9/11 Mesothelioma Crisis Still Unfolding

On September 11, 2001, the collapse of the World Trade Center towers created an immediate catastrophe measured in lives lost and buildings destroyed. But it also created a slow-motion health crisis that continues to claim lives 23 years later—and experts warn that for some diseases, the worst is yet to come.

Among those diseases is mesothelioma, an aggressive cancer caused almost exclusively by asbestos exposure. The towers contained asbestos insulation in their lower floors, and their destruction released hundreds of tons of the carcinogenic mineral into the air of Lower Manhattan. The responders who rushed to Ground Zero, the workers who spent months on the cleanup, and the residents and employees who returned to the area were all exposed.

“We haven’t seen many yet, but we’re going to see a very significant rise in cases,” one oncologist specializing in mesothelioma has warned.

What Was Released

When the Twin Towers collapsed, they released approximately one million tons of pulverized material into the atmosphere. This toxic cloud contained:

• 400 tons of asbestos: The towers’ lower floors were insulated with asbestos-containing materials. When the buildings collapsed, these materials were pulverized into microscopic fibers.

• Heavy metals: Lead, mercury, cadmium, and other toxic metals from building components and electronics.

• Pulverized concrete: Fine particulate matter that caused immediate respiratory symptoms in many exposed individuals.

• Chemical compounds: Building materials, fuel, and office contents created a complex mixture of hazardous substances.

The dust cloud spread throughout Lower Manhattan and into parts of Brooklyn. Fine particles settled on surfaces and were repeatedly resuspended by wind, foot traffic, and cleanup activities. The exposure was not limited to the day of the attacks—it continued for months as cleanup proceeded.

Who Was Exposed

The potential exposure population is staggering in scope:

First responders: An estimated 90,000 workers participated in the rescue, recovery, and cleanup operations at Ground Zero. This included firefighters, police officers, emergency medical technicians, construction workers, and volunteers who worked on the pile for weeks or months.

Downtown workers and residents: An estimated 400,000 people lived, worked, or attended school in Lower Manhattan when the attacks occurred. Many returned to the area within days or weeks, before full decontamination was complete.

Transit workers: Subway and train workers were exposed to dust that infiltrated tunnels and stations throughout the area.

Healthcare workers: Hospital staff who treated victims and handled their contaminated clothing faced secondary exposure.

The total population potentially exposed to toxic WTC dust has been estimated at 410,000 to 525,000 people.

The Latency Problem

Mesothelioma typically develops 20 to 50 years after asbestos exposure. This long latency period means that the mesothelioma cases resulting from 9/11 exposure are only now beginning to appear—and will continue appearing for decades.

As of July 2023, the WTC Environmental Health Center had documented four mesothelioma cases among community members (survivors) enrolled in its monitoring program. Two patients had peritoneal mesothelioma (affecting the abdominal lining) and two had pleural mesothelioma (affecting the lung lining).

The WTC Health Program, which monitors both responders and survivors, has certified additional mesothelioma cases for treatment coverage. The exact numbers are difficult to track because mesothelioma is relatively rare and patients may receive care through multiple programs.

But the low numbers so far should not be reassuring. The latency clock for 9/11 exposures has barely begun. The period of 2025 to 2050 is when experts expect to see the full mesothelioma toll emerge.

Notable Cases

While overall numbers remain small, individual cases illustrate the human impact:

Nick Ursta: A New York City firefighter who responded to Ground Zero on 9/11, Ursta was diagnosed with pleural mesothelioma and died in 2020. He and his wife had shared a single mask during three days at the site, trying to protect themselves from the dust. His oncology team at UPMC concluded that his exposure to 9/11 dust caused his cancer.

Deborah Reeve: A paramedic who responded to the attacks, Reeve was diagnosed with mesothelioma and died in 2006 at age 41—making her one of the earliest mesothelioma cases attributed to 9/11 exposure. Her case was notable because of the relatively short latency period, suggesting particularly intense exposure.

These cases represent individuals who can be directly linked to Ground Zero exposure. As the years pass and more cases appear, the connection will become harder to trace for community members with less documented exposure histories.

The WTC Health Program

In response to the health crisis affecting 9/11 responders and survivors, Congress established the World Trade Center Health Program. The program provides:

Medical monitoring: Regular health screenings to detect 9/11-related conditions early, when treatment is most effective.

Treatment coverage: No-cost treatment for certified WTC-related health conditions, including mesothelioma.

Network of care: Access to specialized care at Clinical Centers of Excellence, including Memorial Sloan Kettering Cancer Center for cancer treatment.

The program was initially authorized through 2015, but the James Zadroga 9/11 Health and Compensation Act extended coverage through 2090—recognition that 9/11-related diseases will continue to emerge for generations.

In 2019, the Never Forget the Heroes Act made the September 11th Victim Compensation Fund permanent and authorized $10.2 billion for claims through 2090. As of 2024, the VCF has awarded over $12.7 billion to victims and their families, including $1.8 billion in 2023 alone.

The Official Response Controversy

The government’s immediate response to the 9/11 attacks remains controversial from a public health perspective. EPA Administrator Christine Todd Whitman famously declared on September 18, 2001, that the air quality in Lower Manhattan was “safe” and that there was “no need for concern.”

That assurance was premature at best. Subsequent investigations found that the EPA lacked sufficient data to make such claims and that the agency had been pressured by the White House to downplay health risks to encourage the reopening of Wall Street.

Workers at Ground Zero often lacked adequate respiratory protection. Many worked on the pile for months without proper respirators, or with equipment inadequate to filter the fine particulate matter in the air.

The controversy over early assurances has made the long-term health monitoring and treatment programs all the more important. Whatever failures occurred in the immediate response, the subsequent commitment to tracking and treating 9/11-related diseases has been substantial.

Research Continues

Researchers continue to study the health effects of 9/11 exposure, including the risk of mesothelioma and other cancers. Key ongoing efforts include:

Long-term health registries: Both the WTC Health Program and the WTC Health Registry (operated by the New York City Department of Health) track enrolled populations over time, allowing researchers to identify emerging health patterns.

Cancer incidence studies: Researchers are comparing cancer rates among the 9/11-exposed population to expected rates in the general population, looking for elevations that might be attributable to exposure.

Mesothelioma case documentation: Given the rarity of mesothelioma and its specific link to asbestos exposure, each case among the 9/11 population is being carefully documented to understand exposure pathways and latency patterns.

A recent publication in the CDC’s medical literature documented the four mesothelioma cases in the WTC EHC survivor population, noting that “given the known delay in the development of mesotheliomas after asbestos exposure, [we are] documenting these early mesothelioma cases to enhance understanding of the adverse health effects of WTC exposures on the local community.”

What to Watch For

For the hundreds of thousands of people exposed to WTC dust, awareness of mesothelioma risk is crucial. While no screening test can detect mesothelioma before symptoms appear, early recognition of symptoms can lead to earlier diagnosis and potentially better outcomes.

Symptoms that warrant medical attention include:

• Persistent shortness of breath
• Chest pain that doesn’t resolve
• Unexplained weight loss
• Persistent cough
• Difficulty swallowing
• Swelling in the face or arms

Anyone with documented 9/11 exposure who experiences these symptoms should inform their healthcare provider of their exposure history. The WTC Health Program can provide specialized evaluation for enrolled members.

The Coming Wave

Public health experts have long warned that the mesothelioma toll from 9/11 would be a slow-emerging crisis. The peak of the World War II asbestos-exposure epidemic didn’t occur until decades after the war ended. The same pattern is expected for 9/11.

The difference is that the 9/11-exposed population is enrolled in monitoring programs that can track their health over time. The WTC Health Program and VCF provide a safety net that didn’t exist for earlier generations of asbestos-exposed workers.

And advances in mesothelioma treatment—including the immunotherapy combinations approved in recent years—offer more hope than patients had even a decade ago.

But there is no escaping the fundamental reality: asbestos fibers lodged in the lungs of 9/11 responders and survivors will continue causing cancer for decades to come. The attacks of September 11, 2001, continue to claim lives—not in the sudden horror of that morning, but in the quiet tragedy of diagnoses that arrive years later, consequences of exposure that seemed routine at the time.

For the families who have already lost loved ones to 9/11-related mesothelioma, and for those who will face diagnoses in the years ahead, the attacks never really ended. They simply entered a different phase—one measured not in minutes but in decades.