The timing of this comprehensive analysis creates a stark contradiction with current energy policy directions. As the US government commits to expanding coal production following its 2025 energy emergency declaration, this systematic review reveals consistent evidence linking coal operations to elevated cancer risks across multiple exposure pathways.
Researchers analyzed 45 studies spanning four decades of US data, examining cancer outcomes among both residential populations and workers exposed to coal mining, processing, burning, and waste management activities. The findings show remarkable consistency: all 18 studies examining residential exposures near coal operations documented statistically significant increases in cancer mortality. Similarly, every occupational study published after 2003 demonstrated elevated cancer death rates among coal workers.
This evidence synthesis represents the most comprehensive evaluation to date of coal-related cancer risks in American populations. The review methodology was rigorous, screening over 3,000 studies and applying systematic bias assessment tools. However, the included studies faced methodological challenges including healthy worker bias, where employed populations may appear healthier than general populations, and ecological fallacy issues when drawing individual-level conclusions from population data.
The consistency of findings across different study designs, time periods, and exposure scenarios strengthens the case for causal relationships between coal operations and cancer outcomes. This creates a significant public health tension as policy makers navigate energy security concerns against mounting evidence of health consequences. The review's timing during renewed coal expansion efforts makes these findings particularly relevant for communities and workers facing increased coal-related exposures.