The November 24, 2009 issue of the Journal of the National Cancer Institute contains a long-awaited study examining the link between formaldehyde exposure and specific cancers. National Cancer Institute (NCI) researchers observed an association between embalming and death from myeloid leukemia, with the greatest risk among those who practiced embalming for more than 20 years. Deaths from myeloid leukemia also were related to greater estimated formaldehyde exposure. This study is the first of its kind to relate cancer risk to duration of employment, work practices and estimated formaldehyde exposure levels in funeral service.

This latest study, which follows a 1990 report by NCI on funeral directors and embalmers, does not explain how formaldehyde causes cancer, but it does shed some light on the risk it poses to embalmers. The study found that the likelihood of developing leukemia increased with certain factors. These factors include the number of years spent embalming and the number of times a person performs embalming. Researchers noted that further research of leukemia in relation to specific embalming practices and exposures should help explain cancer risks related to formaldehyde.

For the study, NCI researchers examined professionals employed in funeral service who died between 1960 and 1986. Funeral directors who died from brain tumors, nasopharyngeal cancer, and leukemia were compared to a group of randomly selected funeral directors who died from other causes. Interviews were conducted of next of kin and co-workers to estimate a number of measures of formaldehyde exposure. The embalmers’ vital statistics information, including cause of death, was identified by searching state vital statistics offices. Formaldehyde exposure levels referenced in the study were based upon a series of embalmings conducted at the Cincinnati College of Mortuary Sciences. During the embalmings, the level of ventilation, the concentration of the embalming solution, and the type of case (autopsied or intact remains) was controlled. Ventilation was found to have the most important impact on formaldehyde concentrations in the preparation room.

Other study findings include:

• There may be an increased risk of some forms of cancer (leukemia) from exposure to formaldehyde in funeral service, but the results of this study are not definitive because the total number of cancers of any specific kind among those studied was relatively small.
• The study did not find an increased risk of nasopharyngeal cancer (back of throat) or brain cancers among funeral directors.
• The greater one’s exposure in terms of time spent embalming and the number of embalming performed, the greater the risk of cancer.
• The study has limitations based on data quality, sample size and limitations from the methods used.
• Further studies are needed to help to clarify the level of risk from embalming.

In recent years, virtually every domestic and international agency that evaluates chemical risk has reexamined formaldehyde’s cancer-causing potential. For example:

• In October 2009, the World Health Organization’s International Agency for Cancer Research determined there is sufficient evidence to conclude that formaldehyde causes leukemia.
• In early November 2009, in connection with the anticipated development of the “12^th Report on Carcinogens” by the U.S Health & Human Services’ National Toxicology Program, the agency held a three-day hearing, during which experts spoke about formaldehyde and its possible link to cancer.
• The U.S. Environmental Protection Agency’s risk assessment of formaldehyde, in progress since 1997, will soon be completed.
• The European Union member states, in conjunction with the EU biocides review process, are evaluating toxicological data on formaldehyde to assess whether formaldehyde-based embalming products are safe for use.

A growing body of scientific studies under consideration by agencies requires serious consideration. Such widespread study will certainly cause regulators in the United States to consider whether current formaldehyde standards are stringent enough to protect workers’ health and safety.

NFDA’s goal is to educate its members about best work practices and provide information, tools and resources to enable funeral directors to create safe working conditions. As new studies become available, we enhance our efforts to educate our members. 

NFDA has a history of educating members on best practices for maintaining a safe and healthy working environment through best practice documents, workshops and seminars, Webinars and teleconferences, magazine articles, and by commissioning research studies such as the “Funeral Home Wastestream Audit Report” and the “Investigation of the Removal of Formaldehyde and Phenol by Funeral Home Septic Systems.”

NFDA encourages funeral directors and embalmers to take precautions in the preparation room to limit chemical, including formaldehyde, exposure and emissions during the embalming process and to be familiar with and follow all federal, state and local environmental, OSHA, and health and safety laws and regulations when embalming human remains.

NFDA updated its Formaldehyde Best Management Practices guidance earlier this year; the document describes additional safeguards for funeral directors and embalmers in using formaldehyde to preserve the human body for funeral rituals and reducing their exposure during the preparation process. 

The Formaldehyde Best Management Practices urge funeral directors to select and use the embalming and other preparation products appropriate for the condition of the remains. This includes, using the least concentrated solution in standard cases, and reserving the most highly concentrated solutions for the most difficult cases. Since the early 1990s, NFDA also has encouraged funeral directors to substitute products that are less toxic and environmentally-friendly for traditional products. 

Scientific research has shown that when exposure to formaldehyde is reduced, the risk of cancer and other health risks are also reduced. NFDA encourages members to ensure their preparation room has a properly designed and effective ventilation system, which is considered one of the most significant factors in reducing exposure to formaldehyde.

This year, NFDA commissioned a soon-to-be-released study which further examines ventilation in the preparation room, and association leaders anticipate that the results of the study will yield recommendations for improved preparation room ventilation that will better protect funeral directors and embalmers from health risks associated with formaldehyde. 

Informational Links:

• The study as published in the November 24, 2009 issue of the Journal of the National Cancer Institute: “Mortality From Lymphohematopoietic Malignancies and Brain Cancer Among Embalmers Exposed to Formaldehyde” (This link directs you to the abstract (a brief summary) of the study. To access the full text of the study, you must purchase a one-day access pass for $36.)
• National Cancer Insititute Fact Sheet: Formaldehyde and Cancer Risk
• International Agency for Cancer Research Monographs on the Evaluation of Carcinogenic Risks to Humans,
  Volume 88 (2006), Formaldehyde (This monograph supports the 2004 determination that formaldehyde is a carcinogen; an updated monograph referencing the 2009 findings will be published soon.)
• U.S. Department of Health and Human Services, Agency for Toxic Substances & Disease Registry, Toxicological Profile for Formaldehyde (1999)
• U.S. Environmental Protection Agency Integrated Risk Information System (IRIS) (Updated process for IRIS review.)
• U.S. Department of Health and Human Services National Toxicology Program 12th Report on Carcinogens, Formaldehyde Documents