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Health Hazard Evaluations of occupational cancer cluster concerns: the USA, January 2001–December 2020
  1. Dallas S Shi1,2,
  2. Jessica L Rinsky1,
  3. George R Grimes1,
  4. Sophia K Chiu1
  1. 1Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
  2. 2Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Dallas S Shi, Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, NIOSH, Cincinnati, Ohio, USA; dshi{at}


Objectives To describe recent investigations of potential workplace cancer clusters.

Methods We identified Health Hazard Evaluations (HHEs) of cancer concerns during 2001–2020. We described information about industry, requestors, cancer characteristics, investigative procedures, and determinations about the presence of a cluster (ie, presence of excess cases, unusual case distribution or exposure).

Results Of 5754 HHEs, 174 included cancer concerns, comprising 1%–5% of HHEs per year. In 123 HHEs, the cancer cluster concerns involved different cancer primary sites. Investigation procedures varied but included record review (n=63, 36%) and site visits (n=22, 13%). Of 158 HHEs with a cluster determination by investigator(s), 151 (96%) were not considered cancer clusters. In seven HHEs, investigators found evidence of a cluster, but occupational exposure to a carcinogen was not identified.

Conclusions The proportion of HHEs on workplace cancer cluster concerns remained steady over time; most did not meet the definition of a cluster or uncover an occupational cause. Public health practitioners can use this information to provide updated context when addressing workplace cancer cluster concerns and as motivation to refine investigative approaches. More broadly, this review highlights an opportunity to identify best practices on how to apply community cluster investigation methods to the workplace.

  • Public health
  • Occupational Health
  • Public Health Surveillance

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors SKC, GRG and DSS planned and performed data abstraction for the study. DSS performed the data analysis. JLR and SKC supervised the analysis and assisted with data interpretation. All authors contributed to the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data belong to the Health Hazard Evaluation (HHE) programme and are available on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.