The United States has renewed interest in expanding coal production following the declaration of a national energy emergency in early 2025. While coal remains a major energy source, researchers and public health experts continue to study its possible impact on human health, especially cancer risks among workers and nearby communities.
A recent systematic review published in the journal Elsevier Public Health examined decades of research on coal operations and cancer outcomes in the US. The findings raise important questions about environmental exposure, occupational safety, and long-term public health planning.
Coal operations include several stages such as mining, processing, transportation, combustion, and waste management. Each stage may release pollutants into the air, water, and soil. Researchers have long studied the connection between these pollutants and chronic diseases, including cancer.
The review analyzed studies published between 1980 and 2025. Researchers searched major medical databases including PubMed, Embase, Scopus, and CINAHL to identify studies focused on cancer outcomes linked to coal related activities in the United States.
In total, 45 studies met the inclusion criteria. These studies explored both occupational exposure among coal workers and residential exposure among people living near coal operations.
One of the strongest findings from the review was the connection between coal exposure and cancer mortality.
All 18 studies that investigated residential exposure reported statistically significant links between living near coal operations and increased cancer-related deaths. Similarly, occupational studies published after 2003 also showed significant associations between coal-related work environments and higher cancer mortality rates.
Researchers noted that evidence related to cancer incidence was more mixed. Some studies identified higher rates of cancer diagnoses among exposed populations, while others did not find strong statistical relationships.
The review also found that only one study examined cancer-related hospitalizations associated with residential coal exposure, and it did not identify a significant association.
Despite differences in methodology, the overall evidence suggested that long term exposure to coal operations may contribute to worse cancer outcomes.
Coal-related activities can release several potentially harmful substances into the environment. These include heavy metals such as cadmium and chromium, as well as particulate matter and other industrial pollutants.
According to previous scientific evidence, some of these substances are recognized carcinogens. Workers involved in coal mining or combustion may inhale contaminated dust particles over many years. Communities living near coal plants or mining sites may also experience prolonged environmental exposure through air and water pollution.
Researchers emphasized that people are rarely exposed to a single pollutant. Instead, they are exposed to complex mixtures of chemicals that may interact and increase health risks over time.
The review highlighted that areas with active or expanding coal operations often already experience elevated cancer rates. Rural communities in coal producing regions may face additional challenges such as limited healthcare access, economic hardship, and environmental degradation.
Public health experts warn that expanding coal infrastructure without sufficient environmental protections could place additional pressure on vulnerable populations.
At the same time, local governments and county authorities often hold decision-making power regarding permits for coal operations. This means communities may directly influence whether projects move forward.
Although the review found concerning patterns, researchers also acknowledged important limitations in the available evidence.
Many studies relied on observational designs, which cannot fully prove cause and effect relationships. Researchers also identified issues such as healthy worker bias, competing health risks, and ecological fallacy in several studies.
Healthy worker bias occurs when employed individuals appear healthier than the general population because severely ill people are less likely to remain employed. Ecological fallacy refers to drawing conclusions about individuals based on broader population-level data.
Because of these methodological differences, the authors noted that a quantitative meta-analysis was not possible.
A major finding from the review was the role of federal research and surveillance systems. Approximately 82 percent of the included studies relied on US government supported health data and cancer monitoring infrastructure.
Researchers stressed that continued public health surveillance is essential for understanding long-term cancer risks linked to industrial activities. Monitoring environmental exposure and cancer trends can help policymakers make informed decisions regarding future coal expansion projects.
Public health surveillance may also support earlier cancer detection and improve healthcare planning in high-risk communities.
Coal continues to play a significant role in energy production and employment in some regions of the United States. Supporters argue that coal expansion may strengthen energy security and local economies.
However, health experts caution that economic benefits should be weighed alongside potential environmental and medical consequences. Long term healthcare costs, environmental cleanup, and reduced quality of life may create additional burdens for affected communities.
The recent review does not call for specific policy actions, but it does highlight the importance of evidence-based decision-making when considering future coal operations.
The growing body of research on coal operations and cancer outcomes suggests that both workers and nearby residents may face increased health risks from prolonged exposure. While more research is needed to clarify specific mechanisms and cancer types, the evidence reviewed in this study points toward consistent associations between coal-related exposure and higher cancer mortality.
As debates continue over energy policy and industrial expansion in the United States, public health considerations are likely to remain an important part of the conversation.
Nogueira LM, Sakka R, Yabroff KR, Mountrakis G. “Coal Operations and Cancer in the US: A Systematic Review.” Published in Public Health, available online May 19, 2026. DOI: 10.1016/j.puhe.2026.106311.
This article is intended for educational and informational purposes only. It does not provide medical, legal, or environmental policy advice. Readers should consult qualified healthcare professionals, researchers, or regulatory authorities for guidance related to health risks, environmental exposure, or public policy decisions.
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