Chemotherapy: biomarkers of exposure, effect, reproductive hazards, and cancer.
This article discusses approaches that have been used to examine potentially adverse outcomes in healthcare professionals who work with or are exposed to chemotherapy drugs: (1) the use of biomarkers to evaluate genotoxic damage; (2) adverse reproductive outcomes; and (3) the association of cancer with exposure to chemotherapy drugs. Biomarkers of exposure and effect have been used extensively to monitor both healthcare professionals who work with antineoplastic(3-5) and other hazardous drugs, and workers in other occupational settings who may be exposed to genotoxic chemicals. In general, biomarkers are based on mutagenic or other end points of genotoxicity of the drugs. As most of the first generation of antineoplastic drugs were genotoxic in one test system or another, they were ideal candidates for use in exposed worker populations. However, these end points are typically nonspecific in nature and can result from exposure to any genotoxic compound, certain types of radiation, and possibly viral infections. Therefore, studies of worker populations must be carefully designed to rule out extraneous factors such as smoking history, diet, age, and other variables that may compromise test results. Nevertheless, more than half of the 100-plus published studies in the literature have reported a statistically significant association between exposure to antineoplastic drugs and the end point being investigated. Most of these studies have originated outside the United States, and they often have been conducted in countries where safety precautions may not be as rigorous as in the United States.
Drugs; Health-care-personnel; Medical-personnel; Exposure-levels; Risk-factors; Antineoplastic-agents; Chemotherapy; Oncogenic-agents; Biomarkers; Biological-effects; Reproductive-effects; Reproductive-hazards; Reproductive-system-disorders; Cancer; Drug-therapy; Pharmaceuticals; Medicinal-chemicals; Medical-treatment; Genotoxic-effects; Medical-monitoring; Biological-monitoring; Genotoxicity; Mutagenicity