Table 2. Examples of long-known aluminum-related diseases: aluminosis and dialysis encephalopathy, and chronic disorders currently discussed in connection with aluminum exposure: Alzheimer’s disease and breast cancer.

Ref.	Collective/study type	Results/exposure	Limitation
Aluminosis
(10)	62 workers (aluminum powder production); questionnaire, clinical examination, lung function; AI in plasma and urine, X-ray, HRCT, immunological tests	Detection of early-stage aluminosis possible; 15 workers (24.4%) with abnormal HRCT had elevated levels in plasma and urine: 33.5 µg Al/L plasma (vs. 15.4 µg/L, p=0.01) and 340.5 µg Al/g creatinine (vs. 135.1 µg/g, p=0.007), respectively
Neurotoxicity
Dialysis encephalopathy
(15)	21 Patients with dialysis encephalopathy	Plasma aluminum concentrations of 80–500 µg/L
Alzheimer’s disease
(16)	Meta-analysis of 8 cohort and case–control studies	Individuals with chronic aluminum exposure exhibit a higher risk for Alzheimer’s disease (OR 1.71; 95% CI: [1.35; 2.18]); at >100 µg Al/L drinking water: 1.95 [1.47; 2.59]; following occupational aluminum exposure: 1.25 [0.80; 1.94]	Exposure via drinking water cause of significant ORs; no association in considerably higher occupational aluminum exposure; Alzheimer’s disease cases clinically classified as “probable”/”possible” (not ”definitive”) → Uncertain, other causes of dementia also possible
(17)	Meta-analysis of 3 retrospective case–control studies (n = 1056) (e8– e10)	Occupational aluminum exposure not associated with Alzheimer’s disease (OR: 1.0 [0.6; 1.7])	Retrospective case–control studies, no precise determination of exposure
(18)	Case–control study: 198 Alzheimer’s patients (AP), 164 other dementia, 176 controls (C, without dementia)	11.1% of AP and 11.5% of 340 C with occupational aluminum exposure → No association between occupational aluminum exposure and subsequent onset of Alzheimer’s disease; OR 0.98 [0.53; 1.75]; p>0.05	Unmatched case–control study
Breast cancer
Antiperspirant use
(19)	Questionnaire-based study on breast cancer patients	Breast cancer patients that started using antiperspirants/deodorants earlier and frequently, developed disease at a younger age Four exposure groups: maximum vs. non p<0.0001	No controls; retrospective; low participation rate: sent out: 1344, responses: 437, analyzed: 237
(20)	Population-based case–control study, 813 breast cancer patients,793 controls, personal interview	No increased risk of breast cancer due to antiperspirant (AT)/deodorant (D) use following hair removal;Regularly: AT: OR 0.9 [0.7; 1.1]; p = 0.23; D: OR 1.2 [0.9; 1.5]; p = 0.19 Regularly within 1 h of shaving: AT: OR 0.9 [0.7; 1.1]; p = 0.40; D: OR 1.2 [0.9; 1.5]; p = 0.16
(21)	54 breast cancer patients, 50 controls, personal interview	Controls used antiperspirants significantly more frequently than breast cancer patients (51.8% vs. 82.0%; p<0.05); no link between breast cancer risk and the use of aluminum-containing deodorants/antiperspirants	Low case number
(22)	Systematic review, 59 articles reviewed, 19 selected, 11 analyzed	No link between breast cancer risk and the use of aluminum-containing deodorants/antiperspirants

AD, Alzheimer’s disease; Al, aluminum; HRCT, high-resolution computed tomography; CI, confidence interval; Ref., reference; OR, odds ratio; vs., versus