To the Editor: Moline et al.1 have now published data on their cases of multiple myeloma in World Trade Center (WTC) responders, which they have cited at conferences and which have been picked up by the popular and medical press.2 Of the eight cases, there was, if anything, a deficit in older subjects (who are the most likely to get this disease) and a surplus in those younger than 45 years, 4 versus 1.2 expected. This may be sufficient to warrant publication but does not prove causation of malignancy from WTC exposure.
All the four younger patients were police. This raises questions; the article could equally be entitled “Multiple Myeloma in WTC Police Responders.” It is widely reported that various agents, to which police are exposed, may increase the risk for multiple myeloma, including vehicle exhaust and pesticides.3 Do the authors have information on myeloma incidence in police in New York City or elsewhere? Confirmation of this increase in multiple myeloma from another, carefully followed, group of WTC responders, NYC Firefighters, would be of interest. (Note that before September 11, 2001 increased multiple myeloma had been described in firefighters with at least 20 years of service.4)
The report is subject to selection bias in that symptomatic subjects or those with major illness are more likely to present for monitoring. “Patients were asked to self-report any diagnosed conditions to a WTC Medical Monitoring and Treatment Program (MMTP) clinician during a baseline monitoring or treatment visit.” How many of the cases were identified among those already enrolled in the program? Did the others present to the program because of the diagnosis already established?
Albert Miller, MD
Department of Medicine
New York Medical College
1.Moline JM, Herbert R, Crowley L, et al. Multiple myeloma in World Trade Center responders: a case series. J Occup Environ Med.
2.Gotbaum R. Interview with Robin Herbert on the health effects of the World Trade Center dust. New Engl J Med.
3.Alexander DD, Mink PJ, Adami HO, et al. Multiple myeloma: a review of the epidemiological literature. Int J Cancer.
4.Baris D, Garrity TJ, Telles JL, Heineman EF, Olshan A, Zahm SH. Cohort mortality study of Philadelphia firefighters. Am J Ind Med.
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