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Occupational exposure to anticancer drug--potential and real hazards
Abstract:
Many anticancer agents have been shown to be mutagenic, teratogenic and carcinogenic in experimental systems and second malignancies are known to be associated with several specific therapeutic treatments. Anticancer agents thus represent a class of occupational carcinogens, the handling of which should involve no unnecessary exposure. The available methodologies to detect possible exposures from ambient air and from biological samples are discussed, and the published data on results are reviewed. Analytical methods are available for the detection of most frequently used anticancer drugs from all groups, i.e., alkylating agents, mitotic inhibitors, antimetabolites and antibiotics. The ambient samples taken from sites of admixture of cytostatics have often shown detectable, but low concentrations of anticancer agents. Urine samples from patients under chemotherapy as well as from personnel handling the drugs occupationally in hospitals have been analyzed both chemically and for excreted mutagenicity. Both cisplatin and cyclophosphamide have been detected in the urine of patients; furthermore, cyclophosphamide was observed in the urine of nurses who formulate and deliver this drug. Urinary mutagenicity assays have given both positive and negative results in various groups of nursing and pharmacy personnel. Cytogenetic methods have, likewise, been applied for monitoring purposes. Most of the available data concerns chromosome aberrations (CA) or sister-chromatid exchanges (SCE) induced in peripheral blood lymphocytes of patients under chemotherapy. A few studies on groups occupationally exposed to anticancer drugs have given positive results, but also negative reports have appeared for these same cytogenetic parameters. No studies are as yet available on the possible carcinogenic effects of occupational handling of anticancer drugs. Two recent case-referent studies among hospital personnel have pointed to slightly increased risks of disorders in pregnancy outcome; one of the studies has shown an excess of spontaneous abortions and other malformations in children of females with a history of work with anticancer agents.
Insights
Anticancer drugs pose occupational risks as potential carcinogens. Monitoring methods detect these agents in air and biological samples, with some studies showing increased risks for pregnant healthcare workers handling these substances.
Area of Science:
- Occupational Health
- Toxicology
- Pharmacology
Background:
- Anticancer agents are known mutagens, teratogens, and carcinogens.
- Occupational exposure to these drugs necessitates careful handling and monitoring.
- Second malignancies are linked to certain cancer treatments.
Purpose of the Study:
- To review methodologies for detecting occupational exposure to anticancer drugs.
- To analyze existing data on exposure levels and health effects in healthcare personnel.
- To assess the risks associated with handling cytotoxic agents in healthcare settings.
Main Methods:
- Review of analytical methods for detecting anticancer drugs in ambient air and biological samples (urine).
- Analysis of published data on drug concentrations in environmental and biological samples.
- Review of cytogenetic monitoring techniques (chromosome aberrations, sister-chromatid exchanges) and epidemiological studies.
Main Results:
- Analytical methods exist for detecting most anticancer drugs.
- Low concentrations of anticancer agents are detectable in ambient air and urine of exposed personnel.
- Studies show mixed results for urinary mutagenicity and cytogenetic changes; some indicate increased risks for pregnancy outcomes.
Conclusions:
- Occupational handling of anticancer drugs requires stringent exposure control measures.
- Further research is needed on the long-term carcinogenic effects of occupational exposure.
- Potential risks to pregnancy outcomes highlight the need for protective strategies for healthcare workers.