Environmental and direct measures of exposure

The need for epidemiologic reproductive studies of workers exposed to antineoplastic agents has been underscored by a proliferation of literature expressing concern about the potential for biologic hazard, animal and patient studies demonstrating reproductive effects of these drugs, and by the two recent case-control studies reporting findings of reproductive hazard, specifically spontaneous abortion and congenital malformations. The numbers of workers with past exposure must be approaching 100,000, based on the number of exposed workers per hospital in a study at one point in time by Stellman et al. Many of those handling these drugs in the past probably experienced substantial exposure because protection was unavailable and handling practices were careless since the hazard was not recognized until 1979. Because of the recent and continuing publicity given in the professional literature to antineoplastic drugs as potential hazards to the health and reproductive function of pharmacists and nurses, it is hoped that exposure to these agents will decrease in sizable portions of the occupational groups who have current and past exposure to these drugs, although many workers have reported to the author that they used protection for a short time after hearing a report of possible effects, then returned to their previous unprotected handling practices. Since substantial numbers of persons were heavily exposed in the past, questions about the long-term effects of such exposures remain an issue and need to be studied. Effects on menstrual function, for example, could have ongoing reproductive implications. Answers about reproductive hazard and utility of various protective measures are needed to guide policy decisions about how to best protect workers. Conflict has arisen between nurses and administrators regarding institutional policies that prohibit pregnant nurses from handling antineoplastic drugs or caring for patients on drug protocols. If pregnant nurses are to be permitted to handle these drugs, then it is essential to provide evidence that the use of protective clothing and equipment gives adequate protection. The development of biologic markers of cumulative exposure is thus a desirable, although hard to realize, ideal.(ABSTRACT TRUNCATED AT 400 WORDS)