25 years later, the health toll of 9/11 still follows first responders

COLUMBIA, Mo. (KMIZ)

Twenty-five years after the Sept. 11, 2001, terror attacks in New York City, first responders who worked at Ground Zero continue to suffer health consequences linked to exposure to toxic and hazardous materials.

The World Trade Center Health Program reports more than 9,000 first responders have died from illnesses related to the attacks.

The program was established on Jan. 2, 2011, after former President Barack Obama signed the James Zadroga 9/11 Health and Compensation Act of 2010, officially establishing the program that has been funded through 2090. The program provides eligible responders and survivors with no-cost medical monitoring and treatment for certified 9/11-related health conditions.

As of June 30, 2026, 144,000 people were enrolled in the program, including 56,299 first responders and 38,984 survivors in New York. Missouri has 117 first responders and survivors enrolled.

While 412 first responders died on the day of the attacks, the toll of 9/11 did not end that morning. In the years since, thousands of people have died from illnesses linked to exposure at the World Trade Center site, highlighting the lasting health consequences of the attacks.

Dr. Kate Grossman, a pulmonary and critical care physician at Boone Health, was completing her fellowship and pulmonary medicine training at Mount Sinai on New York's Upper East Side at the time of the attacks. The hospital hosts the World Trade Center Health Program. During her fellowship, she treated patients who were affected by the toxins a decade later.

"That dust that was created there was really unique dust; it had, of course, big material in it that we don't usually breathe into our lungs," Grossman said. "Things from a collapse of a building, so concrete, glass, what makes up drywall mixed with smoke and burning fuel."

First responders were also exposed to asbestos, heavy metals and chemical compounds that were created when the World Trade Center towers collapsed. Many of those materials are carcinogens.

Exposure to toxic materials can have widespread effects on the body, including damage to the respiratory and digestive systems, respiratory and blood cancers, target-organ cancers, vascular damage, nervous system disorders and brain toxicity.

"We see a lot of direct effects to the lungs of people who have a direct impact from the lungs. There is something called 'World Trade Center cough,' which is very, very prominent afterwards," Grossman said. "In addition to that, new-onset asthma, there's something called RADS, or reactive airways dysfunction syndrome, which is kind of like an immediate asthma."

Immediate asthma can be difficult to treat, as the chemicals and fine particles in smoke can act as strong irritants. Smooth muscles surrounding the airways can contract quickly and squeeze the passages shut.

"We also saw more lung disease like [chronic obstructive pulmonary disease] and pulmonary fibrosis from things that got deeper down into the lungs, finer particles that get down there and then you have the health effects that affect the heart and blood vessels," Grossman said.

The World Trade Center Health Program has identified 68 types of cancer linked to 9/11, but doctors are now just seeing the different health effects since there is lag time when a person starts to see effects on the body.

The top 15 most common certified 9/11 cancers are:

• Non-melanoma skin cancer
• Prostate cancer
• Melanoma
• Lymphoma
• Thyroid cancer
• Kidney cancer
• Lung/bronchus cancer
• Leukemia
• Bladder cancer
• Colon cancer
• Female breast cancer
• Myeloma
• Oropharynx cancer
• Rectum cancer
• Neuroendocrine cancer

When the attacks happened, first responders rushed to Ground Zero to save lives. But being the first on the scene meant they were also exposed to some of the highest levels of dust, smoke and other hazardous materials, ultimately coming with a long-term cost.

In the years immediately after 9/11, lung cancer rates among first responders were not initially higher than expected, according to Grossman. Grossman said this may have been because many responders were younger and had not yet reached the typical age when lung cancer develops.

But some cancers take decades to appear.

Lung cancer and mesothelioma, a cancer linked to asbestos exposure, can have a latency period of 20 years or more, Grossman said. That means some first responders are experiencing the health consequences of an event that happened 25 years ago.

Missouri Task Force 1 answers the call for help

Missouri was connected to the long-term health consequences, as 62 men and women of Missouri Task Force 1 were deployed to New York to help with the search and recovery efforts, including Larry
Ronald Duncan, a heavy rigging specialist.

Duncan died from esophageal gastric junction cancer.

The Boone County Fire Protection District said Duncan was a part of the World Trade Center Health Program.

Eight members of Missouri Task Force 1 have died since 9/11, but Duncan is the only member whose death has been linked to his response at Ground Zero, according to Boone County Fire Assistant Chief Chuck Doss.

"He was a unique individual; he was a lot of fun to be around, quiet guy, but again, once you got to know him, he was very outgoing," Doss said.

Thousands of first responders from across the country answered the call to Ground Zero, a call that ultimately changed the lives of many.

"It was difficult seeing people that you knew become ill and then to learn that it was related to getting him volunteering and stepping up and saying, 'I'll help.' That's always difficult," Doss said. "It was a lot to take in; it took me a little bit to process all of it, and still today it's still a lot."

When news began to spread that the first tower had collapsed, Doss said, he knew there would be a call for help.

"I was home from class that day, and I was sitting there and had the alphanumeric pages started getting information about the attacks on my pager. I turned on the TV and saw what was going on," Doss said. "Seeing that first tower collapse, I kind of instinctively knew where things were headed and what was going to happen and just headed down here to get stuff packed and just to be ready when that call came."

When Doss first arrived at Ground Zero, he says the image is "something you never forget."

"We walked around the corner, and just the magnitude, and all we were seeing was just one corner of that giant scene. It was very overwhelming to see it and the magnitude, and you go, 'okay, let's go to work,'" he said.

Twenty-five years later, the fight continues

Doss was one of the 62 members deployed that day. Although he has not experienced any known physical health consequences from exposure to the toxic materials at Ground Zero, he continues to face the mental health effects of what he witnessed and experienced during the 10-day response.

During the response, Task Force 1 conducted urban search-and-rescue operations. Teams used search-and-rescue dogs, cameras, listening devices and ultrasonic equipment to locate people who may have been trapped beneath the debris.

When Task Force 1 arrived at Ground Zero, protection and safety were a priority as responders worked through an environment filled with dust and debris.

"There was a lot of dust; you got to look at some of the pictures and the particulate that was in the air through some of the photos that you may not have seen at the time," Doss said. "We were very fortunate that our hazmat folks told us we need to be sure that when we're working we're wearing respirators and we're being careful, so I think our team benefited from that extra layer of protection."

But some first responders didn't have immediate access to an N-95 respirator, which could have limited exposure to toxic materials.

While masks were available, wearing one while doing physical labor and trying to communicate in a loud environment can present its own challenges, Grossman said.

Preventative measures and education, Doss said, are what the task force focuses on to catch illnesses early. He said they make sure those who responded after the attacks know what resources are available, like the WTCHP, which offers a yearly physical for first responders who are enrolled in the program.

"Every year go get lab work checks, X-rays, make sure that there's baseline and track those things, so when there are issues, hopefully they're caught early and that they're addressed," Doss said. "I'm still a member of the task force, so I get an annual physical through the task force every year, and then I see my own personal physician every year, so I get three annual physicals a year."

Doss hopes that with those three annual physicals, if an illness pops up, it will be caught early.

The Boone County Fire Protection District invited members of Task Force 1 who responded to the World Trade Center to participate in events marking the 25th anniversary of the attacks.

Several events will be held, including a morning ceremony on the University of Missouri campus and an evening ceremony at the Missouri Capitol, where Boone County Fire District Chief Dough Westhoff is set to speak.