Epidemiologic evidence on the relationship between mists containing sulfuric acid and respiratory tract cancer

This review identified and evaluated 25 epidemiologic studies pertaining to the carcinogenicity of mists containing sulfuric acid (MSA). Few studies were designed with acid mists as the principal exposure under investigation, and in all studies exposure assessment was limited. The results of the follow-up studies from industries with high or moderate exposure potential and the case-control studies indicate, in aggregate, a moderate association between MSA and larynx cancer. The data suggest a dose-response relationship. However, many of the results from individual studies are imprecise, and confounding by smoking, alcohol, and other occupational agents is not adequately adjusted for. The biologic plausibility and the possible carcinogenic mechanism remain uncertain. There is little evidence in support of a causal relationship between exposure to MSA and lung cancer. Information is inadequate for drawing any meaningful inference about the association between exposure to MSA and nasal cancer.