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Journal of Cancer Prevention


J Cancer Prev 2019; 24(3): 139-145

Published online September 30, 2019

© Korean Society of Cancer Prevention

A Putative Adverse Outcome Pathway Relevant to Carcinogenicity Induced by Sulfuric Acid in Strong Inorganic Acid Mists

Jun Hyuek Yang1,*, Preeyaporn Koedrith2,*, Doo Seok Kang1,*, Nam Kook Kee1, Jong-Hyeon Jung3, Cheol Min Lee4, Yeon-Soon Ahn5, Young Rok Seo1

1Department of Life Science, Dongguk University Biomedi Campus, Goyang, Korea, 2Faculty of Environment and Resource Studies, Mahidol University, NakhonPathom, Thailand, 3Faculty of Health Science, Daegu Haany University, Gyeongsan, 4Department of Chemical and Biological Engineering, College of Natural Science and Engineering, Seokyeong University, Seoul, 5Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to :
Young Rok Seo
E-mail:, ORCID: Young Rok Seo,

*These authors contributed equally as the co-first author.

Received: December 31, 2018; Revised: September 14, 2019; Accepted: September 17, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Based on epidemiological studies, an International Agency for Research on Cancer Working Group determined that strong inorganic acid mists containing sulfuric acid are carcinogenic to human even though, sulfuric acid, per se, is not. Accumulative studies indicate that there is a link between chronic occupational exposure to sulfuric acid mists and an increased risk of laryngeal cancer. Unintended, acute exposure to sulfuric acid mists can cause corrosive damage to target tissues depending on the route of exposure. This review compares the toxicity and carcinogenicity of sulfuric acid mists compared to other strong inorganic acid mists. It also examines the routes and duration of exposure (short-term, prolonged, and long-term). In vivo evidence does not support or refute the carcinogenicity of sulfuric inorganic mists even though its co-carcinogenic or promoting potential has been considered. On the basis of existing evidence on sulfuric acid mist toxicity, we suggested a putative adverse outcome pathway (AOP) relevant to carcinogenicity caused by mists containing sulfuric acid. A possible key factor involved in sulfuric acid mist carcinogenesis is the genotoxic effects of low pH since it can increase instability in chromosomes and DNA. A putative AOP for sulfuric acid mist carcinogenicity would help generate better risk assessments and more accurate predictions regarding the risk of developing cancer due to prolonged exposure. Establishing an AOP would also be useful for future studies examining the carcinogenicity of other strong inorganic mists.

Keywords: Sulfuric acids, Adverse outcome pathways, Chemical accidents, Carcinogenesis

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