Formaldehyde is classified as a probable human carcinogen. DNA-protein crosslinks (DPCs) and sister chromatid exchanges (SCEs) may represent early lesions in the carcinogenic process. The authors examined the DPCs and SCEs in peripheral-blood lymphocytes of 12 and 13 workers exposed to formaldehyde and eight and 20 unexposed workers, respectively. The amounts of DPCs and SCEs in the exposed and the unexposed differed significantly after adjustment for smoking. There was a linear relationship between years of exposure and the amounts of DPC and SCE. The authors conclude that the data indicate a possible mechanism of carcinogenicity of formaldehyde, and that formaldehyde is mutagenic to humans. These results support the use of DPCs as a biomarker of occupational exposure to formaldehyde and to detect high-risk populations for secondary prevention.