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Background: Oil refinery workers are exposed to benzene, which is a well-known cause of leukaemia, but results on leukaemia in oil refinery workers have been mixed, and the data on workers’ exposure is limited. Oil refinery workers are also exposed to asbestos and several studies have shown increased risk of mesothelioma.

Aim: The objective was to investigate cancer incidence, especially leukaemia, at low to moderate exposure to benzene in an update of a previous study of employees at three Swedish oil refineries.

Methods: Cancer incidence was followed up in 2264 men (1548 refinery operators) employed at three oil refineries in Sweden for at least one year. Job types and employment times were collected from complete company files. A retrospective assessment of the benzene exposure was performed by occupational hygienists in collaboration with the refineries using historic measurements as well as detailed information on changes in the industrial hygiene and technological developments. Cases of cancer were retrieved by a linkage with the Swedish Cancer Register through 35–47 years of follow-up and standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated.

Results: In total, 258 tumors had occurred versus 240 expected (SIR 1.07; 95% CI 0.95–1.21). There were 10 cases of leukaemia, all in refinery operators (SIR 2.4; 95% CI 1.18–4.51). There were three cases of pleural mesothelioma, two of which in refinery operators. The mean estimated cumulative benzene exposure for the cases of leukaemia was 7.9 ppm-years (median 4.9, range 0.1–31.1). Discussion: The study suggests that low to moderate average cumulative benzene exposure increases the risk of leukaemia. Limitations include the modest number of cases and potential misclassification of exposure.

Conclusion: The present study indicated an increased risk of leukaemia in male oil refinery workers with low to moderate exposure to benzene.