To assess quantitatively the association between benzene and leukemia, we evaluated the rate of mortality experienced by a cohort occupationally exposed to benzene. Using data from historical air sampling surveys, we estimated the daily benzene exposure for each member of the cohort. The expected number of leukemia deaths was calculated and compared to the actual number of leukemia deaths that occurred. The overall standardized mortality ratio (SMR) for leukemia was 337. Person-years at risk within the cohort were stratified by increasing levels of cumulative benzene exposure. The resulting SMRs increased from 109 to 322 to 1186 and to 6637 with respective increases in cumulative benzene exposure from less than 40 ppm-years to 40-199, 200-399, and greater than 400. The shape of the exposure-response relation was examined with a case-control analysis. Another analysis was performed to take into account an induction period for leukemia. All of the analyses demonstrated that a strongly positive exposure-response relationship exists between benzene and leukemia. Previous attempts to quantify this cohort's risk of developing leukemia were based on surrogates of exposure, such as duration of employment. Using actual air sampling data to estimate individual exposures represents a marked improvement over these previous attempts and emphasizes the importance of conducting industrial hygiene surveys and maintaining historical exposure records.

To assess quantitatively the association between benzene and leukemia, we evaluated the rate of mortality experienced by a cohort occupationally exposed to benzene. Using data from historical air sampling surveys, we estimated the daily benzene exposure for each member of the cohort. The expected number of leukemia deaths was calculated and compared to the actual number of leukemia deaths that occurred. The overall standardized mortality ratio (SMR) for leukemia was 337. Person-years at risk within the cohort were stratified by increasing levels of cumulative benzene exposure. The resulting SMRs increased from 109 to 322 to 1186 and to 6637 with respective increases in cumulative benzene exposure from less than 40 ppm-years to , and greater than 400. The shape of the exposure-response relation was examined with a case-control analysis. Another analysis was performed to take into account an induction period for leukemia. All of the analyses demonstrated that a strongly positive exposure-response relationship etists between benzene and leukemia. Previous attempts to quantify this cohort's risk of developing leukemia were based on surrogates of exposure, such as duration of employment. Using actual air sampling data to estimate individual exposures represents a marked improvement over these previous attempts and emphasizes the importance of conducting industrial hygiene surveys and maintaining historical exposure records.

To evaluate the possible association between occupational exposure to benzene and subsequent death from leukemia, the National Institute for Occupational Safety and Health (NIOSH) conducted a retrospective cohort mortality study of workers who had been exposed to benzene in the manufacture of rubber hydrochloride at two locations in Ohio. Ascertainment of vital status was accomplished for 98% of the cohort. Among 748 workers who had at least one day of exposure to benzene between 1940 and 1950, seven deaths from leukemia occurred; from United States death rates standardized for sex, age, and calendar time period, only 1.25 leukemia deaths would have been expected (standardized mortality ratio = 560; p less than 0.001). Mean duration of exposure to benzene was brief, and 437 (58%) of the cohort were exposed for less than 1 year. Evaluation of leukemia mortality for those workers exposed five or more years showed an SMR of 2100. All leukemia deaths were myelocytic or monocytic in cell type. Four additional cases of leukemia have been reorganized in workers at the study locations, but occurred in persons not encompassed by the strict definition of the cohort. Reconstruction of past exposures to benzene at the two locations indicates that in some areas of the plant airborne benzene concentrations rose occasionally to several hundred parts per million (ppm), but that for the most part, employee eight-hour time-weighted averages (TWA) fell within the limits considered permissible at the time of exposure. These data corroborate an initial analysis of the same cohort by Infante et al, and indicate that benzene is a human carcinogen at a range of exposures not greatly above the current legal standard.

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These findings reaffirm the leukemogenic effects of benzene exposure and suggest that excess risk diminishes with time.