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. 1992 Dec;49(12):855–861. doi: 10.1136/oem.49.12.855

Leukaemia and reproductive outcome among nurses handling antineoplastic drugs.

T Skov 1, B Maarup 1, J Olsen 1, M Rørth 1, H Winthereik 1, E Lynge 1
PMCID: PMC1061216  PMID: 1472444

Abstract

During the past decades conclusive evidence has accumulated that alkylating antineoplastic drugs (ADs) can cause cancer, most notably acute non-lymphocytic leukaemia, and that most ADs are reprotoxic. Studies on health workers handling ADs have shown significantly increased risks for miscarriages (two studies) and malformations (two studies). The present study monitored the risk for cancer and adverse reproductive outcome among Danish nurses handling ADs. No increased risks were found for miscarriages, malformations, low birth weight, or preterm birth among the offspring of nurses handling ADs during pregnancy. The sex ratio was normal. The relative risk (RR) for leukaemia was significantly increased (10.65) but based on only two cases, one of acute myeloblastic and one of chronic myeloid leukaemia. From the available exposure data occupational exposures to ADs were apparently higher in the studies that have reported increased risks for miscarriages and malformations than in the present one. Regarding reproductive outcome the study gives some confidence that the safety measures which were implemented in the oncology departments around 1980 can protect the health personnel against adverse effects of ADs on reproduction. As the study is as yet the only negative one in a well protected setting, it should be followed up by other studies of well protected health personnel handling ADs. The findings concerning the leukaemia risk, although based on small numbers, encourage larger studies.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson R. W., Puckett W. H., Jr, Dana W. J., Nguyen T. V., Theiss J. C., Matney T. S. Risk of handling injectable antineoplastic agents. Am J Hosp Pharm. 1982 Nov;39(11):1881–1887. [PubMed] [Google Scholar]
  2. Barale R., Sozzi G., Toniolo P., Borghi O., Reali D., Loprieno N., Della Porta G. Sister-chromatid exchanges in lymphocytes and mutagenicity in urine of nurses handling cytostatic drugs. Mutat Res. 1985 Aug-Sep;157(2-3):235–240. doi: 10.1016/0165-1218(85)90121-1. [DOI] [PubMed] [Google Scholar]
  3. Bos R. P., Leenaars A. O., Theuws J. L., Henderson P. T. Mutagenicity of urine from nurses handling cytostatic drugs, influence of smoking. Int Arch Occup Environ Health. 1982;50(4):359–369. doi: 10.1007/BF00377832. [DOI] [PubMed] [Google Scholar]
  4. Hemminki K., Kyyrönen P., Lindbohm M. L. Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. J Epidemiol Community Health. 1985 Jun;39(2):141–147. doi: 10.1136/jech.39.2.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kinlen L. J. Incidence of cancer in rheumatoid arthritis and other disorders after immunosuppressive treatment. Am J Med. 1985 Jan 21;78(1A):44–49. doi: 10.1016/0002-9343(85)90245-1. [DOI] [PubMed] [Google Scholar]
  6. Kinlen L. J., Peto J., Doll R., Sheil A. G. Cancer in patients treated with immunosuppressive drugs. Br Med J (Clin Res Ed) 1981 Feb 7;282(6262):474–474. doi: 10.1136/bmj.282.6262.474-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kinlen L. J., Sheil A. G., Peto J., Doll R. Collaborative United Kingdom-Australasian study of cancer in patients treated with immunosuppressive drugs. Br Med J. 1979 Dec 8;2(6203):1461–1466. doi: 10.1136/bmj.2.6203.1461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kolmodin-Hedman B., Hartvig P., Sorsa M., Falck K. Occupational handling of cytostatic drugs. Arch Toxicol. 1983 Sep;54(1):25–33. doi: 10.1007/BF00277812. [DOI] [PubMed] [Google Scholar]
  9. McDonald A. D., McDonald J. C., Armstrong B., Cherry N. M., Côté R., Lavoie J., Nolin A. D., Robert D. Congenital defects and work in pregnancy. Br J Ind Med. 1988 Sep;45(9):581–588. doi: 10.1136/oem.45.9.581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Nguyen T. V., Theiss J. C., Matney T. S. Exposure of pharmacy personnel to mutagenic antineoplastic drugs. Cancer Res. 1982 Nov;42(11):4792–4796. [PubMed] [Google Scholar]
  11. Nikula E., Kiviniitty K., Leisti J., Taskinen P. J. Chromosome aberrations in lymphocytes of nurses handling cytostatic agents. Scand J Work Environ Health. 1984 Apr;10(2):71–74. doi: 10.5271/sjweh.2355. [DOI] [PubMed] [Google Scholar]
  12. Norppa H., Sorsa M., Vainio H., Gröhn P., Heinonen E., Holsti L., Nordman E. Increased sister chromatid exchange frequencies in lymphocytes of nurses handling cytostatic drugs. Scand J Work Environ Health. 1980 Dec;6(4):299–301. doi: 10.5271/sjweh.2605. [DOI] [PubMed] [Google Scholar]
  13. Rørth M., Jørgensen J., Jørgensen V., Knudsen I., Larsen J. C., Munck F. Mutagenicitet i urinen hos sygeplejersker på onkologisk afdeling. Ugeskr Laeger. 1983 Feb 14;145(7):475–478. [PubMed] [Google Scholar]
  14. Selevan S. G., Lindbohm M. L., Hornung R. W., Hemminki K. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses. N Engl J Med. 1985 Nov 7;313(19):1173–1178. doi: 10.1056/NEJM198511073131901. [DOI] [PubMed] [Google Scholar]
  15. Skov T., Lynge E., Maarup B., Olsen J., Rørth M., Winthereik H. Risks for physicians handling antineoplastic drugs. Lancet. 1990 Dec 8;336(8728):1446–1446. doi: 10.1016/0140-6736(90)93148-i. [DOI] [PubMed] [Google Scholar]
  16. Sorsa M., Hemminki K., Vainio H. Occupational exposure to anticancer drug--potential and real hazards. Mutat Res. 1985 Sep;154(2):135–149. doi: 10.1016/0165-1110(85)90024-7. [DOI] [PubMed] [Google Scholar]
  17. Stücker I., Caillard J. F., Collin R., Gout M., Poyen D., Hémon D. Risk of spontaneous abortion among nurses handling antineoplastic drugs. Scand J Work Environ Health. 1990 Apr;16(2):102–107. doi: 10.5271/sjweh.1811. [DOI] [PubMed] [Google Scholar]
  18. Thiringer G., Granung G., Holmén A., Högstedt B., Järvholm B., Jönsson D., Persson L., Wahlström J., Westin J. Comparison of methods for the biomonitoring of nurses handling antitumor drugs. Scand J Work Environ Health. 1991 Apr;17(2):133–138. doi: 10.5271/sjweh.1724. [DOI] [PubMed] [Google Scholar]
  19. Venitt S., Crofton-Sleigh C., Hunt J., Speechley V., Briggs K. Monitoring exposure of nursing and pharmacy personnel to cytotoxic drugs: urinary mutation assays and urinary platinum as markers of absorption. Lancet. 1984 Jan 14;1(8368):74–77. doi: 10.1016/s0140-6736(84)90005-9. [DOI] [PubMed] [Google Scholar]
  20. Waksvik H., Klepp O., Brøgger A. Chromosome analyses of nurses handling cytostatic agents. Cancer Treat Rep. 1981 Jul-Aug;65(7-8):607–610. [PubMed] [Google Scholar]

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