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Nurses’ exposures to antineoplastic drugs in Canada and risk assessment of lifetime cancer incidence
Presenter: Avital Jarus-Hakak
Authors: Avital Jarus-Hakak, Sharla Drebit, Chun-Yip Hon, Anne-Marie Nicol, George Astrakianakis.
Oncology as well as non-oncology nurses are at risk for exposure to antineoplastic drugs some of which
are known to be carcinogenic. Exposures may occur while transporting, preparing, administering and
disposing the drugs but also indirectly when caring for treated patients by handling excreta, washing or
removing linen (1). Despite the safety guidelines regarding handling and disposing of these drugs, issues
of work environment contamination and biologic evidence for personal occupational exposure are still
described in the literature (2). Occupational exposure limits for these drugs have not been set
anywhere. Our objectives were to estimate the number of patients treated with potentially carcinogenic
antineoplastic drugs and to evaluate the magnitude of possible occupational exposures to these drugs
among nurses in Canada. Furthermore, we aimed to review publications which measured
cyclophosphamide in the urine of nurses in order to quantify the average cumulative lifetime uptake of
this drug and extrapolate the personal lifetime risks for developing certain types of cancer.
Within the framework of an occupational study of chemical exposures among acute care nurses in BC, a
comprehensive review of exposures to antineoplastic drugs was performed. In order to estimate the
potential number of nurses involved with handling antineoplastic drugs, Canadian incidence rates of
cancer types associated with potentially carcinogenic antineoplastic drug therapies were gathered to
evaluate the amounts of antineoplastic drugs prescribed annually in Canada. Data on urinary levels of
cyclophosphamide among health care workers, a widely used anticancer drug that is known to be
carcinogenic, was collected through literature review to estimate it’s uptake among nurses. Based on
bladder cancer incidence rates from a Swedish study on patients diagnosed with Wegener’s
Granulomatosis, an autoimmune condition, and followed up after treatment with cyclophosphamide (3),
bladder cancer risk estimates resulting from lifetime exposures were evaluated. Additional task specific
risk estimates were made for assessing the risks among nurses involved with indirect exposure to
Annually about 177,000 Canadians are diagnosed with cancer (4). About 20% of them are treated with
antineoplastic drugs that are potentially carcinogenic including cyclophosphamide among others. Some
patients with severe autoimmune conditions that are also treated with these drugs should be added to
these numbers. According to estimates from CAREX about 17,000 Canadians are exposed to
antineoplastic drugs at their workplaces of whom the vast majority (almost 15,000) are nurses (5). Based
on literature review on urine Cyclophosphamide monitoring among Nurses and Pharmacists that handle
these drugs we have estimated a cumulative lifetime uptake of 10-19mg cyclophosphamide (2). Our
calculated lifetime bladder cancer risk is 42-83 per million. Further specific cancer estimates will be
Despite nurses’ awareness of the risks, exposure to antineoplastic drugs is still prevalent (6). It is
forecasted that the potential magnitude of health care personnel exposure to antineoplastic drugs will
grow with the increasing number of patients newly diagnosed with cancer as the Canadian population
grows and ages.
Therefore, new strategies for mitigating exposures among health care personnel and especially nurses


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The Right Medicine A look at how we help children by shipping medicines by Dr. Mark Wise, Past Board Chair My background as a doctor is in Tropical Medicine. Back in 1977, I trained at the London School of Tropical Medicine and Hygiene in England. At that time, I learned about many fascinating and debilitating illnesses that were called tropical diseases. Time, travel and experience

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