Twenty-five years ago, the attack on the World Trade Center engulfed Ground Zero in a shroud of smoke, leaving Lower Manhattan covered in toxic dust for months.
Surely, the massive, sustained exposure to smoke and dust would cause an uptick in lung cancer, particularly among first responders.
“My greatest concern was that they were gonna get lung cancer,” said Michael Crane, then medical director at Con Edison, the energy provider for New York City, whose job was to take care of people working at Ground Zero. “I remember standing there. I couldn’t breathe. I had to walk away. I didn’t have a mask on or anything.”
His job was to treat workers who were repairing and inspecting utility lines, as well as digging through the rubble as part of the cleanup efforts.
“I was thinking to myself, ‘God, we don’t have enough respiratory stuff, we don’t have enough protection, the masks. My god, what’s gonna happen?’ My number one concern was the respiratory health going forward.”
Anticipating a massive uptick in lung cancer, Crane, now medical director of the World Trade Center Health Program Clinical Center of Excellence at Mount Sinai in New York City, wanted to do something to muffle this deadly impact.
Photo Credit: Gregory Semendinger, NYC Police Aviation Unit.
The World Trade Center Health Program is a federal program that provides health monitoring and treatment to people—particularly first responders—who were directly exposed to the environmental toxins of the Sept. 11, 2001, terrorist attacks.
Among its most impactful programs is one that sounds so simple that its success is stunning: a smoking cessation program.
Would smoking cessation slow down the lung damage, muffling the effect of the smoke and dust?
“I will posit right now that lung cancer is caused by that junk in the pile, for sure, but when you took that cigarette risk away, you slowed that down,” said Crane, who is also a professor in the Department of Environmental Medicine at the Icahn School of Medicine at Mount Sinai, medical director of the Selikoff Centers for Occupational Health.
“In our population of responders, who had minimal protection, we seem to have a risk of exposure that needed that extra boost of the cigarette to cause the cancer. We may have slowed it to the point it will not happen in a normal lifespan. So, the people will maybe be at risk until they’re 92 and pass away. But if they had kept smoking, the risk would have raised its ugly head at 72, right? The way I put it together is we slowed the clock,” Crane said.
Today, the data obtained over a quarter century provide a picture of the impact of 9/11 attacks on cancer incidence among rescue and recovery workers.
A study published in the Journal of the National Cancer Institute in 2021 reported an elevated incidence of melanoma-skin, prostate, thyroid, and tonsil cancers—but no elevated incidence of lung cancer.
According to the JNCI paper, reduced smoking rates may be the cause:
The consistent finding on the deficit of lung cancer may be because of lower smoking rate in our study population, as the prevalence of smoking at enrollment (16.2%) was lower than the prevalence in NYS adults (19.9%-23.2%) in a similar time period. However, the risk of both cancers remains a major concern in this exposed cohort given their long latency periods and numerous known carcinogens well described in WTC dust and fumes.
So far, the much-feared uptick in lung cancer has not appeared.
“The numbers don’t show it,” Crane said. “When I say that, I want to get up and do my happy dance around the desk. Fingers crossed, fingers crossed, lung cancer might be off the table. But of course, there’s no guarantees in life, as in anything else.”
Crane appeared on the Cancer History Project Podcast.
This episode is available on Spotify, Apple Podcasts, and YouTube.
The workers at Ground Zero put their lives on the line, often working without safety equipment.
“They would diligently put the mask on and go off to work,” Crane said. “The problem was that the filters would clog up within about 30 minutes. We gave them, of course, extra filters, but you can’t just hand everybody 8-10 filters. With hundreds of people, you run out pretty soon. People were compensating by [wearing] the mask on top of the helmet or they’d wear a handkerchief.”
Workers were coming into his clinic with coughs.
“I said to them, ‘Look, come on out, let’s get you out,’” Crane said. “Basically they told me to go jump in the lake very politely. They weren’t gonna stop. They had lost friends. As one guy told me, ‘Doc, I got family in this pile.’ They were not gonna stop.”
Scientists would later learn that the dust contained hundreds of chemical hazards, including known human carcinogens. How would that impact responders?
Source: Library of Congress.
“When I got up to Mount Sinai, which I guess was 2006, people were already working on that, working on the research. But also specifically starting a very, very rigorous stop smoking program,” Crane said.
“I’m sure you know about stopping smoking programs. It is really tough. You gotta keep going, you gotta keep encouraging, you need the add-ons, the gum, whatever, the nicotine replacement. But it really took hold through some wonderful magical intelligence of the responders. I mean and they dropped smoking like they were dropping yesterday’s news.”
The smoking rate declined from 20% to just 3%, according to Mount Sinai.
Crane marvels at this datapoint.
“When I die, and God asks me: ‘What did you do with your life?’ I’m gonna give them that statistic and demand to get into the doors. ‘Open the doors, buddy! Look what I did here,’” Crane said.
My greatest concern was that they were gonna get lung cancer. I remember standing there. I couldn’t breathe. I had to walk away. I didn’t have a mask on or anything.
Michael Crane
Crane said the work is not done, as the World Trade Center Health Program enters a new chapter.
The number of 9/11 survivors, who are served by a slightly different program than first responders, receiving aid for cancer care has more than tripled in recent years, according to a recent analysis by The Washington Post.
In 2021, 8,800 survivors received aid for cancer. In 2026, that number had grown to more than 27,000 survivors—a trend that may be attributed in part to an aging population.
In a law called the James Zadroga 9/11 Health and Compensation Act, which funds the World Trade Center Health Program, the federal government provides medical monitoring and treatment benefits for first responders, Ground Zero workers, and survivors.
Source: WTC Health Program
Source: NIOSH’s Health Effects Laboratory Division (HELD) and WTC Health Program
Cancer is explicitly covered by the Zadroga Act.
“They felt if they highlighted it in the program that we on the ground would also do everything we possibly could to reduce the risk, as in our stop smoking program,” Crane said. “So, in a way it was saying, ‘Yep, we’re gonna cover it, but I wanna give you guys, you doctors a boot in the fanny to do all the protective stuff.’”
Crane hopes the Zadroga Act can be expanded to increase coverage of heart disease and cognitive issues.
He also believes the program needs to enroll more young survivors who were exposed to the dust as children.
“Remember, they were grade school kids, who are now maybe 30 or 35. They’re going to have kids of their own. If there’s an issue here for the young people because of that exposure, we really want to know about that,” Crane said. “I think it’s absolutely critical.
They weren’t gonna stop. They had lost friends. As one guy told me, ‘Doc, I got family in this pile.’ They were not gonna stop.
Michael Crane
“Potentially there’s something that could pass between the generations that we don’t even know about. We should be ringing the bells from the rooftop for this next generation [to join the program].”
On Sept. 8, the administration of New York City Mayor Zohran Mamdani released thousands of pages of documents, suggesting that public officials knew that dangerous levels of carcinogens were present for months after the attacks. All the while, they assured the public that the air quality in those areas was safe. Mamdani has accused city leaders of lying to the public at the time.
“I mean, look at the reports now,” Crane said. “The dust was there in the corner, when you opened the drawer, on the windowsill. It didn’t get cleaned up.
“Let’s take care of that population of people. They are deserving. They were there. They kept New York open. Come on, let’s take care of them.”
Coverage of 9/11 in The Cancer Letter
The Cancer Letter dedicated the Sept. 21, 2001 issue “to the stories, thoughts, and fears of individuals in the cancer research community as they experience this national crisis and suddenly confront an uncertain economy, with possible implications for federal research funding, and a difficult climate for travel and international communication.”
The following are excerpts from this issue. These articles have now been digitized, and are available on the Cancer History Project.
Gilles Frydman, president of the Association of Online Cancer Resources, spent the night of Sept. 10 working to recover data from a failed hard drive in a server at ACOR headquarters in Queens.
He arrived home at 5:30 a.m. and went to bed. A few hours later, his wife, Monica, took their children to school on the subway. “I remember seeing them go, then fell asleep again,” he said.
“All of a sudden, I heard a sound, an incoming sound,” Frydman said. “I lived in Israel next to an airport. I knew instantly it was not OK. I thought it was a military plane, but then I thought it was a plane that was going to crash, and crash on me, and I would never see my children again. That sound threw me out of my bed.
“One second later, I heard—Boom! I looked in front of my window and saw it. The World Trade Center was just in front of us. My building on 173 Duane Street is yards from what the journalists are calling ‘ground zero.’”
A little after 10 a.m., Sept. 11, during a coffee break, members of the FDA Oncologic Drugs Advisory Committee learned that airplanes had crashed into the World Trade Center and the Pentagon.
A fourth plane was thought to be heading toward the Washington area, employees were being evacuated from federal buildings, and the city was gridlocked.
Committee Chairman Stacy Nerenstone decided to go on with the meeting.
“I made the announcement that if we were to stop the meeting, then the terrorists have won, because routine business couldn’t get done,” said Nerenstone, an oncologist at the Hartford Hospital Gray Cancer Center.
IDEC Pharmaceutical Corp. was in the midst of presenting the data on Zevalin (ibritumomab tiuxetan), a therapy for non-Hodgkin’s lymphoma. FDA was yet to present its evaluation of the data. Suspending the meeting would have been unfair to the sponsor, FDA, and the patients.
“I made the decision that everybody was prepared, and everybody was there,” Nerenstone said. “To suspend it and just to have people milling around was just a waste of people’s time.”
For more than three hours that followed, the committee members maintained their concentration on the New Drug Application as the sound of fighter jets rattled the oversized, garish crystal on the chandeliers at the Versailles Room of Bethesda Holiday Inn.
“We continued the meeting, and actually it went over the time, because it was a very complicated subject,” Nerenstone said.
Three pharmaceutical and medical device industry executives were passengers on hijacked airplanes and died on Sept. 11, 2001.
Dora Menchaca, 45, a cancer researcher and associate director of clinical research for Amgen Inc, and Lisa Raines, 43, senior vice president of government relations for Genzyme Corp., were passengers on American Airlines Flight 77, which crashed into the Pentagon.
Thomas Burnett Jr., 38, chief financial officer of the medical research firm Thoratec Corp., of Pleasanton, CA, was a passenger on United Flight 93.
During the flight, Burnett called his wife and said he and other passengers were “going to do something” about the hijackers. The airplane crashed in a field in Pennsylvania, killing all 44 on board. Investigators believe it was probably headed for Washington, DC, or Camp David, MD.
Coverage of the ongoing health impacts of 9/11 in The Cancer Letter
- 9/11 responders have increased overall cancer incidence in thyroid, prostate, and leukemia cancers, study finds, Jan. 24, 2020
- Research shows 9/11 disaster site exposure led to doubled risk of myeloma, Sept. 9, 2022
- Vanderbilt study: World Trade Center responders at higher risk for blood cancer-associated mutations, March 11, 2022
- DNA methylation contributes to 9/11-related breast cancers, Sept. 13, 2024
Read more on the Cancer History Project. This interview is available on Spotify, Apple Podcasts, and YouTube.
The Cancer History Project is a free, collaborative archive of oncology history that aims to engage the scientific community and the general public in a dialogue on progress in cancer research and discovery.
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The Cancer History Project is an initiative of The Cancer Letter, and is backed by over 60 partners, spanning academic cancer centers, government agencies, advocacy groups, professional societies, and more.
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