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The 9/11 memorial is seen in reflection in lower Manhattan. Liao Pan/China News Service via Getty Images
  • Tens of thousands of 9/11 responders and survivors have developed illnesses related to ground zero exposures.
  • The federally funded World Trade Center (WTC) Health Program recognizes dozens of illnesses, injuries, cancers, and mental health conditions that are linked to ground zero exposures.
  • More than 4,600 responders or survivors in the program have died.

This Saturday marks the 20th anniversary of 9/11, when nearly 3,000 people died during the terrorist attacks in New York, Washington, D.C., and Pennsylvania.

The day is also a reminder of the toll those attacks took on survivors and first responders who were exposed to noxious chemicals, fumes, and dust at the site of the attacks, especially at ground zero.

Many of those who worked at ground zero have become sick with illnesses linked to those sites. Many have died.

The federally funded World Trade Center (WTC) Health Program — which monitors the health of 9/11 responders and survivors — recognizes dozens of illnesses, injuries, cancers, and mental health conditions that are linked to ground zero exposures.

The most common conditions seen in responders and survivors include cancers, asthma, sleep apnea, post-traumatic stress disorder (PTSD), and anxiety or major depression.

Of the more than 107,000 people enrolled in the WTC Health Program, over 65,000 have at least one health condition covered by the program.

More than 23,000 have a diagnosis of at least one type of cancer. This includes people who are now deceased.

In addition, over 4,600 responders or survivors in the program have died.

Not all these deaths can be attributed to exposures at ground zero. The program records all deaths, including accidents and unrelated conditions.

But the true number of deaths due to ground zero exposures is likely higher.

The roughly 100,000 people enrolled in the program is out of an estimated 410,000 first responders, cleanup crews, and survivors.

Researchers have been monitoring the health of 9/11 responders for many years to better understand the health risks from ground zero exposures.

A 2019 study found that 9/11 responders have an elevated risk of certain cancers compared with the general population. Their risk is 25 percent higher for prostate cancer, more than double for thyroid cancer, and 41 percent higher for leukemia.

Two studies published this week found similarly increased health risks for 9/11 responders.

In one study, researchers found that male firefighters who were at ground zero following the 9/11 attacks are 13 percent more likely to develop cancer than firefighters who didn’t work at the site.

The risk for 9/11 firefighters was also 39 percent higher for prostate cancer and more than twice as high for thyroid cancer.

Another group of researchers found that the risk of prostate cancer was 24 percent higher for 9/11 rescue and recovery workers compared with the general population.

The highest risk was for those who responded earliest at the disaster site.

Researchers will continue to monitor 9/11 responders over the coming decades for changes in their health, some of which may take years to show.

“Cancers have long latency periods. Some cancers take 15 to 25 years to manifest themselves,” said Dr. Iris Udasin, principal investigator at the World Trade Center Health Program Clinical Center of Excellence at Rutgers University.

Other health conditions related to ground zero exposures may worsen as responders and survivors age.

“Lung problems do get worse as people get older,” Udasin said, “because lung problems are worse if you have something else, such as high blood pressure or heart disease.”

Recent research shows that efforts like the WTC Health Program may be improving the survival of responders. The program covers all the medical care for certified health conditions.

In a July 2021 study, researchers found that 9/11 first responders enrolled in the World Trade Center medical monitoring and treatment programs are 28 percent more likely to survive their cancer than the general population.

In addition, 9/11 responders in the program have a 36 percent lower risk of dying from noncancer causes.

“These results provide evidence that systematic health surveillance and treatment improves survival among cancer patients,” the authors wrote.

Researchers also noted that better survival may be related to better health among responders than the public, because firefighters and emergency medical technicians (EMTs) have to be more physically active than people with sedentary jobs.

However, Udasin said people enrolled in the WTC Health Program have good access to early diagnosis and treatment, which can make a big difference for their health.

Recently, a WTC Health Program enrollee told Udasin that she needed a lung cancer therapy that was not covered by many insurance companies.

“We were able to get it for her [through the program],” she said. “And the woman’s still alive with her stage 4 lung cancer, because we got her that treatment.”

Other research shows that treatment programs focused on the needs of 9/11 responders can help reduce their health risks.

A study by researchers at NYU Langone Health found that overweight 9/11 firefighters who followed a calorie-restricted Mediterranean diet for 6 months reduced their body mass index (BMI).

They also had fewer signs of lung disease than before the study.

All the responders included in the study had diagnosed lung injury linked to ground zero exposures.

The Mediterranean diet emphasizes unrefined whole grains, olive oil, fruits, and fish.

Study author Dr. Anna Nolan, a professor of medicine and environmental health at NYU Langone, said seeing the links between ground zero exposures, lung disease, and risk factors such as BMI, has been “eye-opening.”

“It was important for me as a healthcare provider to see this complex relationship evolve over time,” she said, “and to see that it was still possible to help these first responders mitigate their risk even after so many years.”

She said this is also the first study to show that changing one or more risk factors can reduce the lung disease risk in 9/11 responders.

Other risk factors linked to lung disease in 9/11 responders include insulin resistance, high blood pressure, and increased sugar or cholesterol (lipid) levels in the blood.

These, along with high BMI, are all components of metabolic syndrome, a collection of factors that increase the risk of heart disease, stroke, and diabetes.

Researchers also assessed firefighters’ smoking history. Nolan said their work shows that BMI and blood lipid levels contributed more than smoking to the risk of lung disease due to 9/11 exposures.

Monitoring of the firefighters included in the study will continue.

These responders and others will also continue to receive care through the WTC Health Program. The care they receive will adapt based on the latest research.

“As their healthcare needs evolve, the program should evolve to take these new needs into account,” Nolan said.