When Mariama James returned to her Lower Manhattan apartment on the evening of Sept. 11, 2001, it was covered in dust. She’d left the windows open that warm day, and the clouds of toxic material released when the twin towers collapsed had rushed in.
“Everything was blanketed in white, like after a good snow,” James said.
A few years later, James developed skin cancer. In 2013, James’s mother, Juanita, who was on her way to work in the financial district on the morning of the attacks and covered in the dust, was diagnosed with Stage 4 colon cancer. She died in 2023.
“I immediately connected it to 9/11,” James said of her and her family’s diagnoses.
First responders and other New Yorkers around the World Trade Center that day have reported conditions including respiratory issues, mental health impacts and dementia. Toxic air was present in the air soon after the attacks even though people were assured it was safe, according to a trove of records New York City officials released this week.
Twenty-five years later, attention is increasingly falling on cancer.
The number of 9/11 survivors who are receiving aid for cancer has roughly tripled over the last five years, according to a Washington Post analysis of reports from the World Trade Center Health Program, which funds health care for first responders and 9/11 survivors in New York. In June 2021, 8,870 survivors received aid for cancer treatment, jumping to 27,300 survivors in 2026 — numbers that sharply outpaced cancer claims among first responders.
Of the roughly 54,000 survivors enrolled in the health program as of June, about half are receiving aid for cancer. Five years ago, that share was 35 percent.
A recent New York University study of a smaller cohort of 9/11 survivors receiving medical aid as of 2024 reported a similar increase in cancer cases; it found that cases had increased around 2.5-fold between 2019-2024.
“This is something that we are worried about,” said Alan Arslan, an associate professor of population health at NYU and one of the authors of the study. “We’re seeing more and more patients.”
Matt Karwowski, the WTC Health Program’s research and evaluation branch chief, said in a statement to The Post that the group also expects more patients with serious conditions like cancer to enroll in the coming years as 9/11 survivors age. The program has seen record enrollment in recent years, he said.
Experts stressed that drawing definitive conclusions about 9/11-associated cancer rates from the WTC Health Program’s data is limited because survivors self-enroll. But the trends that have emerged still shed light on how the disease is impacting a cohort that was exposed to a unique mix of carcinogens in a deadly, man-made disaster, researchers said.
“When we first started looking at cancers in this population … we thought, ‘Okay, you’d have [smoke] inhalation, and therefore what we were going to see was lung cancer,’” said Joan Reibman, an adjunct professor of medicine at NYU and another author of the study. “And instead, what we started seeing was all different cancers.”
The fumes and debris that blanketed Lower Manhattan after the attacks included asbestos, benzene and a mixture of other known carcinogens released from the burning rubble, Arslan said. Those chemicals spread long after the attack as some fires continued to burn for months, and dust lingered in homes and workplaces.
The most common cancers among 9/11 survivors include breast and prostate cancer, which mirrors national trends. But breast cancer cases among 9/11 survivors were diagnosed around four years earlier than the national average and included a higher proportion of more aggressive breast cancers, Arslan said.
“One potential explanation is that World Trade Center exposure contributes to earlier onset for breast cancer … or it can accelerate progression,” Arslan said.
Lung cancer, the deadliest cancer for Americans, was also among the most common cancer types in the study. Female 9/11 survivors who had never smoked made up a high proportion of lung cancer patients, another abnormal trend, according to the study. Raja Flores, chairman of the department of thoracic surgery at the Icahn School of Medicine at Mount Sinai, said he has seen an increase at his practice of patients with lung cancer who are 9/11 survivors.
“I don’t know if we’ve hit our peak yet,” Flores said. “These cancers can take 20, 30, 40 years to develop. … I think we’re going to be seeing more.”
Flores urged that anyone who may have been exposed to dust and debris from the 9/11 attacks contact the WTC Health Program to discuss cancer screenings and other medical checkups.
Officials involved in the program have said that the medical aid it provides is making a difference. A 2021 study by the New York City Fire Department and the WTC Health Program found that the cancer-specific mortality rate for enrollees in the program was 34 percent lower than that of demographically similar New York residents with cancer.
James said her family continues to grapple with health impacts from the disaster. She has regular screenings to check for any recurrence of skin cancer, while her children have sought treatment for post-traumatic stress disorder as well as for respiratory and gastrointestinal issues. The heightened risk that they could develop cancer weighs on her.
“Imagine being raised in a family where everyone’s sick, and then you’re sick, too, due to an event that occurred before you were even born,” James said.
James said support for 9/11 survivors in the years to come should focus on cancer screening, especially for younger generations whose health impacts may only be starting to appear.
“We want to make sure that our children are educated about this and are getting checked out and staying on top of their health issues,” she said. “Because we expect that something’s definitely going to happen to us.”
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