Search tips
Search criteria 


Logo of oenvmedOccupational and Environmental MedicineVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Occup Environ Med. 2000 June; 57(6): 376–384.
PMCID: PMC1739963

Occupational exposure to formaldehyde and wood dust and nasopharyngeal carcinoma


OBJECTIVES—To investigate whether occupational exposures to formaldehyde and wood dust increase the risk of nasopharyngeal cancer (NPC).
METHODS—A multicentred, population based case-control study was carried out at five cancer registries in the United States participating in the National Cancer Institute's SEER program. Cases (n=196) with a newly diagnosed NPC between 1987 and 1993, and controls (n=244) selected over the same period from the general population through random digit dialing participated in structured telephone interviews which inquired about suspected risk factors for the disease, including a lifetime history of occupational and chemical exposure. Histological type of cancer was abstracted from clinical records of the registries. Potential exposure to formaldehyde and wood dust was assessed on a job by job basis by experienced industrial hygienists who were blinded as to case or control status.
RESULTS—For formaldehyde, after adjusting for cigarette use, race, and other risk factors, a trend of increasing risk of squamous and unspecified epithelial carcinomas was found for increasing duration (p=0.014) and cumulative exposure (p=0.033) but not for maximum exposure concentration. The odds ratio (OR) for people cumulatively exposed to >1.10 ppm-years was 3.0 (95% confidence interval (95% CI) 1.3 to 6.6) compared with those considered unexposed. In analyses limited to jobs considered definitely exposed, these trends became stronger. The associations were most evident among cigarette smokers. By contrast, there was no association between potential exposure to formaldehyde and undifferentiated and non-keratinising carcinomas. There was little evidence that exposure to wood dust increased risk of NPC, as modest crude associations essentially disappeared after control for potential exposure to formaldehyde.
CONCLUSIONS—These results support the hypothesis that occupational exposure to formaldehyde, but not wood dust, increases risk of NPC. This association seems to be specific to squamous cell carcinomas. Established cohorts of workers exposed to formaldehyde and wood dust should continue to be monitored for NPC and other respiratory cancers. Future studies of NPC should take into account histological type in assessing risk from environmental and host factors.

Keywords: occupational exposure; formaldehyde; wood dust

Full Text

The Full Text of this article is available as a PDF (170K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Blair A, Stewart P, O'Berg M, Gaffey W, Walrath J, Ward J, Bales R, Kaplan S, Cubit D. Mortality among industrial workers exposed to formaldehyde. J Natl Cancer Inst. 1986 Jun;76(6):1071–1084. [PubMed]
  • Hayes RB, Blair A, Stewart PA, Herrick RF, Mahar H. Mortality of U.S. embalmers and funeral directors. Am J Ind Med. 1990;18(6):641–652. [PubMed]
  • Vaughan TL, Strader C, Davis S, Daling JR. Formaldehyde and cancers of the pharynx, sinus and nasal cavity: I. Occupational exposures. Int J Cancer. 1986 Nov 15;38(5):677–683. [PubMed]
  • Roush GC, Walrath J, Stayner LT, Kaplan SA, Flannery JT, Blair A. Nasopharyngeal cancer, sinonasal cancer, and occupations related to formaldehyde: a case-control study. J Natl Cancer Inst. 1987 Dec;79(6):1221–1224. [PubMed]
  • West S, Hildesheim A, Dosemeci M. Non-viral risk factors for nasopharyngeal carcinoma in the Philippines: results from a case-control study. Int J Cancer. 1993 Nov 11;55(5):722–727. [PubMed]
  • Walrath J, Fraumeni JF., Jr Mortality patterns among embalmers. Int J Cancer. 1983 Apr 15;31(4):407–411. [PubMed]
  • Gardner MJ, Pannett B, Winter PD, Cruddas AM. A cohort study of workers exposed to formaldehyde in the British chemical industry: an update. Br J Ind Med. 1993 Sep;50(9):827–834. [PMC free article] [PubMed]
  • Olsen JH, Jensen SP, Hink M, Faurbo K, Breum NO, Jensen OM. Occupational formaldehyde exposure and increased nasal cancer risk in man. Int J Cancer. 1984 Nov 15;34(5):639–644. [PubMed]
  • Acheson ED, Cowdell RH, Hadfield E, Macbeth RG. Nasal cancer in woodworkers in the furniture industry. Br Med J. 1968 Jun 8;2(5605):587–596. [PMC free article] [PubMed]
  • Leclerc A, Martinez Cortes M, Gérin M, Luce D, Brugère J. Sinonasal cancer and wood dust exposure: results from a case-control study. Am J Epidemiol. 1994 Aug 15;140(4):340–349. [PubMed]
  • Vaughan TL, Davis S. Wood dust exposure and squamous cell cancers of the upper respiratory tract. Am J Epidemiol. 1991 Mar 15;133(6):560–564. [PubMed]
  • Demers PA, Kogevinas M, Boffetta P, Leclerc A, Luce D, Gérin M, Battista G, Belli S, Bolm-Audorf U, Brinton LA, et al. Wood dust and sino-nasal cancer: pooled reanalysis of twelve case-control studies. Am J Ind Med. 1995 Aug;28(2):151–166. [PubMed]
  • Blair A, Kazerouni N. Reactive chemicals and cancer. Cancer Causes Control. 1997 May;8(3):473–490. [PubMed]
  • Burt RD, Vaughan TL, McKnight B. Descriptive epidemiology and survival analysis of nasopharyngeal carcinoma in the United States. Int J Cancer. 1992 Oct 21;52(4):549–556. [PubMed]
  • Vaughan TL, Shapiro JA, Burt RD, Swanson GM, Berwick M, Lynch CF, Lyon JL. Nasopharyngeal cancer in a low-risk population: defining risk factors by histological type. Cancer Epidemiol Biomarkers Prev. 1996 Aug;5(8):587–593. [PubMed]
  • Teschke K, Hertzman C, Morrison B. Level and distribution of employee exposures to total and respirable wood dust in two Canadian sawmills. Am Ind Hyg Assoc J. 1994 Mar;55(3):245–250. [PubMed]
  • Teschke K, Demers PA, Davies HW, Kennedy SM, Marion SA, Leung V. Determinants of exposure to inhalable particulate, wood dust, resin acids, and monoterpenes in a lumber mill environment. Ann Occup Hyg. 1999 May;43(4):247–255. [PubMed]
  • Teschke K, Marion SA, Vaughan TL, Morgan MS, Camp J. Exposures to wood dust in U.S. industries and occupations, 1979 to 1997. Am J Ind Med. 1999 Jun;35(6):581–589. [PubMed]
  • Flyvholm MA, Andersen P. Identification of formaldehyde releasers and occurrence of formaldehyde and formaldehyde releasers in registered chemical products. Am J Ind Med. 1993 Nov;24(5):533–552. [PubMed]
  • Hamill A, Ingle J, Searle S, Williams K. Levels of exposure to wood dust. Ann Occup Hyg. 1991 Aug;35(4):397–403. [PubMed]
  • Jones PA, Smith LC. Personal exposures to wood dust of woodworkers in the furniture industry in the High Wycombe area: a statistical comparison of 1983 and 1976/77 survey results. Ann Occup Hyg. 1986;30(2):171–184. [PubMed]
  • McCammon CS, Jr, Robinson C, Waxweiler RJ, Roscoe R. Industrial hygiene characterization of automotive wood model shops. Am Ind Hyg Assoc J. 1985 Jul;46(7):343–349. [PubMed]
  • Sass-Kortsak AM, Holness DL, Pilger CW, Nethercott JR. Wood dust and formaldehyde exposures in the cabinet-making industry. Am Ind Hyg Assoc J. 1986 Dec;47(12):747–753. [PubMed]
  • Teschke K, Hertzman C, Morrison B. Level and distribution of employee exposures to total and respirable wood dust in two Canadian sawmills. Am Ind Hyg Assoc J. 1994 Mar;55(3):245–250. [PubMed]
  • Nicholls JM, Agathanggelou A, Fung K, Zeng X, Niedobitek G. The association of squamous cell carcinomas of the nasopharynx with Epstein-Barr virus shows geographical variation reminiscent of Burkitt's lymphoma. J Pathol. 1997 Oct;183(2):164–168. [PubMed]
  • Thomas DC. Re: "When will nondifferential misclassification of an exposure preserve the direction of a trend?". Am J Epidemiol. 1995 Oct 1;142(7):782–784. [PubMed]
  • Birkett NJ. Effect of nondifferential misclassification on estimates of odds ratios with multiple levels of exposure. Am J Epidemiol. 1992 Aug 1;136(3):356–362. [PubMed]
  • Lerchen ML, Samet JM. An assessment of the validity of questionnaire responses provided by a surviving spouse. Am J Epidemiol. 1986 Mar;123(3):481–489. [PubMed]
  • Shalat SL, Christiani DC, Baker EL., Jr Accuracy of work history obtained from a spouse. Scand J Work Environ Health. 1987 Feb;13(1):67–69. [PubMed]
  • Vaughan TL. Occupation and squamous cell cancers of the pharynx and sinonasal cavity. Am J Ind Med. 1989;16(5):493–510. [PubMed]
  • Blair A, Stewart PA, Hoover RN, Fraumeni JF, Jr, Walrath J, O'Berg M, Gaffey W. Cancers of the nasopharynx and oropharynx and formaldehyde exposure. J Natl Cancer Inst. 1987 Jan;78(1):191–193. [PubMed]
  • Marsh GM, Stone RA, Esmen NA, Henderson VL, Lee KY. Mortality among chemical workers in a factory where formaldehyde was used. Occup Environ Med. 1996 Sep;53(9):613–627. [PMC free article] [PubMed]
  • Collins JJ, Acquavella JF, Esmen NA. An updated meta-analysis of formaldehyde exposure and upper respiratory tract cancers. J Occup Environ Med. 1997 Jul;39(7):639–651. [PubMed]
  • Vaughan TL, Strader C, Davis S, Daling JR. Formaldehyde and cancers of the pharynx, sinus and nasal cavity: II. Residential exposures. Int J Cancer. 1986 Nov 15;38(5):685–688. [PubMed]
  • Demers PA, Vaughan TL, Checkoway H, Weiss NS, Heyer NJ, Rosenstock L. Cancer identification using a tumor registry versus death certificates in occupational cohort studies in the United States. Am J Epidemiol. 1992 Nov 15;136(10):1232–1240. [PubMed]
  • Kawachi I, Pearce N, Fraser J. A New Zealand Cancer Registry-based study of cancer in wood workers. Cancer. 1989 Dec 15;64(12):2609–2613. [PubMed]
  • Sriamporn S, Vatanasapt V, Pisani P, Yongchaiyudha S, Rungpitarangsri V. Environmental risk factors for nasopharyngeal carcinoma: a case-control study in northeastern Thailand. Cancer Epidemiol Biomarkers Prev. 1992 Jul-Aug;1(5):345–348. [PubMed]
  • Demers PA, Boffetta P, Kogevinas M, Blair A, Miller BA, Robinson CF, Roscoe RJ, Winter PD, Colin D, Matos E, et al. Pooled reanalysis of cancer mortality among five cohorts of workers in wood-related industries. Scand J Work Environ Health. 1995 Jun;21(3):179–190. [PubMed]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group