9/11 Breast Cancer

Breast Cancer and the September 11th Victim Compensation Fund

Following the terrorist attacks and disintegration of the Twin Towers on September 11, 2001, a toxic dust cloud engulfed Lower Manhattan. Over 2,500 hazardous components, including benzene, were detected in the New York City Exposure Zone air quality samples. A year after 9/11, those toxic chemicals and carcinogens (cancer causers) were still detected in the area. Among the more than 70 cancers linked to the NYC Exposure Zone’s toxic dust is breast cancer. Although breast cancer can be diagnosed in both men and women, female cancer is much more prevalent. Female breast cancer is the second most diagnosed cancer in women who were in the 9/11 Exposure Zone following September 11, 2001. Anyone diagnosed with breast cancer during the nine months after the September 11, 2001 terrorist attacks may be eligible for an award from the September 11th Victim Compensation Fund.

How prevalent is 9/11 breast cancer?

• Female breast cancer is the second-highest cancer diagnosed in people who were in the exposure zone in the months following September 11, 2001
• 9/11 breast cancer is the third most common cancer diagnosed among World Trade Center Health Program (WTCHP)  members 

What is breast cancer?

This form of cancer is found within any structure of the breast. Since there are many forms of breast cancer, the term is applied broadly. Specific types of breast cancer are categorized by the cancer’s cells and location. The two determining cell types are carcinoma and sarcoma. Carcinoma cells grow inside skin and tissue cells. Sarcoma cells grow in the connective tissues of blood vessels, fat, nerves, bones, muscles, cartilage, and deep tissue. (Although rare, men can also be diagnosed with breast cancer. Both men and women diagnosed with breast cancer are eligible for compensation - 9/11 survivors and first responders (workers, residents, volunteers and visitors). 

Breast cancer is also categorized by its location. The two most common forms are lobular cancer and ductal cancer. Lobular cancer is found in the area responsible for producing milk. Ductal cancer affects the ducts that carry the milk from the lobules to the nipple. There are three less common forms of breast cancer: 

• Paget disease of the breast (found in the nipple)
  
• Phyllodes tumors in the fat and connective tissue
  
• Angiosarcoma in blood vessels or lymph nodes

Although breast cancer occurs exclusively in women, men can also develop a form of breast cancer. 

Anatomy of the breast

The mammary glands, or breasts, are organs that are comprised of several structures. Both the left and right breast have lobule glands, ducts, nipples, fat and connective tissue (also called stroma), and blood vessels and lymph vessels.

What are the symptoms of breast cancer?

Like other cancers, breast cancer may not immediately be noticeable. The discovery of a new mammary mass is the most common symptom of breast cancer. A cancerous breast growth may be firm and painless with irregular borders, or it may be a soft growth that is tender or painful. Benign (not cancerous) lumps or masses can occur inside the breast but will not expand beyond breast tissue and are not lethal.  Some benign lumps can increase the chances of developing breast cancer and a medical provider should examine all breast growths.  

Breast cancer can cause breast swelling (to all or parts of the organ), breast texture changes (skin resembling an orange peel), breast or nipple pain, nipple reversion (pointing inward), and nipple or breast-skin discoloration like redness, dryness, flaking, or thickening. Discharge from the nipple that is not breast milk is a symptom as is swelling in the lymph nodes around the collar bones or underarms. Any of these symptoms should be brought to the attention of a physician. 

Breast cancer screening is vital against the disease. Women should maintain regular screenings to help detect breast cancer in its earliest stages.

What causes breast cancer?

Researchers have not determined the exact cause of breast cancer. There are risk factors that increase the chances of developing this cancer. Damage to an individual’s DNA will lead to cancer, but the mechanisms driving DNA change can be genetic factors (age, race, family history, menstruation age, and age of menopause) or environmental agents. 

Environmental links to breast cancer include exposure to radiation and toxic chemicals found in solvents, flame retardants, and stain-resistant textiles as well as combustible agents. Gasoline and other combustion chemicals like benzene used to make jet fuel, have been found to be the largest source of “mammary carcinogens.” 

Could 9/11 have caused breast cancer?

In 2004, the Environmental Protection Agency WTC Expert Technical Review Panel was formed and provided recommendations for continued clean-up efforts of businesses, schools, and homes in Lower Manhattan. The panel determined that thousands were exposed to levels of contamination that had “the potential to harm their health.”

The WTCHP has more than 2,000 members who have been diagnosed with breast cancer. Most of these victims were not 9/11 first responders. They are civilian survivors who were exposed to toxic vapors, smoke, dust, and debris at the attack sites—where hazardous conditions persisted from September 11, 2001, until May 30, 2002. 

Treatment and monitoring of breast cancer are provided by the WTCHP at no cost to anyone who visited a 9/11 site during the exposure period. Financial compensation may be available to these victims from the 9/11 VCF.

IMAGE Kreindler client

How is breast cancer diagnosed? 

The American Cancer Society has different breast cancer screening guidelines for women considered at average risk and those deemed at high risk. High-risk considerations include:

• personal or family history of breast cancer.
  
• genetic mutation of BRCA 1 or 2 gene.
  
• those who have received radiation therapy before age 30.
  
• women who have been or have a relative who has been diagnosed with Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome.

Breast cancer is often diagnosed after symptoms manifest. Early detection, before symptoms begin, is beneficial to successfully treating breast cancer. It is a highly treatable disease when it is found in its early stages.

The most common tests used for diagnosis are mammograms, breast ultrasound, or a breast MRI – using contrast dye. Contrast-enhanced mammography also uses a dye to define the tumor’s area but is a newer technology that is not yet widely utilized. Three dimensional, 3-D mammograms are becoming more common. This technology does not use dye to provide an enhanced image but uses a merging of multiple pictures of the breast taken from different angles to create a three-dimensional image. If cancer is suspected, CT, bone scans, or PET scans may be performed to determine if it has grown beyond the breast.

When imaging indicates cancer is present, a biopsy will be performed. There are several types of biopsies for breast cancer: needle aspiration, surgical removal of the mass, and possibly the lymph nodes under the arms. All biopsy samples are examined by a laboratory.

How is breast cancer treated?

Before beginning treatment for breast cancer, physicians will investigate if the cancer has spread and how much it has advanced. Stage determination allows doctors to establish how much cancer is present and how to treat it. There are five stages of breast cancer, Stage 0 - Stage IV. Each numerical increase indicates an escalation risk for the cancer to have metastasized or spread. 

There are seven criteria for assigning cancer stage: 

1. Tumor size
   
2. Presence in lymph nodes
   
3. Presence in organs
   
4. Presence of an estrogen receptor in the cancer
   
5. Presence of a progesterone receptor in the cancer
   
6. Excess amount of HER2 protein
   
7. Cancer grade
   

Each stage of breast cancer is treated differently.

Stage 0 includes ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). DCSI is treated with either breast-conserving surgery or a simple mastectomy, radiation, and sometimes, hormone therapy. During a breast-conserving surgery, the tumor and surrounding tissue are removed. Radiation usually follows. Larger DCSI tumors typically require a simple mastectomy and a lymph node biopsy.  After a mastectomy, a woman may immediately seek breast reconstruction surgery since radiation is not needed after this surgery. Hormone therapy may be needed after either surgery if the cancer cells were hormone receptor-positive to estrogen or progesterone.

 LCIS is not typically treated because it is not categorized as cancer, but having it increases the risk of developing breast cancer and requires continued monitoring.

Stage I-III breast cancer treatment may include surgery and radiation. It often requires drug therapy and chemotherapy prior to surgery or post-operatively.

Stage IV breast cancer (metastatic breast cancer) has spread outside of the mammary gland and nearby lymph nodes into other areas of the body. Metastatic breast cancer is deemed incurable, but treatments may extend a woman’s life. Surgery is sometimes a treatment option for metastatic breast cancer, but systemic drugs like hormone therapy, chemotherapy, targeted drugs, immunotherapy, or a drug combination are the most common treatment courses.

Does the VCF provide compensation for 9/11 breast cancer?

Living or deceased women who have had or have certified 9/11 breast cancer may qualify to receive compensation from the September 11th Victim Compensation Fund. It is important that any person who was in an exposure zone between September 11, 2001, through May 30, 2002, register with the WTCHP as soon as possible; it is the first step in filing a claim for the 9/11 VCF. The deadline to file a VCF claim has been extended to October 1, 2090.

Trust Kreindler with your 9/11 breast cancer VCF claim

Kreindler has successfully recovered over $4 billion in VCF awards for September 11th victims. We filed our first claim in 2001 and have an experienced VCF team that works solely on those claims. Our VCF team is led by Kreindler’s managing partner, Noah Kushlefsky, a leading 9/11 victims’ advocate.