The human cytogenetic assays presently available for biomonitoring are still inadequate for use in routine surveillance procedures and they must be applied with care. Knowledge of the effects of the agents concerned in experimental systems is a prerequisite, and confounding factors should be assessed. Consequently, the methods are useful and informative under carefully selected conditions and can indicate agents and exposures that are capable of causing chromosomal damage in humans, hinting at possible human cancer risk. Established and potential human carcinogens have frequently been shown to induce chromosomal aberrations in humans in vivo. It is also well documented that chromosomal rearrangements play an important role in the development of neoplasia. These combined lines of evidence suggest that structural chromosomal aberration in vivo has advantages over other cytogenetic end-points in predicting potential human cancer risk. Preliminary findings in a prospective follow-up study suggest that subjects with a high percentage of structural chromosomal aberrations but not sister chromatid exchanges may be at elevated risk for cancer.