Cancer effects of formaldehyde: a proposal for an indoor air guideline value

Formaldehyde is a ubiquitous indoor air pollutant that is classified as “Carcinogenic to humans (Group 1)” (IARC, Formaldehyde, 2-butoxyethanol and 1-tert-butoxypropanol-2-ol. IARC monographs on the evaluation of carcinogenic risks to humans, vol 88. World Health Organization, Lyon, pp 39–325, 2006). For nasal cancer in rats, the exposure–response relationship is highly non-linear, supporting a no-observed-adverse-effect level (NOAEL) that allows setting a guideline value. Epidemiological studies reported no increased incidence of nasopharyngeal cancer in humans below a mean level of 1 ppm and peak levels below 4 ppm, consistent with results from rat studies. Rat studies indicate that cytotoxicity-induced cell proliferation (NOAEL at 1 ppm) is a key mechanism in development of nasal cancer. However, the linear unit risk approach that is based on conservative (“worst-case”) considerations is also used for risk characterization of formaldehyde exposures. Lymphohematopoietic malignancies are not observed consistently in animal studies and if caused by formaldehyde in humans, they are high-dose phenomenons with non-linear exposure–response relationships. Apparently, these diseases are not reported in epidemiological studies at peak exposures below 2 ppm and average exposures below 0.5 ppm. At the similar airborne exposure levels in rodents, the nasal cancer effect is much more prominent than lymphohematopoietic malignancies. Thus, prevention of nasal cancer is considered to prevent lymphohematopoietic malignancies. Departing from the rat studies, the guideline value of the WHO (Air quality guidelines for Europe, 2nd edn. World Health Organization, Regional Office for Europe, Copenhagen, pp 87–91, 2000), 0.08 ppm (0.1 mg m−3) formaldehyde, is considered preventive of carcinogenic effects in compliance with epidemiological findings

Identifying an indoor air exposure limit for formaldehyde considering both irritation and cancer hazards

Formaldehyde is a well-studied chemical and effects from inhalation exposures have been extensively characterized in numerous controlled studies with human volunteers, including asthmatics and other sensitive individuals, which provide a rich database on exposure concentrations that can reliably produce the symptoms of sensory irritation. Although individuals can differ in their sensitivity to odor and eye irritation, the majority of authoritative reviews of the formaldehyde literature have concluded that an air concentration of 0.3 ppm will provide protection from eye irritation for virtually everyone. A weight of evidence-based formaldehyde exposure limit of 0.1 ppm (100 ppb) is recommended as an indoor air level for all individuals for odor detection and sensory irritation. It has recently been suggested by the International Agency for Research on Cancer (IARC), the National Toxicology Program (NTP), and the US Environmental Protection Agency (US EPA) that formaldehyde is causally associated with nasopharyngeal cancer (NPC) and leukemia. This has led US EPA to conclude that irritation is not the most sensitive toxic endpoint and that carcinogenicity should dictate how to establish exposure limits for formaldehyde. In this review, a number of lines of reasoning and substantial scientific evidence are described and discussed, which leads to a conclusion that neither point of contact nor systemic effects of any type, including NPC or leukemia, are causally associated with exposure to formaldehyde. This conclusion supports the view that the equivocal epidemiology studies that suggest otherwise are almost certainly flawed by identified or yet to be unidentified confounding variables. Thus, this assessment concludes that a formaldehyde indoor air limit of 0.1 ppm should protect even particularly susceptible individuals from both irritation effects and any potential cancer hazard

Is exposure to formaldehyde in air causally associated with leukemia?—A hypothesis-based weight-of-evidence analysis

Recent scientific debate has focused on the potential for inhaled formaldehyde to cause lymphohematopoietic cancers, particularly leukemias, in humans. The concern stems from certain epidemiology studies reporting an association, although particulars of endpoints and dosimetry are inconsistent across studies and several other studies show no such effects. Animal studies generally report neither hematotoxicity nor leukemia associated with formaldehyde inhalation, and hematotoxicity studies in humans are inconsistent. Formaldehyde's reactivity has been thought to preclude systemic exposure following inhalation, and its apparent inability to reach and affect the target tissues attacked by known leukemogens has, heretofore, led to skepticism regarding its potential to cause human lymphohematopoietic cancers. Recently, however, potential modes of action for formaldehyde leukemogenesis have been hypothesized, and it has been suggested that formaldehyde be identified as a known human leukemogen. In this article, we apply our hypothesis-based weight-of-evidence (HBWoE) approach to evaluate the large body of evidence regarding formaldehyde and leukemogenesis, attending to how human, animal, and mode-of-action results inform one another. We trace the logic of inference within and across all studies, and articulate how one could account for the suite of available observations under the various proposed hypotheses. Upon comparison of alternative proposals regarding what causal processes may have led to the array of observations as we see them, we conclude that the case fora causal association is weak and strains biological plausibility. Instead, apparent association between formaldehyde inhalation and leukemia in some human studies is better interpreted as due to chance or confounding

Granica izlaganja formaldehidu u alkoholnim pićima

Formaldehyde has been classified as carcinogenic to humans (WHO IARC group 1). It causes leukaemia and nasopharyngeal cancer, and was described to regularly occur in alcoholic beverages. However, its risk associated with consumption of alcohol has not been systematically studied, so this study will provide the first risk assessment of formaldehyde for consumers of alcoholic beverages. Human dietary intake of formaldehyde via alcoholic beverages in the European Union was estimated based on WHO alcohol consumption data and literature on formaldehyde contents of different beverage groups (beer, wine, spirits, and unrecorded alcohol). The risk assessment was conducted using the margin of exposure (MOE) approach with benchmark doses (BMD) for 10 % effect obtained from dose-response modelling of animal experiments. For tumours in male rats, a BMD of 30 mg kg-1 body weight per day and a “BMD lower confi dence limit” (BMDL) of 23 mg kg-1 d-1 were calculated from available long-term animal experiments. The average human exposure to formaldehyde from alcoholic beverages was estimated at 8·10-5 mg kg-1 d-1. Comparing the human exposure with BMDL, the resulting MOE was above 200,000 for average scenarios. Even in the worst-case scenarios, the MOE was never below 10,000, which is considered to be the threshold for public health concerns. The risk assessment shows that the cancer risk from formaldehyde to the alcohol-consuming population is negligible and the priority for risk management (e.g. to reduce the contamination) is very low. The major risk in alcoholic beverages derives from ethanol and acetaldehyde.Formaldehid je kancerogen za ljude te je klasificiran u skupinu 1 prema WHO IARC-u. Uzrokuje leukemiju i nazofaringealni karcinom, a navodi se i kao redoviti sastojak alkoholnih pića. Međutim, rizik od izlaganja formaldehidu konzumacijom alkoholnih pića nije sustavno istražen pa će ovo istraživanje pružiti prvu takvu procjenu rizika. Količina formaldehida koju ljudi unose alkoholnim pićima u Europskoj je uniji procijenjena temeljem podataka Svjetske zdravstvene organizacije o konzumaciji alkohola i literature o sadržaju formaldehida u različitim skupinama alkoholnih pića (pivo, vino, jaka alkoholna pića i neregistrirani alkohol). Procjena rizika obavljena je korištenjem pristupa granice izlaganja (eng. margin of exposure, MOE) i graničnih doza (eng. benchmark doses, BMD) za 10 %-tni učinak koji se postiže modeliranjem odnosa doza-odgovor u ispitivanjima provedenima na životinjama. BMD od 30 mg kg-1 tjelesne težine na dan i BMD s nižom granicom pouzdanosti (BMDL) od 23 mg kg-1 d-1 izračunati su za tumore kod mužjaka štakora temeljem raspoloživih dugotrajnih ispitivanja provedenih na životinjama. Prosječno izlaganje ljudi formaldehidu u alkoholnim pićima procijenjeno je na 8·10-5 mg kg-1 d-1. U usporedbi s BMDL vrijednošću krajnji MOE je iznosio više od 200.000 u prosječnim situacijama. Čak i u najlošijim situacijama MOE nije nikada bio niži od 10.000, što se smatra graničnom vrijednošću za zdravlje ljudi. Procjena rizika pokazuje da je rizik od nastanka karcinoma uslijed izlaganja formaldehidu iz alkoholnih pića zanemariv te da je prioritet upravljanja rizikom u takvim slučajevima (npr. kako bi se smanjila kontaminacija) vrlo nizak. Najveći rizik proizlazi iz etanola i acetaldehida koji se također nalaze u alkoholnim pićima

Lessons from health hazards | Vinyl chloride: a saga of secrecy 8 Vinyl chloride: a saga of secrecy

This chapter is about how early warnings in the 1950s and 1960s concerning the short-term harm of vinyl chloride (VC) to the skin and bones of workers, and to the livers of laboratory animals, were initially hidden from other workers and regulators. This was despite some early misgivings by company experts whose advice was initially ignored by their employers. This pattern was repeated when the later, more devastating news of a rare liver cancer in workers was revealed by long-term animal studies and by an attentive and concerned company physician. Unlike many other histories, however, this story features a very prompt response from the global chemical industry to the publication of the liver cancer evidence, a response that included funding cancer testing and later compliance with a large reduction in the permissible exposure limits. The case also provides early evidence of reproductive effects of vinyl chloride monomer (VCM). Other features of this story presage the later and common responses of the corporate world to heightened public awareness and pressure from non-governmental organisations (NGOs) and trade unions, including greatly exaggerated estimates of the likely costs of complying with tighter pollution controls; a frequent mismatch between the position of the trade association and tha

Merkel-cell polyomavirus (MCPyV) is rarely associated to B-chronic lymphocytic leukemia (1 out of 50) samples and occurs late in the natural history of the disease

BACKGROUND: Previous studies have reported conflicting results on the frequency and potential pathogenetic role of Merkel-cell polyomavirus (MCPyV) in B-chronic lymphocytic leukemia (B-CLL). OBJECTIVES: To evaluate the association of MCPyV to B-CLL and to investigate the occurrence of MCPyV infection in relationship to the natural history of B-CLL. STUDY DESIGN: Samples of primary B-CLL peripheral blood mononuclear cells were obtained from two distinct University Hospitals of Italy from January 2010. For one B-CLL patient, it was possible to retrospectively examine the blood sample at diagnosis of B-CLL (March 2004) and several pathological tissues of cutaneous tumors occurring during the course of the disease. RESULTS: Only one out of 50 B-CLL blood samples examined was positive for MCPyV DNA. Retrospective analysis revealed that MCPyV DNA was absent in peripheral blood sample at diagnosis, becoming present only in advanced disease stages also in tonsil tissue as well as in a biopsy of differentiated squamous cell carcinoma. CONCLUSIONS: The association with MCPyV seems to represent a rare and late event during the natural history of B-CL