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What the experts find most telling are the types of cancer now emerging. They say the blood cancer cases seem too disproportionate to be random. Two percent of these workers have been diagnosed with what amounts to related diseases, none of which fall into the "high-frequency" category, which includes prostate cancer. One out of 9,000 people nationwide gets lymphoma a year; for myeloma, it's one out of 30,000. By contrast, the 75 blood cancer patients translate into several dozen new cases a year.
"That's not just a fluke," says Ozonoff, who studies cancer clusters and toxic waste sites.
Samet, a worldwide expert on smoking and cancer, notes that when so many cases of related cancers emerge, it can signal a forming cluster. "It sounds like an impressive cluster of cancer cases, and I would want to study it," he says.
To be sure, the experts advise caution until more evidence is collected. They acknowledge that the data needed to draw a definite link between 9-11 and cancer don't exist. None of the cancers emerging now are the kinds that come only from toxic exposureslike, say, asbestosis, which is caused by asbestos and can take two decades to grow. This sentinel cancer would go a long way toward proving a 9-11 connection. Absent that, scientists would want to determine whether a higher proportion of cancer patients exists among the workers than in the general public. But because there are no independent data on the 40,000-strong group, they can't make this calculation yet. Meanwhile, the latency periods for most cancers from the time of a full-blown carcinogenic exposure to a full-blown malignancy can take years, if not decades. Says Thun, of the American Cancer Society: "It is the exception rather than the rule to have cancers develop this quickly."
Despite the lack of definitive data, we may still be in the midst of a cancer epidemic. Indeed, according to these experts, traditional data don't help much here because 9-11 represents such a singular exposure. No one can deny that the workers were exposed to a blend of pulverized and aerosolized toxins that had never existed in any occupational setting before. And this mix of toxins alone is enough to cause more aggressive cancers.
"It's also enough to throw out prescriptions on timing," Hesdorffer adds.
Back in May 2004, before most doctors even contemplated a 9-11 link to cancer, Hesdorffer provided testimony to the federal government's September 11 Victim Compensation Fund on behalf of one police officer who had developed pancreatic cancer within a year after his recovery stint. Hesdorffer finds it odd that two of his patients had been diagnosed with the rare cancer after working on the Pile. "It's strange to have two people who were subjected to the same exposure," he says, "developing the same cancer in the same time frame." Now that he has learned of Worby's statistics, he is convinced that "there is definitely more than a likely link between the 9-11 exposures and cancer."
Francine Laden, who specializes in air pollution and cancer, agrees. Because so many of Worby's clients have blood cancerswhich have faster incubation periods than tumor cancers, forming in as little as five yearsLaden confirms that it's not a stretch to attribute their diseases to the dust cloud. "Blood cancers are different," she says, noting the tie between benzene and leukemia, as well as dioxin and lymphoma. "It's not beyond the realm of feasibility that these chemicals caused these cancers."
Ozonoff puts it more firmly: "For an acute episode like this, it's definitely possible these blood cancers were caused by 9-11."
Ozonoff echoes all five of his colleagues when he draws parallels between the aftermath of 9-11 and that of another massive exposure: the atomic-bombs dropped on Japan. Bomb survivors experienced excessive spikes in leukemia rates within the first five years, a surprising discovery for epidemiologists in the mid 20th century. While this outbreak resulted from radiation, both it and 9-11 involved a sudden and intense blast of carcinogens. For bomb survivors, leukemia appeared first, followed by breast and lung cancer. "That could happen with 9-11," says Samet, the Johns Hopkins epidemiology department chair. "It might be what we're seeing today."
It's also possible that the carcinogens in the Trade Center dust accelerated cancers already dormant or developing in the recovery workers, epidemiologists say. According to Richard Clapp, who directed the Massachusetts Cancer Registry from 1980 to 1989, toxins can not only instigate the genes that cause cancerous cells to divide, but also hasten their dividing. That means that a person with an undetected cancer will develop it faster and in a more virulent manner. He calls this the "promotional effect" and says some toxins associated with 9-11 have been known to speed up lymphomas and leukemias. "The promotional effect could have happened already," he says.
Either way, Clapp adds, "It's hard not to attribute these cancers to 9-11." His gut, he says, is telling him one thing: "We'll be seeing a cancer explosion from 9-11, and we're starting to see it today."
A nurse would ask John Walcott about possible causes of his acute myelogenous leukemia. Like Vallebuona, Walcott answered no to all the questions. And like Vallebuona, he didn't connect the dots between his time at ground zero and the cancer growing in his body.
photo: Scott McDermott
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