Cancer risk associated with pulp and paper mills: a review of occupational and community epidemiology.

Pulp and paper mills use a variety of chemical substances potentially hazardous to human health. Compounds of both short- and long-term toxicological significance are found in workplaces, air emissions, and water effluent. In this paper we evaluate the body of published literature on cancer associated with working in pulp and paper mills as well as in surrounding communities. Multiple comparisons, questionable statistical power, and the absence of individual exposure assessments have resulted in non-corroborative findings over the years. However, a new generation of study sophistication, international in scale and coordinated by the International Agency for Research on Cancer (IARC), has catalogued tens of thousands of exposure measurements made at a large number of work stations within the pulp and paper industry, allowing for greatly improved individual-level exposure assessments. This approach reduces non-differential misclassification of exposure, increasing the power of these studies to detect exposure disease relationships, especially for rarer cancers. While the ability to associate specific chemical exposures with cancer outcomes in the large IARC multinational cohort may yet help to resolve the status of some of the many chemicals not currently classifiable as to their carcinogenicity by IARC, this effort has, to date, not added significantly to knowledge. Of the three studies they have published to date, one involved a well-established carcinogen (asbestos) and another involved a mixture containing probable carcinogens (volatile organochlorines). While the asbestos study is somewhat unremarkable for finding an association with pleural cancer in the expected direction, the volatile organochlorine study may be most notable for failing to find an association between volatile organochlorine exposure and liver cancer, non-Hodgkin's lymphoma, or esophageal cancer, as some previous studies had found. Nonetheless, given the known hazards and the potential for both environmental and human exposure by any of a number of pathways, vigilance on the part of governments for regulation and for ongoing workplace and environmental monitoring remains a health imperative.