Valanis B
Occup Med. 1986 Jul-Sep;1(3):431-44.
The need for epidemiologic reproductive studies of workers exposed to antineoplastic agents has been underscored by a proliferation of literature expressing concern about the potential for biologic hazard, animal and patient studies demonstrating reproductive effects of these drugs, and by the two recent case-control studies reporting findings of reproductive hazard, specifically spontaneous abortion and congenital malformations. The numbers of workers with past exposure must be approaching 100,000, based on the number of exposed workers per hospital in a study at one point in time by Stellman et al. Many of those handling these drugs in the past probably experienced substantial exposure because protection was unavailable and handling practices were careless since the hazard was not recognized until 1979. Because of the recent and continuing publicity given in the professional literature to antineoplastic drugs as potential hazards to the health and reproductive function of pharmacists and nurses, it is hoped that exposure to these agents will decrease in sizable portions of the occupational groups who have current and past exposure to these drugs, although many workers have reported to the author that they used protection for a short time after hearing a report of possible effects, then returned to their previous unprotected handling practices. Since substantial numbers of persons were heavily exposed in the past, questions about the long-term effects of such exposures remain an issue and need to be studied. Effects on menstrual function, for example, could have ongoing reproductive implications. Answers about reproductive hazard and utility of various protective measures are needed to guide policy decisions about how to best protect workers. Conflict has arisen between nurses and administrators regarding institutional policies that prohibit pregnant nurses from handling antineoplastic drugs or caring for patients on drug protocols. If pregnant nurses are to be permitted to handle these drugs, then it is essential to provide evidence that the use of protective clothing and equipment gives adequate protection. The development of biologic markers of cumulative exposure is thus a desirable, although hard to realize, ideal.(ABSTRACT TRUNCATED AT 400 WORDS)
大量文献表达了对抗肿瘤药物潜在生物危害的担忧，动物和患者研究证明了这些药物的生殖影响，以及最近两项病例对照研究报告了生殖危害的结果，特别是自然流产和先天性畸形，这些都凸显了对接触抗肿瘤药物的工人进行流行病学生殖研究的必要性。根据斯特尔曼等人在某一时刻进行的一项研究中每家医院接触工人的数量来计算，过去接触过这些药物的工人数量肯定接近10万。过去许多接触这些药物的人可能接触量很大，因为当时没有防护措施，而且由于直到1979年才认识到危害，操作规范也很粗心。由于专业文献最近不断宣传抗肿瘤药物对药剂师和护士的健康及生殖功能存在潜在危害，希望目前和过去接触这些药物的相当一部分职业群体接触这些药物的情况会减少，尽管许多工人向作者报告说，他们在听到可能有影响的报告后短时间内使用了防护措施，但随后又恢复了以前无防护的操作规范。由于过去有大量人员大量接触这些药物，此类接触的长期影响问题仍然存在，需要进行研究。例如，对月经功能的影响可能会对生殖产生持续影响。需要了解生殖危害及各种防护措施的效用，以指导如何最好地保护工人的政策决策。护士和管理人员在禁止怀孕护士处理抗肿瘤药物或护理接受药物治疗方案的患者的机构政策上产生了冲突。如果允许怀孕护士处理这些药物，那么必须提供证据证明使用防护服和设备能提供充分的保护。因此，尽管难以实现，但开发累积接触的生物标志物仍是一个理想目标。（摘要截选至400字）
