http://www.nytimes.com/2012/06/09/nyregion/ruling-to-allow-9-11-health-fund-to-cover-cancers.html?_r=1&emc=na

Ruling Allows Health Fund for Sept. 11 to Cover Cancers
By ANEMONA HARTOCOLLIS
Published: June 8, 2012

A federal health official’s ruling has cleared the way for 50 different types of cancer to be added to the list of sicknesses covered by a $4.3 billion fund set up to compensate and treat people exposed to the toxic smoke, dust and fumes in the months after the Sept. 11, 2001, terrorist attack.
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The decision, released on Friday afternoon, came as a vindication for hundreds and perhaps thousands of people who have claimed — often in the face of resistance from public health officials — that their cancers were caused by their exposure to the dust cloud and debris thrown up in the aftermath of the attack.

It will allow not only rescue workers but also volunteers, residents, schoolchildren and passers-by to apply for money to pay for compensation and treatment for cancers developed in the aftermath of the attack. The cancers will not officially be added to the list until after a period of public comment lasting several months.

The decision, by Dr. John Howard, director of the National Institute for Occupational Safety and Health, comes despite a lack of epidemiological evidence linking the attack to cancer. It also poses a number of logistical challenges, since it will be difficult if not impossible to separate people who developed cancer as a result of ground zero from those who would have gotten the disease anyway, and because many cancer diagnoses are likely to be made years after the fund is exhausted.

But in a lengthy report defending his decision, Dr. Howard said that a New York Fire Department study published last fall in the British journal The Lancet, which showed that firefighters exposed to ground zero toxic substances had a 19 percent higher rate of cancer than firefighters who were not exposed, had provided a strong foundation for a conclusion that some cancers had been caused by exposure to the World Trade Center debris.

But beyond the Lancet study, he said, he had relied on recommendations made in late March by a scientific and technical advisory committee consisting of experts from the fields of cancer, environmental medicine, toxicology and epidemiology as well as neighborhood activists and union officials. He fully adopted the committee’s recommendation that 14 broad categories of cancer, encompassing 50 specific types, should be deemed as World Trade Center related.

Among the cancers Dr. Howard approved are some of the most common, including lung, breast, colon, trachea, esophageal, kidney, bladder, skin, thyroid, blood and bone marrow cancers.

The committee had considered but rejected, by a 14-to-3 vote, the notion of adding all cancers to the list. It had also explicitly rejected pancreas, brain and prostate cancer, for various reasons.

The committee report said that 70 known and potential carcinogens had been found in the smoke, dust and fumes from the disaster, that 15 of those were known to cause cancer in humans, 37 were “reasonably anticipated” to cause cancer and others were probable and possible carcinogens. In many cases, the report said, it is believed that “any level of exposure carries some risk.” Some of the substances might act synergistically, the committee said, to produce unexpected health effects.

From the beginning, scientists, doctors and victims of the attack have complained that there was very little real-time data collected on toxic substances at the World Trade Center site and on levels of exposure. On the contrary, in the early days, there were official statements that it was safe to operate at the site.

Many first responders unflinchingly followed orders to report for work downtown for days, weeks, months and years on end, without thinking of the health consequences. Volunteers poured into the site. School-children at schools in the immediate vicinity, like Stuyvesant High School, Public School 89 and P.S. 234, were at first evacuated, but returned to school while the area was still a wasteland.

The committee report said that no data were collected during the first four days after the attacks, when the air was the most contaminated, and that samples taken after Sept. 16, 2001 were not good enough to allow for estimates of individual or area exposures to toxic materials.

But the committee said the “high prevalence of acute symptoms and chronic conditions” in rescue workers and residents and the descriptions of conditions in Lower Manhattan provided “highly credible” evidence that people had been exposed to toxic levels of materials.