People who were stricken with cancer after being exposed to the toxic ash that exploded over Manhattan when the World Trade Center collapsed during the 9/1 1 terrorist attack would qualify for free treatment of the disease and potentially hefty compensation payments under a rule proposed Friday by federal health officials.
After months of study, the National Institute for Occupational Safety and Health said it favored a major expansion of an existing $4.3 billion 9/1 1 health program to include people with 50 types of cancer.
People with any of the cancers on the list could qualify for treatments and payments as long as they and their doctors make a plausible case that the disease was connected to the caustic dust.
The decision followed years of lobbying by construction workers, firefighters, police officers, office cleaners and other people who fell ill in the decade after the terror attack, and were sure it had something to do with the many days they spent toiling in the gray soot.
"It's amazing," said Ernie Vallebuona, a former New York City police detective who retired after being diagnosed with lymphoma in 2004. "It's nice to have the federal government recognize that your cancer was caused by ground zero. It's something we've always known. I'm just ecstatic that we are finally being recognized. You almost felt like you were being brushed aside."
The institute, which oversees the 9/1 1 health program, acted after an advisory committee made up of doctors, union officials and community advocates recommended that cancer be added. Previously, the aid effort has only covered people with mostly less-serious ailments, including asthma, acid reflux disease and chronic sinus irritation.
The decision on whether to add cancer to that list is a difficult one, and there are still substantial questions about how the program will function.
While stories about first responders struck by cancer are common, there is still little scientific evidence of elevated cancer rates connected to either the trade center dust or other toxins at the ground zero recovery site.
Cancer experts also say that it usually takes many years for an environmental exposure to lead to a cancer case, due to the slow, undetectable development of many types of the disease. That means that many of the people falling ill with cancer now, or in the past 10 years, are unlikely to have gotten it as a result of the attacks.
Questions about whether the dust truly caused cancer was one of the reasons Congress did not include it in the initial list of covered illnesses.
But some occupational health experts have expressed concern about the presence of carcinogens in the ash and soot, and the advisory panel said it believed there were enough toxins present that it was plausible that some people with heavy exposures might get cancer.
In a 123-page report explaining its decision, the institute agreed with that assessment.
The ruling isn't final. It will be open for public comment for several weeks, or up to two months, before being finalized. It will still be open to revisions, or even outright abandonment, during that time.