This paper reviews the available literature regarding the work environment in pulp and paper mills and the risk for malignant diseases. An increased risk for
lung cancer among pulp and paper mill workers has been reported. Most studies are inconclusive with regard to considerations of etiologic agents. However, maintenance workers seem to be at an increased risk for
lung cancer, as well as for
malignant mesothelioma, indicating that this occupational group was (is) exposed to
asbestos. Workers exposed to
chlorine compounds also seem to run an increased risk for
lung cancer. An increased risk for
malignant lymphomas among pulp mill workers is a constant finding. The increased risk is observed both among
sulfite and
sulfate workers, indicating a common exposure. Such an exposure could be wood dust,
terpenes, or preservatives present in the wood. An increased risk for
leukemias has been found in many studies carried out on pulp and paper workers, but the studies do not permit any conclusions about etiologic factors. In some studies an increased risk for
stomach cancer has been found. However, the socioeconomic status of the workers is strongly related to
stomach cancer, and factors, such as dietary habits, have not been taken into account in any of the reviewed studies. Hence, no further conclusions can be drawn regarding etiologic agents.