Introduction Peak exposures, often characterised by short-term high intensities, are well established as major etiological contributors to acute adverse health outcomes. Associations between peak chemical exposures and risk of occupational cancers have been contrasted with observed effects related to more conventional metrics, cumulative exposure and exposure duration. However, the definitions of peak exposure have been highly idiosyncratic, which complicates data interpretation, risk assessment and ultimately setting occupational exposure standards. Thus, there is a need to develop a standardised epidemiologic framework for defining and assessing peak exposures in occupational epidemiology studies of chemical carcinogens, with consideration of underlying toxicological mechanisms, exposure assessment requirements, and policy implications.

Methods We reviewed and contrasted cancer risk findings for peak and cumulative exposures from influential occupational epidemiology studies of benzene and formaldehyde, both classified by IARC as causes of lymphohematopoetic malignancies (LHM) in humans, and for some other possible chemical carcinogens.

Results There is evidence for a strong association between high cumulative exposure to benzene and AML, but little support for an etiologic relation with peak exposure; in contrast, peak benzene exposure has been associated with risk of myelodysplastic syndrome. Peak, but not cumulative formaldehyde exposure has been associated with various LHM. For styrene, no relationship was seen between number of peaks and several cancers of interest. These patterns may be due to variable definitions of peak exposures or may reflect differences in toxicokinetic and carcinogenic mechanisms of these chemicals.

Discussion A peak exposure should be defined quantitatively in terms of exposure intensity, duration, and frequency of occurrence. Future epidemiologic research should apply standardised definitions that can be applied to existing datasets and in newly initiated epidemiologic studies that are consistent with or shed light on the underlying disease processes.