Occupational exposure to formaldehyde: an established link with myeloid leukaemia

The risk of myeloid leukaemia increases in workers exposed to formaldehyde

Formaldehyde has been classified as a carcinogenic substance by various European and international organisations, in particular in relation to nasopharyngeal cancer.  Until recently, its connection with an increased risk of leukaemia was still under discussion. 

Based on an analysis of the available data and, in particular, the conclusions of the 2014 report of the US National Research Council, ANSES has concluded that there is an established causal relationship between occupational exposure to formaldehyde and myeloid leukaemia.

This finding is a strong argument in favour of the creation of an occupational disease table. This new table would supplement the existing tables of occupational diseases linked to formaldehyde in the French social security schemes (general and agricultural). These cover conditions such as dermatitis, eczema, rhinitis and asthma. A table for nasopharyngeal cancer was also created in 2012.

Formaldehyde is a widely used substance

Formaldehyde is or has been used in a wide range of professional activities, for example as a: 

• preservative, especially in embalming,
• disinfectant in hospitals and agriculture,
• fixative in anatomical and cytological pathology laboratories.

Furthermore, in the wood, textile and rubber industries, certain products and resins are known to release formaldehyde.

The expert appraisal lists the sectors and occupations that have exposed or are currently exposing workers to this carcinogenic substance. ANSES notes that 86 of the 88 sectors in the French Classification of Activities (NAF) are concerned, i.e. almost all of them.

Ever since specific rules for preventing carcinogenic, mutagenic and reprotoxic risks were introduced in the French Labour Code in the early 2000s, there has been an overall reduction in the proportion of exposed workers, all sectors combined. Nevertheless, some workers are still subject to high levels of exposure in sectors such as:

• funeral services,
• healthcare (formaldehyde fixation),
• carpentry work,
• the manufacture of veneer and wood panels and furniture made from these panels, etc. 

To improve prevention and make it easier for employers to fulfil their obligation to replace formaldehyde, ANSES identified potential alternatives to formaldehyde in five occupational sectors.

Raising awareness among patients, preventionists and medical professionals

Over the last 10 years, few applications for recognition of occupational diseases have been submitted for myeloid leukaemia. Among the reasons put forward to explain this situation, studies have shown that haematologists have widely varying degrees of knowledge when it comes to occupational risk factors and how the recognition system works. Yet along with general practitioners, these professionals are often on the front line for the diagnosis and medical monitoring of leukaemia patients.

Another factor that makes it complicated for victims to obtain recognition is the difficulty of tracing occupational exposure to formaldehyde. This general difficulty particularly affects certain professionals, such as cleaning workers. Their often fragmented career paths make it difficult to identify and trace exposure to hazardous substances such as formaldehyde, which can be contained in some of the products they use.

The creation of an occupational disease table would make it easier to recognise cases of cancer associated with occupational exposure. It would also help raise awareness among employees, patients, employers, preventionists and medical professionals, constituting an important step towards improving the overall prevention of exposure to formaldehyde. 

“Haematologist-oncologists and their teams, in conjunction with general practitioners and occupational physicians, have an important role to play in improving the detection of occupational exposure to formaldehyde and helping their patients obtain recognition”.