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　　研究發(fā)現(xiàn)，世貿(mào)中心從事救援和恢復(fù)工作的人員患某些癌癥的風(fēng)險(xiǎn)較高，包括前列腺癌、甲狀腺癌和骨髓瘤。盡管研究人員承認(rèn)，需要更多的數(shù)據(jù)和更長(zhǎng)的隨訪，但他們推測(cè)可能的原因是暴露于倒塌建筑物所釋放出的致癌物質(zhì)。

　　Jiehui Li（美國(guó)紐約市健康與心理衛(wèi)生局）及其共同作者在JAMA雜志中寫道，“考慮到隨訪時(shí)間相對(duì)較短，缺乏醫(yī)學(xué)篩查和其它危險(xiǎn)因素的數(shù)據(jù)，前列腺癌、甲狀腺癌和多發(fā)性骨髓瘤發(fā)病率升高應(yīng)該被重視。”

　　Li等人分析了2003到2004年世界貿(mào)易中心健康登記系統(tǒng)中55778名的相關(guān)信息。這是紐約州居民的觀察性數(shù)據(jù)庫(kù)，其中有21850位是2001年世界貿(mào)易中心被**之后的救援和恢復(fù)工作人員。在登記之后到2008年12月份，有1187例新診斷出的癌癥，其中37%曾是世界貿(mào)易中心救援和恢復(fù)工作人員。

　　結(jié)合所有的癌癥病例，世界貿(mào)易中心救援和恢復(fù)工作人員標(biāo)準(zhǔn)化發(fā)病比為1.14每10萬(wàn)人年，未參與救援和恢復(fù)工作人員的標(biāo)準(zhǔn)化發(fā)病比為0.92每10萬(wàn)人年，兩者無(wú)統(tǒng)計(jì)學(xué)差異。然而，在研究的23個(gè)部位中，有3個(gè)部位的標(biāo)準(zhǔn)化發(fā)病比明顯增加，前列腺（標(biāo)準(zhǔn)化發(fā)病比為1.43），甲狀腺（標(biāo)準(zhǔn)化發(fā)病比為2.02），多發(fā)性骨髓瘤（標(biāo)準(zhǔn)化發(fā)病比為2.85）。對(duì)于世界貿(mào)易中心未參與救援和恢復(fù)工作人員，上述三個(gè)部位的標(biāo)準(zhǔn)化發(fā)病比未見(jiàn)增加。

　　研究者們注意到，高樓倒塌后使成百上千的人籠罩在灰塵、碎片、毀壞的建筑材料和潛在的毒物中。這些灰塵、煙霧和氣溶膠包含了多種已知和未知的致癌物，包括石棉、硅、苯、多氯化聯(lián)苯、多環(huán)芳烴、揮發(fā)性有機(jī)化合物和多種金屬。然而，通過(guò)隊(duì)列內(nèi)比較，他們發(fā)現(xiàn)無(wú)論是參與救援和恢復(fù)工作人員還是未參與救援和恢復(fù)工作人員，暴露于世貿(mào)中心相關(guān)碎片的強(qiáng)度與特定部位的癌癥無(wú)明顯相關(guān)性。

　　研究者們寫道，“暴露個(gè)體的劑量是否達(dá)到足以致癌的程度，以及過(guò)量的暴露能否通過(guò)現(xiàn)在的流行病學(xué)途徑檢測(cè)到目前仍處于爭(zhēng)論中”。需要通過(guò)對(duì)參與救援和恢復(fù)工作人員和未參與救援和恢復(fù)工作人員進(jìn)行更長(zhǎng)期的隨訪以及對(duì)選定部位的癌癥進(jìn)行細(xì)致的觀察，經(jīng)過(guò)相當(dāng)長(zhǎng)的潛伏期來(lái)檢測(cè)其癌癥風(fēng)險(xiǎn)。

　　Association Between World Trade Center Exposure and Excess Cancer Risk

　　Jiehui Li, MBBS, MSc; James E. Cone, MD, MPH; Amy R. Kahn, MS; Robert M. Brackbill, PhD, MPH; Mark R. Farfel, ScD; Carolyn M. Greene, MD; James L. Hadler, MD, MPH; Leslie T. Stayner, PhD; Steven D. Stellman, PhD, MPH

　　Context The terrorist attacks of September 11, 2001, resulted in the release of known and suspected carcinogens into the environment. There is public concern that exposures may have resulted in increased cancers. Objective To evaluate cancer incidence among persons enrolled in the World Trade Center Health Registry. Design, Setting, and Participants Observational study of 55 778 New York State residents enrolled in the World Trade Center Health Registry in 2003-2004, including rescue/recovery workers (n = 21 850) and those not involved in rescue/recovery (n = 33 928), who were followed up from enrollment through December 31, 2008. Within-cohort comparisons using Cox proportional hazards models assessed the relationship between intensity of World Trade Center exposure and selected cancers. Main Outcome Measures Cases were identified through linkage with 11 state cancer registries. Standardized incidence ratios (SIRs) adjusted for age, race/ethnicity, and sex were computed with 2003-2008 New York State rates as the reference, focusing on cancers diagnosed in 2007-2008 as being most likely to be related to exposure during September 11 and its aftermath. The total and site-specific incidence rate differences (RDs) per 100 000 person-years between the study population and the New York State population in 2007-2008 also were calculated. Results There were 1187 incident cancers diagnosed, with an accumulated 253 269 person-years (439 cancers among rescue/recovery workers and 748 among those not involved in rescue/recovery). The SIR for all cancer sites combined in 2007-2008 was not significantly elevated (SIR, 1.14 [95% CI, 0.99 to 1.30]; RD, 67 [95% CI, ??6 to 126] per 100 000 person-years among rescue/recovery workers vs SIR, 0.92 [95% CI, 0.83 to 1.03]; RD, ??45 [95% CI, ??106 to 15] per 100 000 person-years among those not involved in rescue/recovery). Among rescue/recovery workers, the SIRs had significantly increased by 2007-2008 for 3 cancer sites and were 1.43 (95% CI, 1.11 to 1.82) for prostate cancer (n = 67; RD, 61 [95% CI, 20 to 91] per 100 000 person-years), 2.02 (95% CI, 1.07 to 3.45) for thyroid cancer (n = 13; RD, 16 [95% CI, 2 to 23] per 100 000 person-years), and 2.85 (95% CI, 1.15 to 5.88) for multiple myeloma (n = 7; RD, 11 [95% CI, 2 to 14] per 100 000 person-years). No increased incidence was observed in 2007-2008 among those not involved in rescue/recovery. Using within-cohort comparisons, the intensity of World Trade Center exposure was not significantly associated with cancer of the lung, prostate, thyroid, non-Hodgkin lymphoma, or hematological cancer in either group. Conclusions Among persons enrolled in the World Trade Center Health Registry, there was an excess risk for prostate cancer, thyroid cancer, and myeloma in 2007-2008 compared with that for New York State residents; however, these findings were based on a small number of events and multiple comparisons. No significant associations were observed with intensity of World Trade Center exposures. Longer follow-up for typically long-latency cancers and attention to specific cancer sites are needed.