By Delthia Ricks
Newsday (New York)
Copyright 2007 Newsday, Inc.

AP PHOTO MATT MOYER Firefighters carry an injured fireman from the World Trade Center area on 9/11.

NEW YORK — Some of the first responders who were exposed to the cocktail of toxins produced at Ground Zero are developing a form of cancer often seen in much older people in what one doctor calls the "third wave" of disorders to emerge from the World Trade Center disaster.

Dr. Robin Herbert, co-director of the WTC Medical Monitoring Program at Mount Sinai Hospital in Manhattan, said a wide range of medical conditions has been detected since the program began in 2001, after the attacks on Sept. 11 that year. She and her colleagues are overseeing the health of 20,000 men and women who worked at the site in the weeks after the attack, such as firefighters, police officers, rescuers and construction workers.

Speaking yesterday in an interview aired online by the New England Journal of Medicine, Herbert said the medical conditions have been typified by specific disorders. "The first wave is the acute respiratory problems that now in many have persisted," she said. "The second wave is what seemed to be the interstitial lung diseases such as sarcoid granulomas." Sarcoid granulomas are small nodules on the lungs characterized by inflammatory cells.

"We are worried about the third wave, which is the possibility of cancer down the road," she added, saying that some of the malignancies have already begun to appear.

"The group of cancers we're most concerned about and that we're focusing on right now are cancers of the hematologic system and lymphatic system such as leukemias and lymphomas," Herbert said. "The kind of thing that worries us is that we know that we have a handful of cases of multiple myeloma in very young individuals and multiple myeloma is a condition that almost always presents [itself] much later in life. So that's the kind of odd, unusual, troubling finding that we're seeing already."

Multiple myeloma is a cancer of the plasma cell in the blood and is an incurable disease, but symptoms can be treated.

Herbert would not return phone calls yesterday to clarify how many first responders have been diagnosed, or who they are, and whether their disease is considered mild or advanced.

Dr. Ben Luft, who heads an affiliated program at Stony Brook University Medical Center where more than 3,000 first responders are also being monitored, said he does not consider the number of cancers detected so far to be alarming.

"We're seeing patients who are sporadically developing a variety of cancers, but it is not significantly above what we would have expected in a group of patients of this size," he said. "Some of these malignancies are a little bit atypical, which makes us want to examine them a little bit more closely.

"But when you are following such a large number of patients one would expect to see some who are developing cancer. What is most important is for us to say scientifically that there is a causal relationship," Luft said, referring to World Trade Center debris and cancer.

"The only way we can really deal with it effectively is to be as rational and scientific as possible."