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Impact of healthcare services on thyroid cancer incidence among World Trade Center‐exposed rescue and recovery workers
Author(s) -
Goldfarb David G.,
Colbeth Hilary L.,
Skerker Molly,
Webber Mayris P.,
Prezant David J.,
Dasaro Christopher R.,
Todd Andrew C.,
Kristjansson Dana,
Li Jiehui,
Brackbill Robert M.,
Farfel Mark R.,
Cone James E.,
Yung Janette,
Kahn Amy R.,
Qiao Baozhen,
Schymura Maria J.,
Boffetta Paolo,
Hall Charles B.,
ZeigOwens Rachel
Publication year - 2021
Publication title -
american journal of industrial medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.7
H-Index - 104
eISSN - 1097-0274
pISSN - 0271-3586
DOI - 10.1002/ajim.23277
Subject(s) - medicine , poisson regression , population , relative risk , rate ratio , thyroid cancer , incidence (geometry) , demography , cancer , cohort study , environmental health , confidence interval , physics , sociology , optics
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.