title: Critical review and synthesis of the epidemiologic evidence on formaldehyde exposure and risk of leukemia and other lymphohematopoietic malignancies.
abstract: OBJECTIVE
  Recent epidemiologic studies indicate elevated risks for some lymphohematopoietic malignancies (LHM) related to formaldehyde exposure. We performed a systematic review of literature to assess the strength and consistency of associations.
  
  
  METHODS
  We summarized published literature in the PubMed database of the National Library of Medicine during 1966-2012. Literature was categorized according to study design and population: industrial cohort studies, professional cohort studies, and population-based case-control studies.
  
  
  RESULTS
  Findings from occupational cohort and population-based case-control studies were very inconsistent for LHM, including myeloid leukemia. Apart from some isolated exceptions, relative risks were close to the null, and there was little evidence for dose-response relations for any of the LHM.
  
  
  CONCLUSIONS
  At present, there is no consistent or strong epidemiologic evidence that formaldehyde is causally related to any of the LHM. The absence of established toxicological mechanisms further weakens any arguments for causation. To be informative, future epidemiologic research should improve on formaldehyde exposure assessment and apply modern diagnostic schemes for specific LHM.
authors.affiliation: Department of Environmental Health, School of Public Health and Medicine, University of Washington, Box 357234, Seattle, WA 98195, USA. checko@u.washington.edu
authors.forename: Harvey
authors.initials: H
authors.lastname: Checkoway
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Mundt
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Mundt
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D005557:Formaldehyde / Q000009:adverse effects; D019337:Hematologic Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D007938:Leukemia / Q000139:chemically induced / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D012130:Respiratory Hypersensitivity / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D005557:Formaldehyde