Edition: U.S. / Global

Logistics Hang Over a Ruling on 9/11 Cancer

Patricia Workman, who volunteered at ground zero, believes her cancer was caused by toxic substances released by the fall of the World Trade Center.

About five years ago, Patricia Workman’s bones started breaking, and she was found to have multiple myeloma, a cancer of the bone marrow. At the same time, her skin cancer started to proliferate, leaving her face so scarred that she needed reconstructive surgery and still hides it with dark glasses.

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Chester Higgins Jr./The New York Times

Paul Gerasimczyk, a Sept. 11 responder, has renal cancer, which is on the list of cancers a panel recommended for coverage.

Ms. Workman had been a volunteer at ground zero for about two years after the Sept. 11 attacks. “They’ve asked me a thousand times since then, didn’t they give you masks, gloves or anything?” she said of her doctors and friends. “They didn’t.”

Ms. Workman and others who believe their cancers were caused by toxic substances released by the fall of the World Trade Center are due to learn this week whether they may be treated and compensated from a $4.3 billion fund set aside by Congress.

An advisory committee in March found justification for covering 14 broad categories of cancer, raising expectations that the fund would cover at least some of them. But such a decision would create a logistical quagmire, advocates for patients and government officials conceded, and could strain the fund’s resources.

“Depending on the numbers of cancers and the criteria for those cancers, we would certainly be getting more and different claims than we were receiving previously,” said Sheila Birnbaum, the special master overseeing the Sept. 11 Victim Compensation Fund. “We cannot add any more money to the fund, so we would have to prorate what we’re giving to people depending on the amount of people that apply, the seriousness of their injuries, the economic loss that they’ve sustained.”

The advisory committee found some evidence linking Sept. 11 to increased rates of cancer, but existing studies are far from conclusive. And since there is probably no way to distinguish those who developed cancer from ground zero from those who might have developed it anyway, anyone who can prove sustained exposure could potentially be eligible for payment.

“There’s tens of thousands of people that are potentially eligible, so how do you sort through that?” said Dr. James Melius, administrator of the New York State Laborers’ Health and Safety Trust Fund, who has closely monitored the research. “Will it be everybody with lung cancer in Lower Manhattan who was there around Sept. 11?”

And many cancers may develop long after the fund expires in 2016. “You know they’re going to continue for 10, 20, 30, 40 years, and you have a victim compensation fund that runs out of money and that ends in about five years,” Dr. Melius said.

After heavy lobbying by the Bloomberg administration, Congress in 2010 approved the James Zadroga 9/11 Health and Compensation Act, named after a police officer who died years after working at ground zero. It allocated $2.8 billion for compensation for those sickened by World Trade Center dust, smoke and fumes, or their survivors. It also set aside $1.5 billion for treatment and monitoring.

The law listed certain ailments that could be covered by the fund, almost all of them respiratory. It did not cover cancer but said evidence would be periodically reviewed to determine if it should.

Dr. John Howard, director of the National Institute for Occupational Safety and Health, is expected to rule by Saturday on whether to accept the advisory committee’s recommendation. If he does, no one knows for sure how many more people will become eligible for the fund.

So far, more than 5,000 people have registered for the fund, but fewer than 400 of them have actually submitted claims, according to Ms. Birnbaum, the special master. Many, she presumes, are still gathering documentation to prove they meet the eligibility rules. Federal officials have estimated that up to 35,000 people could ultimately sign up, even without cancer’s inclusion.

Ms. Workman’s cancers, myeloma and melanoma, are on the list of cancers that the World Trade Center Health Program Scientific and Technical Advisory Committee has recommended for coverage, though if Dr. Howard approved those cancers, whether Ms. Workman would be covered would depend on her individual circumstances as well.

Many of the categories on the list involve parts of the body that would have been directly exposed to dust, like the digestive system, mouth, eyes and respiratory system. Childhood cancers, because of the “unique vulnerability of children to synthetic chemicals commonly found in the environment,” are on the list, as are rare cancers. So is breast cancer, in part because it has been linked to disrupted circadian rhythms from shift work, and long shifts were common in rescue and recovery work.

The committee made its recommendations primarily by correlating substances found in the dust, smoke and fumes at ground zero with the types of cancer they are known to cause.

The panel used reviews of evidence on carcinogenic substances from the International Agency for Research on Cancer in Lyon, France, part of the World Health Organization, and from the National Toxicology Program, under the Department of Health and Human Services. The 17-member committee includes an epidemiologist, physicians, a toxicologist, environmental health specialists, neighborhood activists and union officials.