Occupational exposure of cashiers to Bisphenol A via thermal paper: urinary biomonitoring study

Int Arch Occup Environ Health. 2016 Aug;89(6):935-46. doi: 10.1007/s00420-016-1132-8. Epub 2016 Apr 28.


Purpose: As an essential component of polycarbonate plastics and epoxy resins, Bisphenol A (BPA) is found in numerous industrial and consumer products. BPA may cause adverse health effects because of its endocrine activity. General population exposure to this compound mainly through diet is well documented. Thermal paper was also identified as a source of BPA through dermal intake. In this study, we investigated whether frequent contact with thermal paper is associated with an increase in urinary BPA excretion.

Methods: We evaluated the exposure to BPA in cashiers and in non-occupationally exposed workers from several workplaces. Urinary BPA was quantified in free (unconjugated) and total (unconjugated plus conjugated) forms in 24-h and spot urine samples using LC-MS/MS. BPA concentration in thermal paper was also measured from each workplace. In addition, participants provided information on job, food and drink, tobacco consumption and hands wash during the sampling period through a questionnaire.

Results: Urine samples were collected from 90 cashiers and 44 controls. Free and total BPA were detected in all samples. The median urinary total BPA concentration was 3.54 µg/L (2.89 µg/g creatinine) for controls and 8.92 µg/L (6.76 µg/g creatinine) for cashiers. For the free BPA, the median urinary concentration was 0.20 µg/L (0.21 µg/g creatinine) for controls and 0.28 µg/L (0.22 µg/g creatinine) for cashiers. Any correlation was found between the urinary concentration levels and the number of thermal receipts handled. Hand washes frequency, age, job length of service and tobacco consumption had also no effect on the BPA excretions.

Conclusion: A significant increase in urinary total BPA concentration was observed for cashiers handling daily thermal paper receipts. However, no significant increase was observed in urinary free BPA concentration. These findings are particularly interesting for risk assessment since all available data on occupational exposure to BPA through thermal paper were obtained from models or from simulated experiments.

Keywords: Biomonitoring; Bisphenol A; Cashiers; Exposure; Thermal paper; Urine.

MeSH terms

  • Adult
  • Benzhydryl Compounds / urine*
  • Biomarkers / urine
  • Case-Control Studies
  • Environmental Monitoring / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Occupational Exposure / analysis*
  • Occupations*
  • Paper*
  • Phenols / urine*
  • Surveys and Questionnaires
  • Tandem Mass Spectrometry
  • Young Adult


  • Benzhydryl Compounds
  • Biomarkers
  • Phenols
  • bisphenol A