Evaluation of genotoxicity induced by exposure to antineoplastic drugs in lymphocytes of oncology nurses and pharmacists

Abstract

The hazards of handling antineoplastic drugs have been raised and discussed in several studies. Introduction of new antineoplastics together with abuse of safety standards have contributed to the exposure risk for personnel who handle these substances. Interactions of antineoplastic drugs with biological structures vary according to the drug(s) and the individual's genetic susceptibility. This study was carried out to evaluate the genome damage induced by exposure to antineoplastic drugs in nurses (n = 20) and pharmacists (n = 18) working in the Oncology Department of Tanta Cancer Center. Thirty subjects matched in age, gender and smoking habit were selected as controls. Both chromosomal aberration analysis and micronucleus assay were used to evaluate genome damage in peripheral blood lymphocytes of the study subjects. The numbers of aberrant lymphocytes, as well as chromosomal aberration and micronuclei frequencies, were significantly increased in exposed personnel in comparison to matched controls. Compared with pharmacists, nurses showed notably higher level of chromosome damage. On the other hand, no significant difference in micronuclei frequency was observed between nurses and pharmacists. Correlation analyses pointed to the influence of age and duration of occupational exposure on the level of chromosome damage among exposed subjects. The results of this study confirmed that handling antineoplastic drugs without appropriate precautions imposed a genotoxic risk for exposed healthcare workers. These results address the need for regular biomonitoring of exposed personnel. In addition, they call attention to the need for proper implementation of intervention measures aiming to eliminate or significantly reduce worker exposure and prevent untoward biological effects.

Antineoplásicos e os riscos ocupacionais para os enfermeiros: uma revisão integrativa

“…A corto plazo, trabajadoras que manipularon antineoplásicos en la gravidez presentaron, significativamente, mayores tasas de anomalías congénitas en los ojos de su prole 10 , así como mayores posibilidades de abortar, inclusive en el primer trimestre de la gestación 11 . A medio plazo hubo daños cromosómicos 5,6,8,11,7 , linfocitos anómalos, deleciones, lagunas y rompimiento 5 , anomalías en las cromátidas 8,11 , disminución en la producción de linfocitos 8 , aumento de las frecuencias de micronúcleos 6,14 . A largo plazo las enfermeras que manipulaban quimioterápicos presentaron mayor riesgo de que sus hijos nacieran con labio leporino/ paladar hendido, además de mayor riesgo de cáncer de mama y recto 10 , Los factores de riesgo más comunes para el aumento de los daños laborales fueron: ser enfermero 5,6,7,10 , lugar de trabajo 10 , tiempo de exposición a los antineoplásicos 5,9,10 , edad 5,9,11 , no uso o uso incorrecto de los EPI's 5,11,15 , consumo de alcohol 6 y tabaco 9,11 .…”

“…Hay evidencias científicas de que ellos existenm, y sus daños a la salud del trabajador son indudables 5,8,[10][11][16][17] . Estudio realizado en Croacia reunió a 100 mujeres, mitad tenía contacto con quimioterápicos.…”

“…Siendo los daños a los enfermeros mayores y más significativos que los causados a los farmacéuticos [5][6][7] .…”

Forgotten public health impacts of cancer – an overview

“…The main focus of concern has dwelled upon the pharmacy and nursing personnel who mix and administer drugs and who are likely to experience the highest exposure intensity (87). Inhalation and skin contact/absorption are the most likely routes of exposure, but unintentional ingestion from hand to mouth contact and unintentional exposure from a needle is also possible (80,82,83,88,89). Inhalation results from aerosolisation of powder or liquid during reconstitution and spillage taking place while preparing or administering to patients; skin contact or skin absorption results from contact with contaminated surfaces mostly when control measures are inadequate.…”

“…Furthermore, patients may excrete these drugs and their metabolic by-products in body wastes, exposing personnel who handle such items (80,89). Contamination of workplace surfaces and permeation of gloves to some antineoplastic drugs were reported already in several studies (22,79,80,92 The National Institute for Occupational Safety and Health (NIOSH) in the USA has compiled several case studies that suggest both acute and long-term health effects associated with antineoplastic drug occupational exposure scenarios.…”