Formaldehyde is a colorless gas with a pungent, suffocating odor at room temperature and is readily soluble in water at room temperature ((US Environmental Protection Agency, 2020). Formaldehyde and goods containing this chemical reportedly account for more than 5% of the yearly US gross national product, which is about 500 billion dollars (Zhang et al., 2010). Formaldehyde is a known carcinogen and is of particular concern for those exposed to it in their homes and occupations. Healthcare workers such as nurses and pathologists, embalmers, and manufacturers are at particular risk due to occupational exposure. Public awareness of formaldehyde rose in the wake of Hurricane Katrina when FEMA trailers provided as temporary housing units to survivors were reported to have elevated levels of formaldehyde (Gates, 2015). A significant number of people are exposed to formaldehyde more than they think as it is generated by automobiles, present in tobacco smoke, and released from various household products such as plywood, particleboard, furniture, and carpeting. But formaldehyde is not a villain in certain contexts. It is naturally occurring in human beings, necessary for certain biological functions like the production of amino acids. It is also innocuously a part of some favorite fruits and veggies like apples, pears, and spinach at nontoxic levels (Guiden, 2016).
According to the United States Department of Labor, acute exposure is highly irritating to the eyes, nose, and throat. Acute exposure can induce coughing and wheezing. Subsequent exposure may result in severe allergic reactions of the skin, eyes, and respiratory tract. Ingesting can be fatal and long-term exposure at low-levels in the air or on the skin can cause asthma-like respiratory problems such as dermatitis and itching (OSHA Fact Sheet: Formaldehyde | Occupational Safety and Health Administration). The study performed by Zhang et al. showed an association between formaldehyde exposure and increased risk of myeloid leukemia. The investigators looked at chromosome 7 and 8, which frequently show cytogenetic changes observed in myeloid leukemias. Under formaldehyde exposure, chromosome 7 and 8 showed specific abnormalities related to myeloid leukemia, monosomy (loss) of 7 and trisomy (gain) of 8 (Zhang et al., 2010).
However, the US Environmental Protection Agency (EPA) estimates the probability of a person developing cancer from breathing air containing a specified concentration of formaldehyde is one in a million. EPA claims that a person would have to breathe air continuously for the rest of his or her life to develop cancer from formaldehyde exposure. The EPA also claims that current occupational studies on formaldehyde exposure are limited and are not sufficient evidence as there could have been other contributing factors within the environment leading to the poor health outcome. (US Environmental Protection Agency, 2020).
The graphic below from the Global Burden of Disease website displays the number of deaths from leukemia attributable to occupational exposure of formaldehyde among males and females in 2019. The blue areas indicate low number of deaths and red areas indicate higher number of deaths. China and India are most impacted by occupational exposures of formaldehyde. Although the EPA is under the impression that there is a one-in-a-million chance of developing cancer from prolonged exposure, there are at least 189 men and women in China, 70 men and women in India, and many more throughout the world who may beg to differ if they were still around to do so.
Recently, formaldehyde has been gaining public attention yet again. TRESemme is involved in a class action lawsuit as some of the shampoo and conditioner users are claiming to have been exposed to formaldehyde from their products