There is an excess of thyroid cancer risk in World Trade Center first responders that our previous research has confirmed to be true malignancies and not the result of over diagnosis from heightened screening. Understanding the aggressiveness of these cancers has implications for treatment; if these tumors arise from a microenvironment characterized by high inflammation and immune depression, and have a higher mutational burden and/or mutations known to be associated with poor prognostic outcomes, then it may be that more aggressive treatments such as total thyroidectomy are most appropriate. Additionally, whole exome sequencing of these tumors may illuminate novel mutations that are useful targets for immunotherapy or chemotherapy.
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