Use of cancer hazard assessments in Federal and state policy decision-making: Case studies of formaldehyde and trichloroethylene

Abstract

Background: Every day over 1500 people die from cancer in the United States with estimated cancer-related economic costs reaching over $170 million. But approximately 42% of all cancers are preventable. Identification of cancer hazards, such as the National Toxicology Program’s Report on Carcinogens (RoC), is a first step in public health decision-making; however, the relationship between these activities is unclear. As part of a larger study to address knowledge gaps, we highlight two case studies of known human carcinogens – formaldehyde and trichloroethylene – which are listed in the RoC based on sufficient evidence from epidemiology studies.Methods: We searched U.S. Federal Register and Lexis Advance® for federal and state rulemaking actions citing RoC listings, among other scientific evidence. Relevant qualitative and qualitative data related to health and economic costs were extracted from regulations citing the formaldehyde and trichloroethylene listings. Monetized health benefit estimates were normalized and aggregated across relevant regulations.Results: We identified one state and 16 Federal regulations citing RoC’s formaldehyde assessment. Most federal rules aimed to reduce multiple air toxins, including formaldehyde, emitted from motor vehicles or other sources. One regulation targeted formaldehyde exposure specifically; the Environmental Protection Agency (EPA) estimated yearly benefits of $153 million from avoiding 26 to 65 cancer cases as a result of reducing exposure from composite wood products. Three federal rulemaking activities cited the trichloroethylene RoC assessment. According to two EPA proposed rules, prohibiting trichloroethylene use for certain commercial purposes, could save an estimated $311 million and avoid 22 to 120 cancer cases. The third rule provides health benefits to veterans exposed to trichloroethylene from military service and diagnosed with trichloroethylene-related diseases.Discussion: The case studies of regulatory actions citing two RoC-listed carcinogens illustrate methods that can be used to estimate economic benefits and health impacts, which are informed by hazard identification.