Thyroid cancer risk in WTC responders

世贸中心响应者的甲状腺癌风险

• 批准号: 9264863
• 负责人: GREGORY Joseph RIGGINS
• 金额: $ 50万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9264863
• 关键词: Thyroid; cancer; risk; WTC; responders

Summary An excess incidence of thyroid cancer has been identified among World Trade Center (WTC) rescue and recovery workers included in the WTC Health Program (WTCHP) at Mount Sinai in New York. An excess has also been reported among participants of two separate WTC-exposed cohorts. It is unclear whether the excess is associated with WTC-related exposures or represents an artifact due to increased surveillance. Current understanding of the etiology and pathogenesis of thyroid cancer is limited, and an association between this cancer and WTC-related exposures would add significant information for the health of WTC responders and beyond. Conversely, the finding that excess risk among WTCHP participants is not attributable to WTC related exposures, but to over- diagnosis because of enhanced surveillance, perhaps related to the increased number of chest imaging due to respiratory problems in this population, would represent an important message to WTCHP members. The objectives of this project are to elucidate the reasons for the increased incidence of thyroid cancer among WTCHP participants and to explore the behavior of these cancers. Specifically, the project will investigate clinical and epidemiological characteristics of thyroid cancer in WTC responders and compare them to those of matched non-WTC thyroid cancers: tumor size, nodal involvement, local and distant metastatic spread, previous history of chest imaging, frequency of medical visits, diagnosis because of symptoms vs. asymptomatic finding during medical surveillance will be compared between the two groups of patients. The prevalence of tyroid cancer risk factors will also be compared between the two groups. The second task of this project is to identify in thyroid tissue samples markers of malignancy that were found to be able to accurately discriminate between benign and malignant thyroid follicular carcinoma. This approach will identify and eliminate false positives for the diagnosis of malignancy. Although there is always an area of uncertainty when scoring a thyroid cancer as malignant, we hypothesize that a false diagnosis of malignancy is more likely to occur among WTC responders than in non WTC thyroid cancers, because of increased surveillance and a more conservative approach towards this population. Upon completion of this study, if the increased incidence appears to be real, the result could have important implications in terms of surveillance and care; if the effects of excess surveillance are proven, that would argue for a decrease in the intensity of screening. In both cases, the project will have important implications on the surveillance and clinical management of thyroid cancer, a frequent cancer among WTCHP members.

总结 世界贸易中心（WTC）的甲状腺癌发病率过高 救援和恢复工作人员包括在世贸中心卫生计划（WTCHP）在西奈山在新 约克。在两个单独的WTC暴露队列的参与者中也报告了过量。 目前还不清楚过量是否与WTC相关的暴露有关，或者代表人为因素 由于加强了监控。甲状腺疾病病因病机的研究现状 癌症是有限的，这种癌症和WTC相关暴露之间的关联将增加 为WTC响应者和其他人的健康提供重要信息。相反， WTCHP参与者的过度风险不是归因于WTC相关暴露，而是过度- 由于加强监测而确诊，可能与胸部数量增加有关 成像由于呼吸问题，在这一人群中，将代表一个重要的信息， WTCHP成员。本项目的目标是阐明增加的原因， WTCHP参与者中甲状腺癌的发病率，并探讨这些癌症的行为。 具体而言，该项目将调查甲状腺疾病的临床和流行病学特征， WTC应答者的甲状腺癌，并将其与匹配的非WTC甲状腺癌进行比较：肿瘤 大小、淋巴结受累、局部和远处转移扩散、既往胸部影像学史， 就诊频率，因症状而诊断与医疗期间无症状发现 将对两组患者的监测进行比较。甲状腺癌的患病率 并比较两组的危险因素。 该项目的第二项任务是在甲状腺组织样本中识别恶性肿瘤的标志物 发现能够准确区分良性和恶性甲状腺滤泡 carcinoma.这种方法将识别和消除恶性肿瘤诊断的假阳性。 虽然在将甲状腺癌评分为恶性时总是存在不确定性，但我们 假设恶性肿瘤的误诊更可能发生在WTC应答者中， 在非WTC甲状腺癌中，由于增加了监测和更保守的方法， 对这个人口。 完成本研究后，如果发生率增加似乎是真实的，则结果可能 在监测和护理方面具有重要意义;如果过度监测的影响 这一点已经得到证实，这将为降低筛查强度提供依据。在这两种情况下，该项目将 对甲状腺癌的监测和临床管理具有重要意义， WTCHP成员中的癌症。