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.
Highlights
To 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)
Despite the introduction of safety guidelines and protective measures, health-care workers can still be exposed to these toxic drugs, as demonstrated by detectable levels of biomarkers found in the urine of nurses and other health professionals, and DNA damage or chromosomal aberrations observed in their lymphocytes and exfoliated buccal cells [6,7,8,9]
Of the 56,213 female RNs who had a work history between 1974 and 2000, 905 (1.6%) RNs were identified as ever having been exposed to antineoplastic drugs according to method 1, based on their employment in oncology nursing units or at a cancer center, and 7,635 (13.6%) of the 56,213 RNs were assigned at least 15 days weighted duration of exposure to antineoplastic drugs according to method 2, based on information acquired through the agency-based survey
Summary
To 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). There has been concern regarding the potential for carcinogenic and teratogenic effects related to antineoplastic drugs exposure. Antineoplastic drugs have been used in the treatment of malignant diseases for more than 50 years. There are almost 100 antineoplastic drugs currently in use, many of which are mutagenic and either known or probable human carcinogens [4]. Second malignancies, including leukemia and bladder cancer, have been reported in patients who have previously received antineoplastic drugs [4]. Mutagenic effects of antineoplastic drugs provide an explanatory mechanism for elevated risks of cancer and adverse reproductive outcomes. Antimetabolites, a commonly used class of antineoplastic drugs, may affect reproductive outcomes through folate antagonist activity [10,11]
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