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Several studies of pulp and paper workers have demonstrated increased risks for certain cancer sites, e.g. tumours of the lymphatic and haematopoietic system as well as stomach cancer. An impressive lung cancer excess was found among paper and board mill workers in Finland, but not in studies elsewhere. Individual exposures have not been estimated, neither has a job-exposure matrix been applied in any of the studies. Therefore, it is impossible to link any of the excesses to specific single compounds or mixtures, of which there are a multitude in the pulp and paper industries. Although there are high quantities of organic chlorine compounds in the process mixtures and waste, the compounds have low volatility and occupational exposures are not necessarily high. Estimations of individual occupational exposure should be mandatory in future epidemiological studies in this industry.

Toxic polychlorinated dioxins and dibenzofurans have been identified in effluents and products from pulp and paper mills using chlorine bleaching. The amounts and levels depend on the bleaching technique used and the product quality. The same compounds have also been identified in sediment samples and aquatic organisms collected in the vicinity of pulp mills. The highest levels were found in hepatopancreas from crustaceans. Much higher levels of alkyl-substituted polychlorodibenzofurans have been found in sediment and sludge samples.