Exposure monitoring programs have been used in the aluminum smelter industry for decades to decrease the risk of cancer from exposure to polycyclic aromatic hydrocarbons (PAHs). Biological monitoring of PAHs incorporates all routes of exposure. Measuring postshift urinary 1-hydroxypyrene (1OHP), a metabolite of pyrene, determines worker's daily PAH exposures, while measuring DNA adducts reflect chronic exposures to PAHs. We reviewed the scientific literature to identify changes over time in (1) 1OHP levels, (2) DNA adduct levels, and (3) other contributing factors associated with 1OHP and DNA adduct levels in the aluminum smelter industry. No trends were observed in 1OHP and DNA adduct levels. This could be due to variable selection of study populations and poorly identified job tasks that prevent comparison of jobs across plants and times, unassessed worker exposure variability, and the impact of cumulative exposures. Thus, it cannot be demonstrated that the use of biological monitoring to estimate PAH exposures has brought about an exposure reduction in the industry. Future studies should be aimed at follow-up in workplaces where dermal and inhalation exposure interventions have been employed. Inconsistent findings were also observed in the analysis of CYP1A1, GSTM1, and GSTP1 polymorphisms and their effect on biomarker levels.