Validation of exposure estimation for benzene in the Australian petroleum industry

Characterizing methane and total non-methane hydrocarbon levels in Los Angeles communities with oil and gas facilities using air quality monitors

Over the past decade, sensor networks have been proven valuable to assess air quality on highly localized scales. Here we leverage innovative sensors to characterize gaseous pollutants in a complex urban environment and evaluate differences in air quality in three different Los Angeles neighborhoods where oil and gas activity is present. We deployed monitors across urban neighborhoods in South Los Angles adjacent to oil and gas facilities with varying levels of production. Using low-cost sensors built in-house, we measured methane, total non-methane hydrocarbons (TNMHCs), carbon monoxide, and carbon dioxide during three deployment campaigns over four years. The multi-sensor linear regression calibration model developed to quantify methane and TNMHCs offers up to 16% improvement in coefficient of determination and up to a 22% reduction in root mean square error for the most recent dataset as compared to previous models. The deployment results demonstrate that airborne methane concentrations are higher within a 500 m radius of three urban oil and gas facilities, as well as near a natural gas distribution pipeline, likely a result of proximity to sources. While there are numerous additional sources of TNMHCs in complex urban environments, some sites appear to be larger emitters than others. Significant methane emissions were also measured at an idle site, suggesting that fugitive emissions may still occur even if production is ceased. Episodic spikes of both compounds suggested an association with oil and gas activities, demonstrating how sensor networks can be used to elucidate community-scale sources and differences in air quality moving forward.

Airborne exposures associated with the typical use of an aerosol brake cleaner during vehicle repair work

Many petroleum-based products are used for degreasing and cleaning purposes during vehicle maintenance and repairs. Although prior studies have evaluated chemical exposures associated with this type of work, most of these have focused on gasoline and exhaust emissions, with few samples collected solely during the use of an aerosol cleaning product. In this case study, we assess the type of airborne exposures that would be expected from the typical use of an aerosol brake cleaner during vehicle repair work. Eight exposure scenarios were evaluated over a 2-day study in which the benzene content of the brake cleaner and potential for dilution ventilation and air flow varied. Both short-term (15 min) and task-based (≥1 hr) charcoal tube samples were collected in the breathing zone and adjacent work area and analyzed for total hydrocarbons (THCs), toluene, and benzene. The majority of personal (N = 48) and area (N = 47) samples had detectable levels of THC and toluene, but no detections of benzene were found. For the personal short-term samples, average airborne concentrations ranged from 3.1-61.5 ppm (13.8-217.5 mg/m³) for THC and 2.2-44.0 ppm (8.2-162.5 mg/m³) for toluene, depending on the scenario. Compared to the personal short-term samples, average concentrations were generally 2-3 times lower for the personal task-based samples and 2-5 times lower for the area short-term samples. The highest exposures occurred when the garage bay doors were closed, floor fan was turned off, or greatest amount of brake cleaner was used. These findings add to the limited dataset on this topic and can be used to bound or approximate worker or consumer exposures from use of aerosol cleaning products with similar compositions and use patterns.

Combined analysis of job and task benzene air exposures among workers at four US refinery operations

Workplace air samples analyzed for benzene at four US refineries from 1976 to 2007 were pooled into a single dataset to characterize similarities and differences between job titles, tasks and refineries, and to provide a robust dataset for exposure reconstruction. Approximately 12,000 non-task (>180 min) personal samples associated with 50 job titles and 4000 task (<180 min) samples characterizing 24 tasks were evaluated. Personal air sample data from four individual refineries were pooled based on a number of factors including (1) the consistent sampling approach used by refinery industrial hygienists over time, (2) the use of similar exposure controls, (3) the comparability of benzene content of process streams and end products, (4) the ability to assign uniform job titles and task codes across all four refineries, and (5) our analysis of variance (ANOVA) of the distribution of benzene air concentrations for select jobs/tasks across all four refineries. The jobs and tasks most frequently sampled included those with highest potential contact with refinery product streams containing benzene, which reflected the targeted sampling approach utilized by the facility industrial hygienists. Task and non-task data were analyzed to identify and account for significant differences within job-area, task-job, and task-area categories. This analysis demonstrated that in general, areas with benzene containing process streams were associated with greater benzene air concentrations compared to areas with process streams containing little to no benzene. For several job titles and tasks analyzed, there was a statistically significant decrease in benzene air concentration after 1990. This study provides a job and task-focused analysis of occupational exposure to benzene during refinery operations, and it should be useful for reconstructing refinery workers' exposures to benzene over the past 30 years.

Benzene Exposures and Risk Potential for Vehicle Mechanics from Gasoline and Petroleum-Derived Products

Benzene exposures among vehicle mechanics in the United States and abroad were characterized using available data from published and unpublished studies. In the United States, the time-weighted-average (TWA) airborne concentration of benzene for vehicle mechanics averaged 0.01-0.05 ppm since at least the late 1970s, with maximal TWA concentrations ranging from 0.03 to 0.38 ppm. Benzene exposures were notably lower in the summer than winter and in the Southwest compared to other geographic regions, but significantly higher during known gasoline-related tasks such as draining a gas tank or changing a fuel pump or fuel filter. Measured airborne concentrations of benzene were also generally greater for vehicle mechanics in other countries, likely due to the higher benzene content of gasoline and other factors. Short-term airborne concentrations of benzene frequently exceeded 1 ppm during gasoline-related tasks, but remained below 0.2 ppm for tasks involving other petroleum-derived products such as carburetor and brake cleaner or parts washer solvent. Application of a two-zone mathematical model using reasonable input values from the literature yielded predicted task-based benzene concentrations during gasoline and aerosol spray cleaner scenarios similar to those measured for vehicle mechanics during these types of tasks. When evaluated using appropriate biomarkers, dermal exposures were found to contribute little to total benzene exposures for this occupational group. Available data suggest that vehicle mechanics have not experienced significant exposures to benzene in the workplace, except perhaps during short-duration gasoline-related tasks, and full-shift benzene exposures have remained well below current and contemporaneous occupational exposure limits. These findings are consistent with epidemiology studies of vehicle mechanics, which have not demonstrated an increased risk of benzene-induced health effects in this cohort of workers. Data and information presented here may be used to assess past, current, or future exposures and risks to benzene for vehicle mechanics who may be exposed to gasoline or other petroleum-derived products.

The structure of deuterated benzene films adsorbed on the graphite (0001) basal plane: what happens below and above the monolayer coverage?

An exact description of the interactions in aromatic carbon systems is a key condition for the design of carbon based nanomaterials. In this paper we investigate the binding and adsorbate structure of the simplest prototype system in this class - the single aromatic ring molecule benzene on graphite. We have collected neutron diffraction data of the ordered phase of deuterated benzene, C6D6, adsorbed on the graphite (0001) basal plane surface. We examined relative coverages from 0.15 up to 1.3 monolayers (ML) in a temperature range of 80 to 250 K. The results confirm the flat lying commensurate (√7 × √7)R19.1° monolayer with lattice constants a = b = 6.5 Å at coverages of less than 1 ML. For this structure we observe a progressive melting well below the desorption temperature. At higher coverages we do neither observe an ordered second layer nor a densification of the structure by upright tilting of first layer molecules, as generally assumed up to now. Instead, we see the formation of clusters with a bulk crystalline structure for coverages only weakly exceeding 1 ML.

Occupational exposure to benzene at the ExxonMobil refinery in Baytown, TX (1978-2006)

Although occupational benzene exposure of refinery workers has been studied for decades, no extensive analysis of historical industrial hygiene data has been performed focusing on airborne concentrations at specific refineries and tasks. This study characterizes benzene exposures at the ExxonMobil Baytown, TX, refinery from 1978 to 2006 to understand the variability in workers' exposures over time and during different job tasks. Exposures were grouped by operational status, job title, and tasks. More than 9000 industrial hygiene air samples were evaluated; approximately 4000 non-task (> 3 h) and 1000 task-related (< 3 h) personal samples were considered. Each sample was assigned to one of 27 job titles, 29 work areas, and 16 task bins (when applicable). Process technicians were sampled most frequently, resulting in the following mean benzene concentrations by area: hydrofiner (n=245, mean=1.3 p.p.m.), oil movements (n=286, mean=0.23 p.p.m.), reformer (n=575, mean=0.10 p.p.m.), tank farm (n=9, mean=0.65 p.p.m.), waste treatment (n=446, mean=0.13 p.p.m.), and other areas (n=460, mean=0.062 p.p.m.). The most frequently sampled task was sample collection (n=218, mean=0.40 p.p.m.). Job title and area did not significantly impact task-related exposures. Airborne concentrations were significantly lower after 1990 than before 1990. Results of this task-focused study may be useful when analyzing benzene exposures at other refineries.

Benzene exposure in refinery workers: ExxonMobil Joliet, Illinois, USA (1977-2006)

While petroleum industry studies have indicated low benzene exposure potential for refinery workers, most provide limited data for assessing job or task-related benzene exposures. This study characterizes job and task-specific airborne benzene concentrations and variability over time for the ExxonMobil refinery in Joliet, Illinois from 1977 to 2006. A database of 2289 industrial hygiene air samples, including 1145 non-task (≥180 min) personal samples and 480 task-related (<180 min) personal samples, were analyzed. Samples were grouped by operational status, job, and task. Benzene concentrations were determined for each job category and task bin, with additional analyses conducted to determine whether benzene concentrations changed over time. The results indicate that the benzene concentrations for non-task and task samples were relatively low. For all non-task samples, the arithmetic mean benzene concentration was 0.12 part per million (ppm). The most frequently sampled workers (process technicians during routine operations) had an arithmetic mean benzene concentration of 0.038 ppm. The most frequently sampled task bin (blinding and breaking) had an arithmetic mean benzene concentration of 1.0 ppm. This study provides benzene air concentration data that can be used in combination with job histories to reconstruct historical benzene exposures for workers at the Joliet Refinery over the past 30 years.

Advances in understanding benzene health effects and susceptibility

Benzene is a ubiquitous chemical in our environment that causes acute leukemia and probably other hematological cancers. Evidence for an association with childhood leukemia is growing. Exposure to benzene can lead to multiple alterations that contribute to the leukemogenic process, indicating a multimodal mechanism of action. Research is needed to elucidate the different roles of multiple metabolites in benzene toxicity and the pathways that lead to their formation. Studies to date have identified a number of polymorphisms in candidate genes that confer susceptibility to benzene hematotoxicity. However, a genome-wide study is needed to truly assess the role of genetic variation in susceptibility. Benzene affects the blood-forming system at low levels of occupational exposure, and there is no evidence of a threshold. There is probably no safe level of exposure to benzene, and all exposures constitute some risk in a linear, if not supralinear, and additive fashion.

Ensuring comparability of benzene exposure estimates across three nested case-control studies in the petroleum industry in support of a pooled epidemiological analysis

BACKGROUND

Three case-control studies each nested within a cohort of petroleum workers assessed exposure to benzene in relation to risk of haematopoietic cancers. These studies have each been updated and the cases will be pooled to derive a more powerful study. The benzene exposure of new leukemia cases and controls was estimated in accordance with each respective study's original methods. An essential component of the process of pooling the data was comparison and rationalisation of the exposure estimates to ensure accuracy and consistency of approach. This paper describes this process and presents comparative estimates before and after appropriate revision took place. The original petroleum industry studies, in Canada, the UK and Australia, were conducted at different points in time by different study teams, but the industry used similar technology in similar eras in each of these countries.

METHODS

A job history for each subject giving job title, dates of starting and leaving the job and location of work, was assembled. For each job or task, the average benzene exposure (Base Estimate (BE) in ppm) was derived from measurements collected at applicable worksites. Estimates of exposure intensity (workplace exposure estimates (WE)) were then calculated for each line of work history by adjusting the BEs for site- and era-specific exposure-related variables such as loading technology and percentage benzene in the product. To ensure that the exposure estimates were comparable among the studies, the WEs were allocated to generic Job Categories, e.g. Tanker Driver (by technology used e.g. bottom loading), Motor Mechanic. The WEs were stratified into eras, reflecting technological changes in the industry. The arithmetic mean (AM), geometric mean (GM) and range of the stratified WEs were calculated, by study, for each generic Job Category. These were then compared. The AMs of the WEs were regarded as substantially similar if they were within 20% in all three studies in one era or for at least two studies in two eras. If the AM of the WE group differed by more than 20%, the data were examined to see whether the difference was justified by differences in local exposure conditions, such as an enclosure versus open work area. Estimates were adjusted in the absence of justification for the difference.

RESULTS

Reconciliation of differences resulted in changes to a small number of underlying BEs, particularly the background values, also the BEs attributed to some individuals and changes to the allocation of jobs between Job Categories. Although the studies covered some differing sectors of the industry and different time periods, for 22 Job Categories there was sufficient overlap, particularly in the downstream distribution sector, to make comparisons possible. After adjustment 12 Job Categories were judged to be similar and 10 were judged to be justifiably different. Job-based peak and skin exposure estimates were applied in a uniform way across the studies and a single approach to scoring the certainty of the exposure estimates was identified.

CONCLUSIONS

The revised exposure estimates will be used in the pooled analysis to examine the risk of haematopoietic cancers and benzene exposure. This exercise provided an important quality control check on the exposure estimates and identified similarly exposed Job Categories that could be grouped for risk assessment analyses.

Occupational exposure to benzene at the ExxonMobil refinery at Baton Rouge, Louisiana (1977-2005)

Because crude oil contains up to 3% benzene and there is an association between high chronic exposure to appreciable concentrations of benzene and acute myelogenous leukemia, exposure of refinery workers has been studied for many years. To date, no extensive industrial hygiene exposure analyses for historical benzene exposure have been performed, and none have focused on the airborne concentrations in the workplace at specific refineries or for specific tasks. In this study, the authors evaluated the airborne concentrations of benzene and their variability over time at the ExxonMobil refinery in Baton Rouge between 1977 and 2005. Refinery workers were categorized into 117 worker groups using company job descriptions. These 117 groups were further collapsed into 25 job categories based on similarity of measured exposure results. Results of 5289 personal air samples are included in this analysis; 3403 were considered nontask (>or= 180 min) personal samples, and 830 were considered task-related (< 180 min) personal samples; the remainder did not fit in either category. In general, nontask personal air samples indicated that exposures of the past 30 years were generally below the occupational exposure limit of 1 ppm, but there was only a small, decreasing temporal trend in the concentrations. The job sampled most frequently during routine operations was process technician and, as broken down by area, resulted in the following mean benzene concentrations: analyzers (mean = 0.12 ppm), coker (mean = 0.013 ppm), hydrofiner (mean = 0.0054 ppm), lube blending and storage (mean = 0.010 ppm), waste treatment (mean = 0.092 ppm), and all other areas (mean = 0.055 ppm). Task-based samples indicated that the highest exposures resulted from the sampling tasks, specifically from those performed on process materials; in general, though, even these tasks had concentrations well below the STEL of 5 ppm. The most frequently sampled task was gauging (mean = 0.12 ppm). Task-related exposures were also similar across job categories for a given task, with a few exceptions. This study thus provides a task-focused analysis for occupational exposure to benzene during refinery operations, which can be insightful for understanding exposures at this refinery and perhaps others operated since about 1975.

Validation of 1,3-butadiene exposure estimates for workers at a synthetic rubber plant

PURPOSE

This investigation assessed the validity of estimates of exposure to 1,3-butadiene (BD) developed for a plant included in a study of mortality among synthetic rubber industry workers. The estimates were developed without using historical measurement data and have not been validated previously.

METHODS

Personal BD measurements came from an exposure-monitoring program initiated in 1977. For each job, we computed the year-specific difference between the BD estimate and the mean of BD measurements. We also computed rank correlation coefficients and calculated the mean, across all measurements, of the difference between the estimate and the measurement.

RESULTS

The mean BD concentration was 5.2 ppm for 4978 measurements and 4.7 ppm for the corresponding estimates. The mean difference between estimates and measurements was -0.50 ppm (standard deviation, 26.5 ppm) overall and ranged from -227.9 to +27.0 ppm among all 306 job/year combinations. Estimates were correlated with measurements for all 306 combinations (rank correlation coefficient, r=0.45, p<0.0001), for 82 combinations pertaining to jobs that were well-defined by a specific set of tasks and typically found in styrene-BD rubber (SBR) plants (r=0.81, p<0.0001), for 70 combinations pertaining to jobs that were well-defined but not typical (r=0.29, p=0.01) and for 92 combinations pertaining to poorly-defined jobs typically found in SBR plants (r=0.56, <0.0001). Estimates were not correlated with measurements for poorly defined jobs not typically found in SBR plants (r=0.01, p=0.93). For well-defined typical SBR jobs with measurement means that were over 7.0 ppm, estimates were consistently lower than measurements.

CONCLUSIONS

Possible reasons for differences between estimates and measurements included faulty assumptions used in developing BD estimates, unstable or nonrepresentive measurements and errors in linking measurement data to the job-exposure matrix. Exposure misclassification may have been more severe for subjects from the validation study plant than for subjects from other plants in the mortality study. BD estimates for typical SBR jobs, which comprise most operations at all but one of the plants in the mortality study, appeared to be useful for ranking workers by cumulative exposure. Uncertainty analyses would enhance the utility of the BD exposure estimates for quantitative risk assessment.

The health watch case-control study of leukemia and benzene: the story so far

A case-control study nested in the Health Watch cohort of petroleum industry workers, investigated whether the excess of lymphohematopoetic cancers, identified among male members of the Health Watch cohort, was associated with benzene exposure. Cases of non-Hodgkin's lymphoma (n = 31), multiple myeloma (n = 15), and leukemia (n = 33) were identified between 1981 and 1999. Cases were age-matched to five controls. Exposure was retrospectively estimated for each occupational history using an algorithm in a relational database. Benzene exposure measurements, supplied by Australian petroleum companies, were used to estimate exposure for specific tasks. The tasks carried out within the job, the products handled, and the technology used, were identified from interviews with contemporary colleagues. More than half of the subjects started work after 1965 and had an average exposure period of 20 years. Exposure was low, 85% of the cumulative exposure estimates were <10 ppm years. Matched analyses showed that non-Hodgkin's lymphoma and multiple myeloma were not associated with benzene exposure. Leukemia risk, however, was significantly increased for the subjects with greater than 16 ppm years cumulative exposure, odds ratio (OR) 51.9 (5.6-477) or with greater than 0.8 ppm intensity of highest exposed job. Cumulative exposures were similar to those found in comparable studies. The inclusion of occasional high exposures, for example, as a result of spillages, reduced the ORs, when the exposure was treated as either a continuous or a categorical variable. Our data demonstrate a strong association between leukemia and modest benzene exposure. The choice of cut-point and reference group has a marked effect on the ORs, but does not change the overall conclusions.

Potential uses of petrochemical products can result in significant benzene exposures: MSDSs must list benzene as an ingredient

According to 29 CFR1910.1200 (Hazard Communication Standard [HCS]), a material safety data sheet (MSDS) must list a carcinogen as an ingredient if its concentration in a product is 0.1% or more by weight. However, according to the HCS, when the concentration of a carcinogen in a product is less than 0.1% (by weight) it may not be necessary to list it as an ingredient on the MSDS. The standard stipulates that if potential uses of the product can result in exposures to the carcinogen that exceed the Occupational Safety and Health Administration (OSHA) permissible exposure limit or the ACGIH threshold limit value (TLV), then it must be listed. This article focuses on the failure of MSDSs to report benzene as a listed ingredient in products that incorporate petroleum-derived ingredients such as toluene and hexane. In the United States, approximately 238,000 people are occupationally exposed to benzene each year. Only rarely is benzene listed as an ingredient on MSDSs even though it often comprises more than 0.1% of petroleum solvents and, when its concentrations in petroleum-derived products are much less than 0.1%, inhalation exposures to benzene can be much higher that its OSHA PEL of one part per million (ppm) by volume (v/v) andACGIH TLV of/one-half ppm (v/v). As a consequence of benzene's omission from MSDSs as a listed ingredient, employers are frequently unaware of their requirement to implement 29 CFR 1910.1028 (Benzene Standard) and of the need to address employee exposures to benzene in the workplace. This article demonstrates that benzene should be listed as an ingredient on MSDSs, even at concentrations in benzene-containing products that are between one and two orders of magnitude below OSHA's 0.1% threshold. An exposure assessment methodology is presented that is applicable to employees whose conditions of exposure are similar to those in the published study. These workers make up a similar exposure group. The information and methodology presented here are germane to preparation of accurate MSDSs for benzene-containing products, employers who must comply with 29 CFR 1910.1028, and retrospectively estimating exposures to benzene.

Benzene exposures associated with tasks performed on marine vessels (circa 1975 to 2000)

In this article, we assemble and synthesize the available industrial hygiene data that describe exposure during the marine transport of benzene-containing products in the United States and abroad. A total of 25 studies were identified and summarized. The measured airborne concentrations of benzene on marine vessels were found to vary depending on several key factors, including the job task, vessel characteristics, cargo type, and sample type and duration. Despite the differences in sampling strategies and benzene content of the liquids being transported, personal time-weighted-average benzene air concentrations typically ranged from 0.2-2.0 ppm during closed loading and 2-10 ppm during open loading operations. Benzene exposures during these activities are likely due to specific short-term tasks, such as connecting and disconnecting hoses and tank gauging and sampling. Similar concentrations of benzene have been reported in the pump room during marine loading operations and during tank cleaning activities in various settings. When compared with contemporaneous occupational health standards, our review indicates that most activities performed on marine vessels from the 1970s to 1990s usually did not result in benzene exposures that exceeded these standards. The information and data presented here may be useful for quantitatively estimating or reconstructing historical exposures during the marine transport of benzene-containing cargo if details about individual's work histories in the maritime industry are available.

Health Watch exposure estimates: do they underestimate benzene exposure?

A nested case-control study found that the excess of leukemia, identified among the male members of the Health Watch cohort, was associated with benzene exposure. Exposure had been retrospectively estimated for each individual occupational history using an algorithm in a relational database. Benzene exposure measurements, supplied by Australian petroleum companies, were used to estimate exposure for specific tasks. The tasks carried out within each job, the products handled, and the technology used, were identified from structured interviews with contemporary colleagues. More than half of the subjects started work after 1965 and had an average exposure period of 20 years. Exposure was low; nearly 85% of the cumulative exposure estimates were at or below 10 ppm-years. Matched analyses showed that leukemia risk increased with increasing cumulative benzene exposures and with increasing exposure intensity of the highest-exposed job. Non-Hodgkin lymphoma and multiple myeloma were not associated with benzene exposure. A reanalysis reported here, showed that for the 7 leukemia case-sets with greater than 16 ppm-years cumulative exposure, the odds ratio was 51.9 (5.6-477) when compared to the 2 lowest exposed categories combined to form a new reference category. The addition of occasional high exposures, e.g. as a result of spillages, increased exposure for 25% of subjects but for most, the increase was less than 5% of total exposure. The addition of these exposures reduced the odds ratios. Cumulative exposures did not range as high as those in comparable studies; however, the recent nature of the cohort and local handling practices can explain these differences.

Estimation of Personal Exposures to Particulate Matter and Metals in Boiler Overhaul Work

OBJECTIVE

We sought to develop an algorithm and estimate unmeasured exposures to particulate matter (PM) and metals in an epidemiologic study of boilermakers.

METHODS

The algorithm was based on limited measurements and workers' task and time activity patterns. Half of the measurements were used to develop exposure estimates for unmeasured person days. The other half was used for method validation.

RESULTS

The validation demonstrated good approximations of actual exposures with differences less than 5% for PM and vanadium (V). Average estimated exposures to PM (mg/m3) and V (microg/m3) were significantly higher for workers doing boiler repair than utility work (0.36 vs. 0.09 for PM and 5.99 vs. 0.38 for V).

CONCLUSIONS

This algorithm provided reasonably accurate exposure indices for our epidemiologic study in this population. It also is likely applicable to similar exposure scenarios in other studies.

Leukemia Risk Associated With Low-Level Benzene Exposure

BACKGROUND

Men who were part of an Australian petroleum industry cohort had previously been found to have an excess of lympho-hematopoietic cancer. Occupational benzene exposure is a possible cause of this excess.

METHODS

We conducted a case-control study of lympho-hematopoietic cancer nested within the existing cohort study to examine the role of benzene exposure. Cases identified between 1981 and 1999 (N = 79) were age-matched to 5 control subjects from the cohort. We estimated each subject's benzene exposure using occupational histories, local site-specific information, and an algorithm using Australian petroleum industry monitoring data.

RESULTS

Matched analyses showed that the risk of leukemia was increased at cumulative exposures above 2 ppm-years and with intensity of exposure of highest exposed job over 0.8 ppm. Risk increased with higher exposures; for the 13 case-sets with greater than 8 ppm-years cumulative exposure, the odds ratio was 11.3 (95% confidence interval = 2.85-45.1). The risk of leukemia was not associated with start date or duration of employment. The association with type of workplace was explained by cumulative exposure. There is limited evidence that short-term high exposures carry more risk than the same amount of exposure spread over a longer period. The risks for acute nonlymphocytic leukemia and chronic lymphocytic leukemia were raised for the highest exposed workers. No association was found between non-Hodgkin lymphoma or multiple myeloma and benzene exposure, nor between tobacco or alcohol consumption and any of the cancers.

CONCLUSIONS

We found an excess risk of leukemia associated with cumulative benzene exposures and benzene exposure intensities that were considerably lower than reported in previous studies. No evidence was found of a threshold cumulative exposure below which there was no risk.