For 61-year-old Karen Biss, Sept. 11, 2001, feels like yesterday.

At the time, Biss worked as a leader at a software company a couple of blocks from the Twin Towers. She had stopped on her way to work to get a bouquet of flowers for her office when she saw debris falling from the sky. After that day, she wanted to get involved and find a way to help, so she briefly volunteered at Ground Zero with the Red Cross. She also continued to commute by ferry from her home in New Jersey to her downtown office until she left her job that November.

“Every day on that ferry, you saw that blaze,” Biss says.

Biss, now a mother of three and grandmother of four, was diagnosed with uterine cancer in 2008 and breast cancer in 2020. Testing showed she was not genetically predisposed to either cancer. She attributes her uterine cancer to 9/11, recalling her time working next to the flames, inhaling toxins in what she says looked like a war zone.

“We weren’t told to wear any kind of mask,” Biss says. “Who knows what else was in that building that we were breathing in for weeks and months.”

The World Trade Center Health Program recognizes dozens of conditions related to 9/11 and assists with their monitoring and treatment. Now, 21 years later, uterine cancer remains the only cancer that has not been recognized as one of them.

Many of the 9/11-related illnesses, like lung cancer, correspond to those experienced by first responders, who are primarily men, says Sara Director, a partner at Barasch & McGarry who represents thousands of 9/11 survivors, many of whom have dealt with uterine cancer.

Uterine cancer, however, is the fourth most common cancer in women in the U.S., and it disproportionately affects Black women. But research on how many 9/11 first responders and workers near Ground Zero were diagnosed with uterine cancer is not clear, making it increasingly hard to categorize this cancer as a 9/11 illnesses.

When a specific cancer or illness is on the list, those without insurance can qualify for free treatment and obtain resources for medical help.

The Federal Register published the proposed rule to include uterine cancer on the list of 9/11 diseases on May 10 of this year.

“The proposed rulemaking by the WTC Health Program recommends that all types of uterine cancer, including endometrial cancer, be added to the List. Adding uterine cancer to the List would allow the WTC Health Program to offer treatment services to members whose uterine cancers are certified as WTC-related.”

Advocates are waiting with bated breath for the approval. In August, Representatives Mikie Sherrill of New Jersey and Carolyn Maloney of New York penned an urgent letter requesting a "prompt decision."