Antineoplastic drugs play an important role in cancer therapy.  A growing number of patients and new fields of application have resulted in an increasing use of these agents.  Most antineoplastic drugs are classified as carcinogenic, mutagenic, or teratogenic for humans.  Antineoplastic drugs also cause adverse effects in health care workers who handle them.  In the late 1960s, acute symptoms by exposure to antineoplastic drugs were first reported.  In 1979, Falck reported a small increase in urine mutagenicity of nurse who handled antineoplastic drugs.  Thereafter several studies showed that association of occupational exposure to antineoplastic drugs with health effects such as DNA damage, chromosomal abnormalities, adverse reproductive outcomes, possibly leukemia and other cancers.  To prevent them, many guidelines for safe handling were published in various countries in 1980s, they are revised periodically afterward.  In 1990s, despite recommended safe handling procedures, environmental contamination with antineoplastic drugs was still observed in hospital and health care workers were still exposed.  In 2004, the National Institute for Occupational Safety and Health (NIOSH) published an Alert on hazardous drugs used in health care settings.  One recommendation was to consider the use of closed system drug transfer devices (CSTD) in addition to ventilated cabinets.  The effectiveness of CSTDs in reduction of environmental contamination and exposure of health care workers has been reported.  Here this report briefly reviews the history of the health effects of exposure to antineoplastic drugs and of safe handling.

Objective: In late 1970s, occupational exposure to antineoplastic agents was reported. Various countries, including Japan, have published guidelines for handling antineoplastic agents. Surveys are still being conducted to determine the levels of environmental exposure to antineoplastic agents at individual hospitals, and incidents of contamination are often reported. This study provides details regarding a literature survey conducted to evaluate the actual state of environmental contamination by antineoplastic agents and identify the related issues in order to promote environmental monitoring.Methods: The literature search was carried out from January 1, 1990 to July 31, 2017. PubMed and Ichushi-Web were searched with the following keywords: “antineoplastic agents,” “occupational exposure,” “surface contamination,” and “environmental monitoring.”Results: Following the literature search, 117 papers were included in the analysis. The findings showed that contamination by antineoplastic agents was widely reported in hospitals and places where antineoplastic drugs were not handled. The findings of this study regarding the actual state of environmental exposure are partial, as there is a lack of information on retail pharmacies and homes of outpatients who have received chemotherapy.Discussion: Therefore, further investigation is warranted. In addition, according to the current Japanese guidelines, published in 2015, environmental surveillance is not required to reduce contamination by antineoplastic agents. To promote environmental monitoring, we feel that it is necessary to determine a new survey method and the clarify optimum interval of environmental monitoring.