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Estimating National-Level Exposure to Antineoplastic Agents in the Workplace: CAREX Canada Findings and Future
Amy L Hall1, Paul A Demers2, George Astrakianakis1
1School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
Objectives:
Occupational exposure to antineoplastic agents occurs in various environments and is associated with increased cancer risk and adverse reproductive outcomes. National-level information describing the location and extent of occupational exposure to antineoplastic agents is unavailable in Canada and most other countries. CAREX Canada aimed to estimate the prevalence and relative levels of occupational exposures to antineoplastic agents across work setting, occupation, and sex.
Methods:
'Exposure' was defined as any potential for worker contact with antineoplastic agents. Baseline numbers of licensed workers were obtained from their respective professional bodies. For unlicensed workers, Census data or data extrapolated from human resources reports (e.g., staffing ratios) were used. Prevalence was estimated by combining population estimates with exposure proportions from peer-reviewed and grey literature. Exposure levels (classified as low, moderate, and high) by occupation and work setting were estimated qualitatively by combining estimates of contact frequency and exposure control practices.
Results:
Approximately 75000 Canadians (0.42% of the total workforce) are estimated as occupationally exposed to antineoplastic agents; over 75% are female. The largest occupational group exposed to antineoplastic agents is community pharmacy workers, with 30200 exposed. By work setting, 39000 workers (52% of all exposed) are located in non-hospital settings; the remaining 48% are exposed in hospitals. The majority (75%) of workers are in the moderate exposure category.
Conclusions:
These estimates of the prevalence and location of occupational exposures to antineoplastic agents could be used to identify high-risk groups, estimate disease burden, and target new research and prevention activities. The limited secondary data available for developing these estimates highlights the need for increased quantitative measurement and documentation of antineoplastic agent contamination and exposure, particularly in work environments where use is emerging.
Insights
Approximately 75,000 Canadians, primarily women, face occupational exposure to antineoplastic agents. This study highlights the need for better data on exposure levels and locations to improve worker safety.
Area of Science:
- Occupational Health
- Environmental Health
- Public Health
Background:
- Occupational exposure to antineoplastic agents poses risks including cancer and reproductive issues.
- Data on the prevalence and location of such exposures is lacking in Canada.
- CAREX Canada was initiated to address this data gap.
Purpose of the Study:
- To estimate the prevalence of occupational exposure to antineoplastic agents in Canada.
- To identify the relative levels of exposure across different work settings, occupations, and sexes.
- To provide data for risk assessment and prevention strategies.
Main Methods:
- Defined exposure as any potential worker contact with antineoplastic agents.
- Utilized worker population data from professional bodies, Census, and HR reports.
- Estimated prevalence by combining population data with literature-based exposure proportions.
- Assessed exposure levels (low, moderate, high) qualitatively based on contact frequency and controls.
Main Results:
- An estimated 75,000 Canadians (0.42% of the workforce) are occupationally exposed.
- Over 75% of exposed workers are female.
- Community pharmacy workers represent the largest exposed group (30,200).
- Non-hospital settings account for 52% of exposed workers.
- The majority (75%) of exposed workers fall into the moderate exposure category.
Conclusions:
- The findings can guide the identification of high-risk groups and inform disease burden estimations.
- Results support targeted research and prevention efforts for antineoplastic agent exposure.
- A need exists for more quantitative data on contamination and exposure, especially in emerging use settings.
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