workers and volunteers who participated in the rescue and recovery efforts following the 9/11 World Trade Center (WTC) attacks. This study explores the use of WTC Health Program (WTC-HP) alcohol and tobacco use data -- two population behavioral risk factors for head and neck cancer (HNC) -- for understanding HNC risk in this population. Methods: The WTC-HP provides medical monitoring and treatment for eligible WTC workers and volunteers. Annual medical monitoring visits include self-administered questionnaires about health and WTC exposure. Data from consenting participants are managed by the WTC General Responders Data, which performs linkages with the state-based cancer registries to verify and update cancer diagnoses. We used a nested case-control design: cases were diagnosed with HNC (standard ICO-3 for oropharyngeal and laryngeal cancer); controls (8:1) were selected by risk-set sampling based on case diagnosis age and date, then matched on sex and race/ethnicity within risk sets. Differences in the distribution of WTC exposure intensity and duration, self- reported alcohol consumption (moderate/heavy drinkers/former heavy drinkers vs. non-/occasional drinkers) and cigarette smoking at first visit (current, former, never) between cases and controls were assessed using bivariate analysis and conditional logistic regression. Results: In this preliminary analysis the 71 cases did not differ from the 594 controls in terms of WTC exposure (OR high vs. low exposure =0.9, 95% CI: 0.4, 2.0) or tobacco use (OR ever vs never=1.0, 95% CI: 0.9, 1.8). A positive association was observed between higher alcohol consumption and HNC (OR=1.6; 95% CI: 0.9, 2.8.; p=.11) Conclusions: The null and non-significant associations with HNC onset were surprising and may indicate: underreporting of risk behaviors; misclassification of WTC exposure; a strong unmeasured causal risk factor e.g. oral infection with oncogenic human papillomavirus; heterogeneity in associations across anatomical sites; and/or inadequate power. Future analyses will include more cases and controls as well as refined and longitudinal risk factor assessments to examine the value of WTC-HP data for epidemiologic analyses of cancer risk.
Keywords: cancer, World Trade Center, epidemiology