NIOSH notes that "the few studies that have measured worker exposure to BPA have focused mainly on cashiers handling point-of-sale thermal receipt paper coated with BPA." It explains that BPA in thermal paper can transfer to skin and be absorbed, and that occupational exposure among cashiers may be higher than in the general population, although health outcome data for these workers are limited.

EFSA states that "Use of BPA has been banned in thermal paper receipts since January 2020." It explains that in April 2023 EFSA "published a re-evaluation of the safety of BPA as used in FCMs, significantly reducing the" tolerable daily intake (TDI) compared to its 2015 assessment and that, based on this reassessment, the European Commission in December 2024 adopted a ban on BPA in food contact materials.

The receipts we receive when we buy groceries, prescriptions, gas, clothing, restaurant meals, and much more are generally printed on thermal paper coated with either Bisphenol-A (BPA) or its chemical cousin Bisphenol-S (BPS). The receipts expose people to these chemicals, particularly those who handle lots of receipts. Studies show that cashiers have higher levels of BPA in their bodies than people in other occupations. Regular receipt handling may be of particular concern to pregnant or nursing women or women of childbearing age and adolescents of any gender who are still developing.

The authors state: "We hypothesized that handling of thermal receipts significantly increases BPA exposure, but use of gloves during handling minimizes exposure." In this pilot study, urinary BPA concentrations increased after continuously handling receipts for 2 hours without gloves, but there was no significant increase when using gloves. The peak urinary BPA level after handling receipts (5.8 µg/L) was lower than that observed after canned soup consumption (20.8 µg/L). The paper notes that the clinical implications of peak level and chronicity of exposure are unknown but may be particularly relevant to occupationally exposed populations such as cashiers who handle receipts 40 or more hours per week.

The ATSDR fact sheet notes that bisphenol A (BPA) is used in polycarbonate plastics and epoxy resins and that exposure in the general population primarily occurs through diet, but that additional exposure may occur in workplaces that manufacture or use BPA. It states that studies in animals suggest BPA can affect the reproductive system and development, and may influence behavior and metabolism. While the document does not focus on cashiers, it highlights that certain workers can have higher BPA exposures than the general public and that health effects depend on dose, duration, and route of exposure such as skin contact.

OEHHA lists bisphenol S (BPS) under California’s Proposition 65 as a chemical known to the state to cause reproductive toxicity. The listing, effective in 2023, is based on evidence of reproductive effects in animal and other studies. While the listing does not single out occupational groups, it applies to exposures from consumer products such as thermal paper receipts, meaning businesses must provide warnings if exposures to BPS from such products exceed specified levels.

The study investigated whether frequent contact with thermal paper is associated with an increase in urinary BPA excretion in cashiers compared with non‑occupationally exposed workers. Urine samples were collected from 90 cashiers and 44 controls and BPA was quantified using LC‑MS/MS. The median urinary total BPA concentration was 3.54 µg/L for controls and 8.92 µg/L for cashiers, while free BPA medians were 0.20 µg/L and 0.28 µg/L, respectively. The authors concluded: "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."

The BfR notes that "The main sources of exposure to bisphenol A were food (oral, i.e. via the mouth) and thermal paper (dermal, i.e. via the skin)." It adds: "As there has been a ban on the use of bisphenol A in thermal paper since the beginning of 2020, exposure from this source is likely to have decreased significantly since then." The document states that use of BPA "in thermal papers in concentrations of more than 0.02% has been banned since 2020."

Bisphenol A (BPA) is an endocrine disrupting chemical used in a wide range of consumer products including photoactive dyes used in thermal paper. Recent studies have shown that dermal absorption of BPA can occur when handling these papers. Studies evaluating urinary concentrations of BPA and its metabolites suggest slightly elevated exposures in individuals that work as cashiers. Work simulations involving handling of thermal paper receipts also suggest that typical occupational exposures can increase urinary concentrations of BPA and its metabolites approximately 3-times (from 1.8 ng/ml prior to handling to 5.8 ng/ml after handling). The authors note that more than 100 epidemiology studies suggest associations between BPA exposures and an increased risk of adverse health outcomes including cardiovascular disease, obesity, diabetes, ADHD, male sexual dysfunction and others, but do not establish causation specifically from receipt handling.

This study investigated whether frequent contact with thermal paper is associated with an increase in urinary bisphenol S (BPS) levels in cashiers. The authors report that "frequent contact with thermal paper could be responsible for an increase in urinary concentration of total BPS in cashiers" compared with controls. They also note that detectable BPS in controls suggests general population exposure but that cashiers may have higher internal doses due to occupational handling of receipts.

NIEHS describes BPA as a high‑production‑volume chemical used in many consumer products and notes that it is an endocrine-disrupting compound capable of mimicking estrogen. The institute reports that human studies have linked BPA exposure with possible health effects such as reproductive problems, altered fetal development, metabolic disorders and cardiovascular disease, although causality and safe exposure thresholds remain under study. It also notes that occupational exposure in workers who directly handle BPA or BPA-containing materials can be higher than in the general population.

This research evaluating cashiers found that those who regularly handle thermal receipts had higher urinary BPA concentrations compared with non-cashier controls. The authors conclude that occupational contact with thermal paper "is associated with an increase in BPA exposure among cashiers," suggesting that handling receipts is an important source of BPA exposure in this workforce. They emphasize that the long-term health implications of this elevated exposure remain uncertain given existing regulatory thresholds at the time.

In this study of U.S. adult volunteers, cashiers who handled thermal receipts during their work shift were compared to non-cashiers. The authors reported that, after a work shift, urinary BPA and BPS concentrations in cashiers were substantially higher than in non-cashiers, indicating occupational exposure from handling receipts. The study concludes that handling of thermal paper receipts may be a source of BPA, BPS, and related compounds in the body. The paper did not directly evaluate disease outcomes, but documented increased internal dose among cashiers.

In thermal paper, BPA and BPS are added in their free form, not chemically bound to the paper or polymerized. Thus the molecules readily transfer to anything touching the paper, including your skin. The skin efficiently absorbs both chemicals and several studies have shown that even briefly handling receipt papers leads to significant BPA or BPS absorbed into the body. While virtually every person tested shows BPA and BPS in their bodies, workers such as cashiers who handle paper receipts have greater amounts of these chemicals in their bodies than the general population. One analysis found over 88% of BPS exposure for most humans comes from handling thermal receipts. Comparing estimated occupational exposures from receipts to certain government tolerable intake limits for BPA suggests that employees may exceed at least the most recent European limit for BPA just from handling receipts.

This review describes thermal receipt paper as a major source of BPA exposure via the skin. It cites transfer experiments showing that BPA is readily transferred from receipts to fingers and that absorption can be enhanced in the presence of skin products such as hand sanitizers or lotions. The authors write that cashier work "may represent a significant occupational source of BPA exposure" and note biomonitoring data where cashiers had higher urinary BPA levels than non‑cashiers. They highlight concerns that chronic low‑dose exposure from occupational handling could contribute to endocrine‑disrupting effects, although direct disease outcomes in humans remain insufficiently characterized.

In this human experimental study, volunteers handled BPA‑containing thermal receipts under controlled conditions. The authors found that BPA transferred readily from receipts to skin and that measurable amounts were absorbed, as reflected in increased serum and urinary BPA levels after handling. They reported that the use of skin products (e.g., hand sanitizers, lotions) before handling receipts significantly increased BPA transfer and absorption. The study concludes that "thermal paper receipts can be a source of significant BPA exposure" and emphasizes that workers with frequent handling could receive much higher cumulative dermal doses.

The article summarizes research showing that bisphenol A (BPA) can transfer from thermal paper receipts to the skin and then migrate into the bloodstream. It notes that some researchers maintain that the BPA levels found after handling thermal paper, around 20 nanograms per mL in blood, are comparable to levels that epidemiological studies have associated with health effects including obesity, miscarriage, reduced libido, impaired sperm quality and altered immune, liver, thyroid and kidney function. The author suggests that although risk quantification is debated, it is advisable to avoid unnecessary BPA exposure and that wearing gloves by cashiers is a reasonable precaution.

This occupational risk assessment reviews studies of BPA exposure in various workplaces, including cashiers handling thermal receipts. The authors summarize biomonitoring data showing that cashiers often have higher urinary BPA concentrations than control groups, consistent with dermal uptake from receipts. They describe BPA as an endocrine‑disrupting chemical linked in epidemiological and toxicological studies to reproductive, metabolic, and cardiovascular effects, but also note that for many occupational scenarios, estimated daily intakes remain below some regulatory reference doses. The paper highlights the need for more long‑term health outcome studies in exposed worker populations such as cashiers.

This review discusses BPA and BPS as endocrine disruptors and identifies thermal paper receipts as an important non‑dietary exposure pathway. It notes that biomonitoring studies report higher urinary BPA among cashiers relative to other workers, implicating occupational contact with receipts. The review associates BPA and BPS exposure in human and animal studies with adverse outcomes including altered reproductive function, metabolic disturbances, and possible links to cardiovascular disease. However, it also calls for more robust epidemiological data to firmly establish causal relationships between occupational exposure via receipts and specific diseases.

This report states that bisphenols, particularly BPA and BPS, are present in high concentrations in many types of receipt paper and are chemicals "linked to reproductive harm" in humans and animals. It flags workers who handle receipts as a group with higher potential exposure and recommends that workers ask employers for disposable non‑vinyl gloves or reusable food‑grade silicone fingertips, wash hands before eating and after changing receipt rolls, and avoid handling receipts with wet hands or after using hand sanitizer because these conditions increase absorption. The report urges businesses to reduce printing receipts, offer digital receipts, and switch to non‑bisphenol or phenol‑free papers to reduce worker and customer exposure.

This regulatory overview explains that, in the EU, "Previously, [BPA] was used in thermal paper, such as for sales slips, parking tickets, and parcel labels, before being banned in January 2020." It cites EFSA’s 2023 re-evaluation, noting that EFSA set "a tolerable daily intake (TDI) of 0.2 nanograms per kilogram of body weight per day, which is significantly lower than the old level of 4 micrograms per kilogram of body weight per day." The article also notes that BPA has been classified as an endocrine-disrupting substance and that most exposure for the general public is via diet.

This medical group article summarizes research on BPA and BPS in thermal receipts. It states that most receipts are printed on thermal paper coated with BPA or BPS, "both of which are known endocrine disruptors," and cites a 2024 Ecology Center study finding about 80% of receipts from major U.S. retailers contained bisphenols. The article notes that "cashiers and retail workers face the greatest risk due to daily, repeated contact" and that even brief handling can increase urinary BPA levels, with moisturizers or hand sanitizers making absorption worse. It also notes that while short, occasional exposure is unlikely to cause harm for most people, chronic repeated exposure is more concerning from a hormone‑health perspective.

Across regulatory and academic reviews up to 2024, there is consistent evidence that cashiers experience higher internal exposure to bisphenol A (BPA) and bisphenol S (BPS) from frequent handling of thermal paper receipts compared with the general population. However, these sources also commonly state that direct epidemiologic evidence linking this occupational exposure to increased incidence of specific diseases (such as cancer, diabetes, or reproductive disorders) in cashiers is limited or absent, so risk assessments rely largely on extrapolation from animal and general-population studies of BPA/BPS toxicity rather than on cashier-specific disease data.