Objectives Beryllium has been identified as a human carcinogen on the basis of animal and epidemiological studies. The authors recently reported updated associations between lung cancer and beryllium exposure in a large, pooled occupational cohort. The authors conducted the present study to evaluate the shape of exposure–response associations between different exposure metrics and lung cancer in this cohort, considering potential confounders (race, plant, professional and short-term work status, and exposure to other lung carcinogens).

Methods The authors conducted Cox proportional hazards regression analyses of lung cancer risk with cumulative, mean and maximum ‘daily weighted average’ (DWA) exposure among 5436 workers, using age-based risk sets. Different exposure–response curves were fitted to the exposure metrics, including categorical, power, restricted cubic spline and piecewise log-linear fits.

Results The authors found significant positive associations between lung cancer and mean (p<0.0001) and maximum (p<0.0001) exposure, adjusting for age, birth cohort and plant, and for cumulative (p=0.0017) beryllium exposure, adjusting for these factors plus short-term work status and exposure to asbestos. The best-fitting models were generally categorical or piecewise log-linear, with the steepest increase in lung cancer risk between 0 and 10 μg/m³ for both mean and maximum DWA exposure and between 0 and 200 μg/m³-days for cumulative DWA exposure. The estimated mean DWA beryllium exposure associated with 10⁻³ excess lifetime risk based on the piecewise log-linear model is 0.033 μg/m³.

Conclusion This study provides evidence that lung cancer risk is elevated at levels near the current US Occupational Safety and Health Administration beryllium exposure limit of 2.0 μg/m³ DWA for workers.