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Risk factors for head and neck cancer in the World Trade Center Health Program General Responder Cohort: results from a nested case–control study
  1. Michelle T Bover Manderski1,
  2. Kathleen Black2,
  3. Iris G Udasin2,
  4. Anna R Giuliano3,
  5. Michael B Steinberg4,
  6. Pamela Ohman Strickland1,
  7. Taylor M Black2,
  8. Christopher R Dasaro5,
  9. Michael Crane5,
  10. Denise Harrison6,
  11. Jacqueline Moline7,
  12. Benjamin J Luft8,
  13. Marian R Passannante1,
  14. Roberto G Lucchini5,
  15. Andrew C Todd5,
  16. Judith M Graber1,2
  1. 1 Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
  2. 2 Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
  3. 3 Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
  4. 4 Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  5. 5 Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  6. 6 Department of Environmental Medicine, Bellevue Hospital Center, New York City, New York, USA
  7. 7 Department of Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
  8. 8 Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York, USA
  1. Correspondence to Dr Michelle T Bover Manderski, Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA; bovermi{at}


Objectives Head and neck cancers (HNCs) may be among the health consequences of involvement in the World Trade Center (WTC) response on and after 11 September 2001. We conducted a nested case–control study of WTC Health Program (WTCHP) general responders to examine the effects of WTC exposures and behavioural risk factors on HNC.

Methods We enrolled 64 cases and 136 controls, matched on age, sex and race/ethnicity within risk sets. We assessed tobacco and alcohol use, sexual activity, and occupational exposures prior to, during and after WTC exposure until case diagnosis via questionnaire. We obtained WTC exposure information (duration (first to last day), total days and location of work) from the WTCHP General Responder Data Center. We assessed associations with HNC, and interaction among exposures, using conditional logistic regression.

Results Responders in protective services versus other occupations had increased odds (OR: 2.51, 95% CI 1.09 to 5.82) of HNC. Among those in non-protective services occupations, arriving to the WTC effort on versus after 11 September 2001 was significantly associated with HNC (OR: 3.77, 95% CI 1.00 to 14.11). Duration of work was not significantly associated with HNC. Lifetime and post-WTC years of cigarette smoking and post-WTC number of sex partners were positively and significantly associated with HNC, while alcohol consumption was not.

Conclusions These findings suggest opportunities for HNC risk factor mitigation (eg, smoking cessation, human papillomavirus vaccination) and contribute to a risk factor profile which may assist WTCHP clinicians with identifying high-risk responders and improve detection and treatment outcomes in this population.

  • World Trade Center
  • head and neck cancer

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  • Contributors MTBM, KB, ARG, IGU and JMG contributed to conception and design of the study. MTBM led the questionnaire development in collaboration with KB, TMB, IGU, MBS, ARG, MRP and JMG. TMB organised the study database. MTBM performed the statistical analysis and wrote the first draft of the manuscript with guidance from JMG, POS, MRP and ARG. IGU, BJL, DH, MC and JM led the GRC data collection and contributed to manuscript writing. CRD, RGL and ACT maintained and provided GRC data and contributed to manuscript writing. All authors contributed to manuscript revisions and approved the submitted version.

  • Funding This work was supported by Grant or Cooperative Agreement Number 1U01OH011322-01 funded by the Centers for Disease Control and Prevention. Its content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This research obtained ethics approval from the Institutional Review Board at Rutgers, The State University of New Jersey. Participants gave informed consent before taking part in this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Certain data are available upon reasonable request, but some data may be obtained from a third party and are not publicly available.