Objective Studies on experimental animals suggest that inorganic lead is a carcinogen.

The purpose of the study was to examine whether occupational exposure to lead increases the risk of cancer.

Methods The study population comprised 20 700 workers who had been biologically monitored for their blood lead (B-Pb) concentrations during 1973-1983.

The mortality and cancer incidence rates were followed among the monitored workers and compared with those of the Finnish general population.

An internal comparison of the cancer incidence rates was also done between subcohorts formed according to individual B-Pb levels.

Questionnaire-based information was also collected on lifetime occupational history and potential confounders, and exposure history was assessed on an individual basis with a nested case-referent design for lung cancer.

Results The internal comparison within the cohort showed a 1.4-fold increase in the overall cancer incidence and a 1.8-fold increase in the incidence of lung cancer among those who had ever had a blood lead level of = 1.0 mumol. l-1.

In the case-referent study, an increased odds ratio for lung cancer was found for concomitant exposure to lead and engine exhaust.

The odds ratio for squamous-cell carcinoma of the lung was increased even when the blood lead level had been slightly elevated.

Bias or confounding did not explain the risks.

Conclusions The results suggest that exposure to lead increases the risk of lung cancer.

Co-exposure t...