The September 11 cancer wave ahead

Mario Tama/Getty Images/File

After the collapse came the dust. It billowed across Lower Manhattan in the wake of the 2001 World Trade Center terror attacks, turning people into ghosts as they trudged to safety.

It blew into buildings through broken windows and air intakes, settling into carpets, curtains and upholstery and leaving a fine powder on surfaces. People wrote messages in the dust coating the windows of buildings.

Despite official assurances at the time, the dust was toxic — loaded with finely pulverized building materials, as well as the byproducts of jet fuel combustion and vaporized heavy metals like cadmium, lead and mercury.

The US Centers for Disease Control and Prevention estimates that as many as 400,000 people were exposed . Some were first responders like firefighters and paramedics, but others were put in harm’s way because they returned to contaminated apartments, schools and offices in Lower Manhattan or Brooklyn, where they breathed in contaminants.

As a result, more people have now died of environmental illnesses that followed the September 11 attacks than perished during the collapse of the towers that day.

Over the past 25 years, the mix of problems experienced by September 11 survivors has changed, too. About half of the 54,000 survivors who have qualified for financial help through the World Trade Center Health Program now have cancer, roughly triple the number who had the same diagnosis five years ago, according to CDC data.

The likelihood that a person will get cancer increases with age, so it’s not surprising that people who lived through the World Trade Center attacks would be more likely to get cancer 25 years later. But there are signs that some of these cancers are linked to the toxic dust people were breathing for months after the attacks, and aren’t just a factor of aging. Rare “sentinel cancers” such as mesothelioma are beginning to show up in World Trade Center survivors, and they appear to be more prevalent than in the general population.

“This is one of the largest man-made disasters in the history of United States,” said Dr. Alan Arslan, a cancer epidemiologist at NYU Langone Medical Center who studies September 11 survivors. “And it is also a disaster characterized by a very complex exposure to many, many potential carcinogens, including asbestos.”

Kevin Dietsch/Getty Images/File

Dr. Leigh Wilson, who directs the World Trade Center Environmental Center — one of seven clinical centers of excellence in the New York area that treat people exposed after the World Trade Center disaster — and works with Arslan, said their program continues to receive about 120 new patients each month.

Enrollment is picking up as people realize they qualify for care. When the program was launched in 2012, more first responders signed up than “survivors”: people who lived, worked or went to school within a certain area around ground zero. But over time, the number of new survivor enrollments each year has outpaced those of first responders. Roughly twice as many survivors as first responders enrolled in the program in 2024 and 2025, according to CDC data.

“I think it’s very well understood that [first] responders are eligible for the World Trade Center Health Program, but a lot of survivors don’t realize that they are eligible,” Wilson said.

One of the chief concerns in the wake of the tragedy was the hundreds of tons of asbestos that had been used as a fireproofing material in one of the towers and blasted free in the attacks.

Asbestos has tiny needle-like fibers that burrow deep into tissue, creating chronic inflammation that spurs the development of cancers of the lungs, voice box and ovaries. It also causes a rare and aggressive cancer called mesothelioma, or cancer of the mesothelium, the thin layer of tissue that protects internal organs like the lungs and abdomen.

Stan Honda/Pool/AP/File

Mesothelioma is what’s known as a sentinel cancer. Almost always, when doctors diagnose it, they also know exactly how how it happened: through exposure to asbestos. Very few cancers have ever been so closely linked to an environmental agent.

Still, exposure doesn’t guarantee a person will get mesothelioma. Somewhere between 1 in 8 and 1 in 13 people who are heavily exposed to asbestos on the job will develop the cancer later in life. And mesothelioma isn’t the only way asbestos makes people sick; it can also cause lung cancer and progressive scarring of the lungs called asbestosis.

But mesothelioma does offer cancer researchers one of the clearest pictures they have of cause and effect. Many chemical exposures, for example, have been linked to breast and prostate cancers, cancers that are also prevalent in World Trade Center survivors, but so are lifestyle factors and genes, making it a thorny problem to tease out the cause of any one person’s cancer after an environmental disaster. Not so with mesothelioma.

Because of this, researchers see it as a kind of harbinger.

“Rates are only going to go up,” said Dr. Jacqueline Moline, who directs the World Trade Center Health Program at Northwell Health. “This will be a foreshadowing” of the cancer burden ahead.

Moline says 38 cases of mesothelioma have been diagnosed among the nearly 155,000 people enrolled in the World Trade Center Health Program to date, an incidence that already appears to be about three times as high as in the general population .

Howard Schnapp/Newsday RM/Getty Images/File

And it’s still early. Mesothelioma takes its time to show up, said Dr. Raja Flores, chairman of the department of thoracic surgery at Mount Sinai Health System, who has pioneered treatments for the disease.

“I think what we’re seeing now is actually the beginning. The latency period for mesothelioma can be 25 to 50 years,” he said. It’s not the most common cancer showing up after the World Trade Center attacks, but “mesothelioma is a very important one because it’s practically a death sentence for most people.”

For one of the residents enrolled in the survivor group, a man who was 23 at the time of the attacks, it took 15 years.

The man lived a few blocks from the World Trade Center. He told investigators he was exposed to the large dust cloud on September 11. He left his apartment for a week after the attacks, and he came home to a light coating of dust on its surfaces. He cleaned up the dust but never had his space professionally cleaned.

He remembered World Trade Center dust being present in his apartment for more than a month after the attacks. He saw it in the air every day for months.

Stan Honda/AFP/Getty Images

Jose Jimenez/Primera Hora/Getty Images/File

Aside from living close to the Twin Towers, the man appeared to have no other risk factors. He didn’t smoke and wasn’t overweight.

In 2012, the man began to have abdominal pain and bloating. Four years later, when doctors performed a minimally invasive procedure to repair what they suspected was a hernia, they found something else.

He was diagnosed in 2016, at age 38, with mesothelioma of his abdominal wall. He had aggressive surgery to cut out the tumors and “hot wash” chemotherapy, in which doctors filled his abdominal cavity with warmed cancer-killing medications to destroy any microscopic tumors that remained.

His case was among four described in a study of mesothelioma in World Trade Center survivors in 2024. He responded well to the treatment and was still alive when the report was published. Two of the four patients had died of their cancers, however.

In a December 2001 memo included among the newly released documents , Cate Jenkins, an environmental scientist in the Waste Identification Branch at the US Environmental Protection Agency, did some rough calculations of the risk people might face from living or working near the Twin Towers after September 11.

In a scenario eerily like the actual case described by the World Trade Center Health Program, Jenkins calculated the increased risk to a person who was enveloped by the initial dust cloud walking back to their apartment in Lower Manhattan and who left for a few days after but came back and tried to clean their own apartment.

In that case, she wrote, the increased risk of getting mesothelioma would be 1 in 100, about 100 times above the EPA’s acceptable threshold for cancer risk from an environmental exposure. If the person continued to live in that apartment for the next 15 years, their risk for mesothelioma would rise to 1 in 10, which is 1,000 times above the EPA’s threshold.

Jenkins’ memo was part of a cache of new documents made public last week by New York City officials in response to two Freedom of Information Act lawsuits filed by the 9/11 Health Watch advocacy group.

Even as internal discussions were sounding the alarm, health officials were making reassuring statements to the public.

Courtesy of Dr. Lung Chi Chen/EPA

In a statement issued a week after the attacks, EPA Administrator Christine Whitman said that air testing in New York and Washington showed that people in those areas were not being exposed to “excessive levels of asbestos or other harmful substances.”

“Given the scope of the tragedy last week, I am glad to reassure the people of New York and Washington DC that their air is safe to breathe, and their water is safe to drink,” Whitman was said a news release. It was only one of many repeated assurances to people who were living or working near the site.

Fifteen years later, Whitman apologized in media interviews. “I’m very sorry that people are sick,” she told the Guardian . “I’m very sorry that people are dying, and if the EPA and I in any way contributed to that, I’m sorry. We did the very best we could at the time with the knowledge we had.”

Investigations later showed that these statements were based on flawed testing.

Early on, the EPA was primarily focused on asbestos levels in outdoor air and didn’t test inside many buildings, where pollutants can concentrate and become trapped, resulting in higher exposures.

The agency also relied on testing thresholds for asbestos that were not health-based.

“Asbestos is unsafe at any amount,” said Kimberly Flynn, director of the nonprofit advocacy group 9/11 Environmental Action.

“The EPA said it was safe many, many, many times and said that that declaration of safety was based on science, which it was not,” said Flynn, who is herself a World Trade Center survivor.

As a result, Flynn said, many people simply didn’t realize the danger they were in and didn’t take steps they should have to protect themselves.

Additionally, the agency’s tests relied on a less sensitive optical microscopy method that can see only larger asbestos fibers. The intensity of the World Trade Center collapse created a range of sizes of asbestos fibers, including some that were very small, which were later picked up by a more sensitive technology: transmission electron microscopy.

This testing , which was commissioned by the Ground Zero Elected Officials Task Force, a group started by Rep. Jarrold Nadler, found that levels of asbestos in two apartment buildings near the World Trade Center were “significantly elevated.”

Robert Giroux/Getty Images/File

Jenkins, the EPA environmental scientist, later said the scientists, who were asbestos testing experts and EPA contractors, found nine asbestos fibers for every one found by the EPA.

Their report recommended that indoor spaces be cleaned by professionals with experience removing asbestos and that residents not reoccupy those spaces until after they had been cleared.

Instead, New York officials recommended that people clean their own apartments with wet mops and wet rags and if possible with vacuum cleaners with HEPA filters.

Many of these homes were not cleaned using even these minimally protective methods, however, according to a door-to-door survey conducted shortly after the attacks by the New York City Department of Health.

“People went home to poison, while the government that was supposed to protect them looked the other way,” said Linda Reinstein, president and co-founder of the nonprofit Asbestos Disease Awareness Association.

As a result, environmental health specialists believe, residents were probably re-exposed to the toxins in the dust in their own homes for months after the attacks. Anything that could stir up the dust – such as vacuuming the carpet, sweeping the floor, even just tracking it in on their shoes – could stir up the dust again.

“The composition of the World Trade Center material should also have demanded caution,” said Dr. Richard Peltier, a professor of environmental health sciences at the University of Massachusetts at Amherst.

“This was not ordinary urban particulate matter. The collapse pulverized concrete, gypsum wallboard, glass fibers, carpeting, stored chemicals and other building materials. The fires and destruction added metals, asbestos and a complex mixture of combustion products and organic chemicals. In effect, thousands of tons of materials that were never intended to be inhaled were crushed, burned, aerosolized and deposited across a densely populated urban area.

“I think this changes how we should think about September 11. The mortality from the World Trade Center disaster did not end when the buildings fell. The health consequences have continued to accumulate for 25 years.”

Mario Tama/Getty Images/文件

坍塌之后，尘土飞扬。2001年世界贸易中心恐怖袭击事件发生后，尘土席卷曼哈顿下城，将艰难逃生的人们变成了幽灵。

它通过破损的窗户和进气口吹进建筑物，落在地毯、窗帘和家具上，在表面留下一层细粉。人们在覆盖着窗户的灰尘上写字。

尽管当时官方做出了保证，但这种粉尘是有毒的——其中含有大量细碎的建筑材料，以及喷气燃料燃烧的副产品和蒸发的重金属，如镉、铅和汞。

美国疾病控制与预防中心估计，多达40万人曾暴露于污染物中。其中一些是消防员和医护人员等一线应急人员，但其他人则因为返回曼哈顿下城或布鲁克林受污染的公寓、学校和办公室而身处险境，在那里他们吸入了污染物。

因此，9·11 袭击事件后因环境疾病死亡的人数已经超过了当天在世贸双塔倒塌中丧生的人数。

过去25年间，9·11事件幸存者面临的问题也发生了变化。据美国疾病控制与预防中心（CDC）的数据显示，在通过世界贸易中心健康计划获得经济援助的54000名幸存者中，约有一半患有癌症，这一数字大约是五年前确诊人数的三倍。

随着年龄增长，患癌风险也会增加，因此，经历过世贸中心袭击事件的人在25年后更容易患癌并不令人意外。但有迹象表明，其中一些癌症与袭击发生后数月内人们吸入的有毒粉尘有关，而不仅仅是年龄增长的因素。一些罕见的“哨兵癌症”，例如间皮瘤，开始在世贸中心幸存者中出现，而且其发病率似乎高于普通人群。

“这是美国历史上最大的人为灾难之一，”纽约大学朗格尼医学中心研究9·11事件幸存者的癌症流行病学家艾伦·阿斯兰博士说。“而且，这场灾难的特点是人们接触到了许多潜在致癌物，包括石棉，情况非常复杂。”

凯文迪奇/盖蒂图片社/文件

负责世界贸易中心环境中心的 Leigh Wilson 博士（该中心是纽约地区七个卓越临床中心之一，专门治疗在世界贸易中心灾难后受到伤害的人们）与 Arslan 合作，他表示，他们的项目每月继续接收约 120 名新患者。

随着人们意识到自己符合领取资格，登记人数正在增加。该项目于2012年启动时，登记的急救人员数量多于“幸存者”：即在世贸中心遗址附近特定区域居住、工作或上学的人。但随着时间的推移，每年新增的幸存者登记人数超过了急救人员。根据美国疾病控制与预防中心（CDC）的数据，2024年和2025年，幸存者登记人数约为急救人员的两倍。

威尔逊说：“我认为大家都很清楚，（第一）救援人员有资格参加世界贸易中心健康计划，但很多幸存者并没有意识到他们也有资格参加。”

悲剧发生后，人们最关心的问题之一是，其中一座大楼里用作防火材料的数百吨石棉在袭击中被炸飞出来。

石棉含有细小的针状纤维，这些纤维会深入组织，造成慢性炎症，从而引发肺癌、喉癌和卵巢癌。它还会导致一种罕见且侵袭性极强的癌症，称为间皮瘤，或间皮癌，间皮是保护肺和腹部等内脏器官的一层薄薄的组织。

斯坦·本田/泳池/美联社/档案照片

间皮瘤是一种被称为哨兵癌症的疾病。几乎所有情况下，医生在诊断出间皮瘤时，都能准确地知道它的发病原因：接触石棉。极少有癌症与环境因素如此紧密地联系在一起。

然而，接触石棉并不意味着一定会患上间皮瘤。大约每8到13名在工作中大量接触石棉的人中，就有1人会在日后患上这种癌症。而且，间皮瘤并非石棉致病的唯一途径；它还会导致肺癌和一种称为石棉肺的肺部进行性瘢痕形成。

但间皮瘤为癌症研究人员提供了最清晰的因果关系图景之一。例如，许多化学物质暴露与乳腺癌和前列腺癌有关，这些癌症在世贸中心幸存者中也很常见，但生活方式因素和基因也同样重要，这使得在环境灾难后确定任何一个人患癌的真正原因成为一个棘手的问题。而间皮瘤则不然。

因此，研究人员将其视为一种预兆。

“发病率只会继续上升，”诺斯韦尔健康中心世界贸易中心健康项目主任杰奎琳·莫林博士说。“这将预示着”未来癌症负担的加重。

莫林表示，迄今为止，在世界贸易中心健康计划登记的近 155,000 人中，已诊断出 38 例间皮瘤病例，这一发病率似乎已经是普通人群的三倍左右。

Howard Schnapp/Newsday RM/Getty Images/档案照片

现在还为时尚早。西奈山医疗系统胸外科主任拉贾·弗洛雷斯博士说，间皮瘤的潜伏期很长，他是该疾病治疗领域的先驱。

“我认为我们现在看到的实际上只是个开始。间皮瘤的潜伏期可能长达25到50年，”他说。虽然它不是世贸中心袭击事件后最常见的癌症，但“间皮瘤非常重要，因为它对大多数人来说几乎等同于死刑判决。”

对于幸存者团体中的一位居民来说，袭击发生时他23岁，他花了15年时间才走出阴影。

这名男子住在离世贸中心几个街区的地方。他告诉调查人员，9月11日当天他曾暴露在大量尘埃云中。袭击发生后，他离开公寓一周，回家后发现公寓表面覆盖着一层薄薄的灰尘。他自己清理了灰尘，但从未请专业人员进行过彻底清洁。

他记得，袭击发生后的一个多月里，他公寓里都弥漫着世贸中心的灰尘。几个月来，他每天都能在空气中看到这些灰尘。

Stan Honda/AFP/Getty Images

何塞·希门尼斯/Primera Hora/Getty Images/File

除了居住在世贸双塔附近，这名男子似乎没有其他风险因素。他不吸烟，体重也正常。

2012年，这名男子开始出现腹痛和腹胀症状。四年后，医生们为他进行了一项微创手术，试图修复他们怀疑是疝气的部位，结果却发现了其他问题。

2016年，38岁的他被诊断出患有腹壁间皮瘤。他接受了积极的手术切除肿瘤，并进行了“热洗”化疗，医生将温热的抗癌药物注入他的腹腔，以摧毁任何残留的微小肿瘤。

他的病例是2024年一项针对世贸中心幸存者间皮瘤的研究中描述的四例病例之一。他对治疗反应良好，在报告发表时仍然健在。然而，四名患者中有两名已经死于癌症。

在 2001 年 12 月的一份备忘录中（该备忘录包含在新公布的文件中），美国环境保护署废物识别部门的环境科学家凯特·詹金斯对 9·11 事件后在世贸双塔附近居住或工作的人们可能面临的风险进行了一些粗略的计算。

詹金斯模拟了一个与世界贸易中心健康计划描述的实际案例惊人相似的情景，他计算了这样一个风险：一个人被最初的尘埃云笼罩，走回位于曼哈顿下城的公寓，之后离开了几天，但又回来尝试清理自己的公寓。

她写道，在这种情况下，患间皮瘤的风险将增加到百分之一，大约是美国环保署（EPA）可接受的环境暴露致癌风险阈值的100倍。如果这个人继续在那间公寓居住15年，那么他患间皮瘤的风险将上升到十分之一，是美国环保署阈值的1000倍。

詹金斯的备忘录是纽约市官员上周公布的一批新文件的一部分，这些文件是对“9/11 健康观察”倡导组织提起的两起《信息自由法》诉讼的回应。

尽管内部讨论已经发出警报，但卫生官员仍在向公众发表令人安心的声明。

图片由陈龙奇博士/EPA提供

在袭击事件发生一周后发表的一份声明中，美国环保署署长克里斯汀·惠特曼表示，纽约和华盛顿的空气检测表明，这些地区的人们没有接触到“过量的石棉或其他有害物质”。

“鉴于上周悲剧的严重程度，我很高兴地向纽约市和华盛顿特区的民众保证，他们的空气可以安全呼吸，饮用水也可以安全饮用，”惠特曼在一份新闻稿中说道。这只是向居住或工作在事故现场附近的人们反复做出的众多保证之一。

十五年后，惠特曼在媒体采访中道歉。“我很抱歉人们生病了，”她告诉《卫报》，“我很抱歉人们正在死去，如果环保署和我以任何方式对此负有责任，我深感抱歉。当时，我们凭借所掌握的知识，已经尽了我们最大的努力。”

后来的调查显示，这些说法是基于有缺陷的测试得出的。

早期，美国环保署主要关注室外空气中的石棉含量，而没有对许多建筑物内部进行检测，而污染物会在建筑物内部聚集和滞留，导致更高的暴露风险。

该机构还依赖于并非基于健康的石棉检测阈值。

“石棉无论含量多少都是不安全的，”非营利倡导组织“9/11环境行动”的主任金伯利·弗林说。

“美国环保署多次声称它是安全的，并声称这种安全声明是基于科学的，但事实并非如此，”弗林说道，她本人也是世界贸易中心的幸存者。

弗林表示，结果就是，许多人根本没有意识到自己身处险境，也没有采取他们应该采取的措施来保护自己。

此外，该机构的检测方法依赖于灵敏度较低的光学显微镜技术，只能观察到较大的石棉纤维。世贸中心倒塌的剧烈冲击导致石棉纤维大小不一，其中一些非常细小，后来被灵敏度更高的透射电子显微镜技术检测到。

这项由众议员贾罗德·纳德勒发起的“世贸中心遗址民选官员工作组”委托进行的测试发现，世界贸易中心附近两栋公寓楼中的石棉含量“显著升高”。

Robert Giroux/Getty Images/文件

美国环保署环境科学家詹金斯后来表示，这些科学家（他们是石棉检测专家，也是美国环保署的承包商）发现的石棉纤维数量是美国环保署发现的九倍。

他们的报告建议由有石棉清除经验的专业人员对室内空间进行清洁，并且居民在室内空间清除干净之前不要重新入住。

相反，纽约官员建议人们用湿拖把和湿抹布清洁自己的公寓，如果可能的话，最好使用带有 HEPA 过滤器的吸尘器。

然而，纽约市卫生局在袭击事件发生后不久进行的挨家挨户调查显示，许多房屋甚至没有采用这些最低限度的防护措施进行清洁。

“人们回家后继续接触有毒物质，而本应保护他们的政府却视而不见，”非营利组织石棉疾病意识协会的主席兼联合创始人琳达·雷恩斯坦说道。

因此，环境健康专家认为，袭击发生后的几个月里，居民们很可能再次接触到家中灰尘中的毒素。任何可能扬起灰尘的行为——例如吸尘、扫地，甚至只是鞋子把灰尘带进屋里——都可能导致灰尘再次扩散。

“世界贸易中心建筑材料的成分也应该引起人们的警惕，”马萨诸塞大学阿默斯特分校环境健康科学教授理查德·佩尔蒂埃博士说。

“这并非普通的城市颗粒物。坍塌的建筑物粉碎了混凝土、石膏板、玻璃纤维、地毯、储存的化学品和其他建筑材料。火灾和破坏还带来了金属、石棉以及复杂的燃烧产物和有机化学物质混合物。实际上，数千吨原本不该被吸入的材料被压碎、燃烧、雾化，并沉积在人口稠密的城市地区。”

“我认为这改变了我们对9·11事件的看法。世贸中心灾难造成的死亡并没有随着大楼的倒塌而结束。其健康后果在25年后仍在持续累积。”