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Nearly two years after Shore died, the city agreed to pay workers' compensation to his family. But despite the certainty of Michelle Shore and others, tying cancer to the 9/11 cloud is a tricky thing. People in this city routinely succumb to the disease as a matter of course; among New Yorkers, cancer is the second leading cause of death. According to local mortality rates, in a random population of 70,000about the number of people enrolled in the WTC registryyou would expect roughly 90 cancer deaths per year, primarily from lung, colon, breast, and prostate cancers.
And in a population of 400,000the estimated number of people exposed at Ground Zeroyou could expect as many as 3,000 people to die of cancer over a six-year period.
No one has yet done a study that attempts to compare cancer rates or cancer fatalities in that Ground Zero population to other groups.
Thorpe says that no data currently exist to show that people exposed to the 9/11 dust cloud are dying of cancer at a higher rate than any random sample of New Yorkers.
"Irrespective of their exposure, some of these people would have developed cancer," Thorpe says. "One or two years later, there's some cause to be cautious in making that leap. That said, this was an intense exposure, it has health ramifications, and we need to stay focused on it."
Similarly, the same FDNY doctors who detailed the increase in respiratory ailments among firefighters say that a preliminary analysis shows "no clear increase" in cancers since 9/11.
Johns Hopkins researchers Samet and Geyh write in their paper that asbestos exposure is "unlikely to have been sufficient to cause asbestosis or a measurable increase in the risk of lung cancer." An increased risk for mesotheliomathe disease commonly tied to asbestos exposure"would not become evident for decades." And the long-term risk of cancer, the authors say, "will be difficult to measure with any precision."
A May 31 study in The New England Journal of Medicine concluded that Ground Zero dust samples did contain fire-related carcinogens, but that "any associated increased risk for respiratory tract and most other cancers will not become apparent for decades." And city health commissioner Frieden likewise has said that it is unknown whether cancers will develop as a result of exposure.
The irony is that even in the best of circumstances, it is extraordinarily difficult to prove that a specific source has caused cancer. In fact, studies of cancer clusters are often inconclusive simply because the mechanism that causes such ailments is still unknown.
In order to verify the relationship, researchers say, one would have to compare the Ground Zero population to a similar but unexposed group and see whether the cancer rates are higher. But there are so many unknowns and variables at play that it would be a very difficult study to do with precision. Even identifying a group of people that could be compared to the Ground Zero population would be difficult.
"In the ideal world, you might try to gather up people exposed and try to understand what they were exposed to," Samet says. "The question is: How well can we reconstruct what people were exposed to, and could enough people be assembled to do that? The hard part would be finding these people. We'll have to see."
In many ways, the very scale of the issueto say nothing of the uncertainty and costhas created something of a muddle and left government officials pursuing a schizophrenic course.
The city is a great example of that. Even as it funds the Bellevue clinic, backs the WTC registry, and pursues further research, it is also fighting a rear-guard action against disability and workers' comp claimsarguing, according to a lawyer involved in those cases, that there is no concrete proof that individual workers have gotten sick from a specific illness related to the dust.
And in papers filed opposing the class- action lawsuit brought by 10,000 ailing people, the city has argued that it is immune from lawsuits because it was acting in an emergency. In legal papers, lawyers for the city slam the plaintiffs for "second-guessing decisions made during a time of crisis."
Joel Shufro, of the Committee for Occupational Safety and Health, acknowledges that all of the outstanding health questions may never be answered. "But it does seem to me that at some point, if you have significant numbers of people developing illness, you have a problem," he says. "To take the other side of itto say, because there is no scientific certainty, that people aren't entitled to treatmentis equally presumptive."
For Shufro, the research is almost a secondary question: "Talk to people who lost their homes, who had to take kids out of college, and ask them whether this is a result of their exposure," he says. "Their lives changed overnight. In the final analysis, what we're talking about here is how does this society respond to peopleand where do you draw the line in terms of care for people who are ill?"
Many have looked to the federal government to fund a long-term health-care program for the workers. Nadler, Maloney, and Senator Hillary Clinton have all submitted bills that would make 9/11 health expenditures part of the annual federal budgetbut estimates of the cost of that program vary widely.