Mortality from lymphohematopoietic malignancies and brain cancer among embalmers exposed to formaldehyde.
BACKGROUND
Excess mortality from lymphohematopoietic malignancies, in particular myeloid leukemia, and brain cancer has been found in surveys of anatomists, pathologists, and funeral industry workers, all of whom may have worked with formaldehyde. We investigated the relation of mortality to work practices and formaldehyde exposure levels among these professionals to address cancer risk in the funeral industry.


METHODS
Professionals employed in the funeral industry who died between January 1, 1960, and January 1, 1986, from lymphohematopoietic malignancies (n = 168) or brain tumors (n = 48) (ie, case subjects) were compared with deceased matched control subjects (n = 265) with regard to lifetime work practices and exposures in the funeral industry, which were obtained by interviews with next of kin and coworkers, and to estimated levels of formaldehyde exposure. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by use of logistic regression. All statistical tests were two-sided.


RESULTS
Mortality from myeloid leukemia increased statistically significantly with increasing number of years of embalming (P for trend = .020) and with increasing peak formaldehyde exposure (P for trend = .036). Compared with subjects who performed fewer than 500 lifetime embalmings, mortality from myeloid leukemia was elevated among those who performed embalmings for more than 34 years (OR = 3.9, 95% CI = 1.2 to 12.5, P = .024), who performed more than 3068 embalmings (OR = 3.0, 95% CI = 1.0 to 9.2, P = .057), and those whose estimated cumulative formaldehyde exposure exceeded 9253 parts per million-hours (OR = 3.1; 95% CI = 1.0 to 9.6, P = .047). These exposures were not related to other lymphohematopoietic malignancies or to brain cancer.


CONCLUSIONS
Duration of embalming practice and related formaldehyde exposures in the funeral industry were associated with statistically significantly increased risk for mortality from myeloid leukemia.
Hauptmann
Michael
M
Department of Bioinformatics and Statistics, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Stewart
Patricia A
PA
Lubin
Jay H
JH
Beane Freeman
Laura E
LE
Hornung
Richard W
RW
Herrick
Robert F
RF
Hoover
Robert N
RN
Fraumeni
Joseph F
JF
Blair
Aaron
A
Hayes
Richard B
RB
D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000139:chemically induced / Q000401:mortality*; D005260:Female; D005404:Fixatives / Q000009:adverse effects*; D005557:Formaldehyde / Q000009:adverse effects*; D005655:Funeral Rites; D019337:Hematologic Neoplasms / Q000139:chemically induced / Q000401:mortality*; D006801:Humans; D007951:Leukemia, Myeloid / Q000401:mortality; D008223:Lymphoma / Q000139:chemically induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality; D009784:Occupational Diseases / Q000139:chemically induced / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*
D005404:Fixatives; D005557:Formaldehyde