Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs

Abstract

BackgroundTo determine the relationships of potential occupational exposure to antineoplastic drugs with cancer incidence and adverse pregnancy outcomes in a historical prospective cohort study of female registered nurses (RNs) from British Columbia, Canada (BC).MethodsFemale RNs registered with a professional regulatory body for at least one year between 1974 and 2000 formed the cohort (n = 56,213). The identifier file was linked to Canadian cancer registries. An RN offspring cohort from 1986 was created by linkages with the BC Birth and Health Status Registries. Exposure was assessed by work history in oncology or cancer agencies (method 1) and by estimating weighted duration of exposure developed from a survey of pharmacists and nursing unit administrators of all provincial hospitals and treatment centers and the work history of the nurses (method 2). Relative risks (RR) were calculated using Poisson regression for cancer incidence and odds ratios (OR) were calculated for congenital anomaly, stillbirth, low birth weight, and prematurity incidence, with 95% confidence intervals.ResultsIn comparison with other female RNs, method 1 revealed that RNs who ever worked in a cancer center or in an oncology nursing unit had an increased risk of breast cancer (RR = 1.83; 95% CI = 1.03 - 3.23, 12 cases) and their offspring were at risk for congenital anomalies of the eye (OR = 3.46, 95% CI = 1.08 - 11.14, 3 cases). Method 2 revealed that RNs classified as having the highest weighted durations of exposure to antineoplastic drugs had an excess risk of cancer of the rectum (RR = 1.87, 95% CI = 1.07 - 3.29, 14 cases). No statistically significant increased risks of leukemia, other cancers, stillbirth, low birth weight, prematurity, or other congenital anomalies in the RNs' offspring were noted.ConclusionsFemale RNs having had potential exposure to antineoplastic drugs were not found to have an excess risk of leukemia, stillbirth, or congenital anomalies in their offspring, with the exception of congenital anomalies of the eye, based on only three cases; however, elevated risks of breast and rectal cancer were observed.

Stillbirths: what difference can we make and at what cost?

“…The list of risk factors for stillbirth, and hence the number of potential interventions, continues to grow, [66][67][68][69] and includes environmental and genetic factors. Although some of these factors are of little public health relevance at present, they are potentially highly important for our future understanding of the pathogenesis and risks associated with stillbirth.…”

Causes of Health Care Workers’ Exposure to Antineoplastic Drugs: An Exploratory Study

“…1 Over the past 4 decades, there have been considerable advances in understanding the health outcomes associated with occupational exposure to antineoplastic drugs, including acute effects, 2,3 reproductive toxicities, [4][5][6] and carcinogenic potential. 5,7 Recent evidence has confirmed that a range of Canadian health care workers are at risk of exposure.…”

“…1 Over the past 4 decades, there have been considerable advances in understanding the health outcomes associated with occupational exposure to antineoplastic drugs, including acute effects, 2,3 reproductive toxicities, [4][5][6] and carcinogenic potential. 5,7 Recent evidence has confirmed that a range of Canadian health care workers are at risk of exposure. Several studies have found detectable levels of drug contamination on various work surfaces, [8][9][10] and others have demonstrated the presence of antineoplastic drugs on health care workers' hands.…”

Safety considerations for Health care Workers involved in Cytoreductive Surgery and Perioperative chemotherapy

“…There are few case reports in literature [60,61]. There are also some Xylene epidemiological studies that have shown an increased incidence of various cancers amongst nurses exposed to chemotherapeutic agents [62][63][64]. Thus, POC poses a risk of exposure to low doses of chemotherapeutic agents and though their long term effects are unknown, every effort should be made to avoid a breach in the safety measures leading to exposure.…”