When the James Zadroga 9/11 Health and Compensation Act (P.L. 111-347) was signed into law in January 2011, among its aims was providing screening and medical treatment for the fire fighters, police officers, emergency responders and certain other survivors. More than $4 billion was authorized by Congress for the program. The adverse health conditions covered by the program for eligible participants were limited primarily to respiratory and mental health disorders. The list included the conditions that the responders and survivors were already suffering due to exposures at the World Trade Center site, such as asthma, chronic obstructive pulmonary disease, reactive airway dysfunction syndrome, chronic cases of rhinosinusitis, nasopharyngitis and laryngitis, as well as PTSD, major depression, substance abuse and anxiety disorders. (Eligible survivors of the 9/11 attacks at the Pentagon and Shanksville, PA sites were also encouraged to participate in the screening and medical treatment program.)
The Zadroga law contained a provision to allow the director of the World Trade Center Health Program, who is also the director of CDC’s National Institute for Occupational Safety and Health (NIOSH), to add new conditions to the list. Recommendations for those new conditions came be made by a periodic review of the scientific evidence, a petition, or the director’s discretion.
In September 2011, the program director received a petition from Senators Kirsten Gillibrand (D-NY) and Charles Schumer (D-NY), and Representatives Carolyn Maloney (D-NY), Jerrold Nadler (D-NY), Peter King (R-NY), Charles Rangel (D-NY), Nita Velazquez (D-NY), Michael Grimm (R-NY), and Yvette Clark (D-NY), requesting that cancer be added to the list of covered conditions. The petition referred to a study of cancer incidence in 9,853 men employed as New York City firefighters which was published that same month in Lancet. The authors of “Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study,” were cautious in the interpretation of their data which identified a modest excess cancer incidence (of any type) among the 8,927 firefighters classified as exposed when compared to the U.S. population.
The petition led the WTC Health Program director to request the expertise and recommendations of the program’s Scientific/Technical Advisory Committee (STAC) to
‘‘review the available information on cancer outcomes associated with the exposures resulting from the September 11, 2001, terrorist attacks, and provide advice on whether to add cancer, or a certain type of cancer, to the List specified in the Zadroga Act.’’
Based on the STAC’s recommendations, and following a public comment period,WTC Health Program director published a final rule on September 10 to amend the list of covered conditions. Effective October 12, 2012, that list will include 50 types of cancer, from malignant neoplasms of the bladder, colon, liver, lung, rectum, and stomach, to leukemia, lymphoma, myeloma and mesothelioma.