The list of dangerous professions doesn’t typically include cashiers, but they might need to be added if results of a pilot study hold true. 

A Cincinnati Children’s study, published in JAMA, shows that extensive handling of thermal receipts – the kind used in cash registers – significantly increases exposure to bisphenol A (BPA), a chemical associated with health hazards in fetuses and children. 

The pilot study is believed to be the first to show that BPA can go through skin resulting in increased levels of BPA in urine. BPA has been present in many hard polycarbonate plastic bottles and canned food and beverages over the past few decades. 

“We observed an increase in urinary BPA concentrations after continuously handling receipts for two hours without gloves, but no significant increase when the simulation was repeated using gloves,” says Shelley Ehrlich, MD, a physician and researcher at Cincinnati Children’s and lead author of the study. 

The study involved 24 student and staff volunteers at the Harvard School of Public Health who printed and handled receipts continuously for two hours without gloves. The researchers detected BPA in 83 percent of the students prior to handling the receipts and in 100 percent of the students after handling the receipts. 

Urinary concentrations of BPA were more than three times higher after handling the receipts (four hours post baseline). In 12 participants who provided sequential urine samples over a 24 hour period, urinary BPA concentrations reached a peak concentration of 11 micrograms per liter at eight hours. This was more than a five-fold increase in BPA compared to baseline. There was no significant increase in urinary BPA after handling receipts while wearing gloves.

This study shows that skin absorption of BPA through receipt handling is an additional source of exposure to BPA which may be a concern particularly to highly exposed individuals such as cashiers in supermarkets and gas stations, bank tellers, and librarians. 

“While our study findings showed that continuous thermal receipt handling without the use of gloves significantly increased urinary concentrations of BPA, a larger study is needed to confirm our findings and evaluate the clinical implications of this type of exposure,” Ehrlich says.