Journal of the National Cancer Institute Advance Access published online on November 20, 2009
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djp416
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Published by Oxford University Press 2009.
ARTICLE |
Mortality From Lymphohematopoietic Malignancies and Brain Cancer Among Embalmers Exposed to Formaldehyde
Affiliations of authors: Department of Bioinformatics and Statistics, Netherlands Cancer Institute, Amsterdam, the Netherlands (MH); Formerly of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (MH, PAS, RBH); Stewart Exposure Assessments, Arlington, VA, LLC (PAS); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (JHL, LEBF, RNH, JFF, AB); Cincinnati Children’s Hospital Medical Center, Cincinnati, OH (RWH); Department of Environmental Health, Harvard School of Public Health, Boston, MA (RFH); Department of Environmental Medicine, New York University Medical Center, New York, NY (RBH)
Correspondence to: Laura E. Beane Freeman, PhD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Bethesda, MD 20892 (e-mail: freemala{at}mail.nih.gov).
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.
Conclusion: Duration of embalming practice and related formaldehyde exposures in the funeral industry were associated with statistically significantly increased risk for mortality from myeloid leukemia.
| CONTEXT AND CAVEATS Prior knowledge More deaths than expected among anatomists, pathologists, and funeral industry workers have been attributed to lymphohematopoietic malignancies, in particular myeloid leukemia, and brain cancer. Individuals in these fields may have worked with formaldehyde. Study design In a case–control study in a cohort of deceased funeral industry workers, those who died from lymphohematopoietic malignancies and brain tumors were compared with control subjects. Lifetime work practices and exposures to formaldehyde were obtained by interviews with next of kin and coworkers. Contribution The number of years of embalming practice and related formaldehyde exposures in the funeral industry was associated with statistically significantly increased mortality from myeloid leukemia. No associations were observed with other lymphohematopoietic malignancies. Associations with brain cancer were unclear. Implications Further studies are warranted to investigate the risk of leukemia in relation to specific embalming practices and exposures and to investigate this risk in other groups of professionals who are exposed to formaldehyde and have an increased risk of leukemia (ie, anatomists and pathologists). Limitations Exposures to formaldehyde were obtained from interviews with next of kin and coworkers. There were relatively few deaths from myeloid leukemia among case subjects. There was a considerable amount of missing data that required imputation for analyses. From the Editors
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Manuscript received May 19, 2009; revised October 10, 2009; accepted October 13, 2009.
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J Natl Cancer Inst 2009 101: 1659.