John Libbey Eurotext

Environnement, Risques & Santé


Antineoplastic drugs in sewage from hospitals and households Volume 5, issue 4, Juillet-Août 2006


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Les Collanges, 07240 Saint Jean Chambre, Pharmacie Hôpital Lapeyronie-Arnaud de Villeneuve, 371, Avenue Doyen Gaston Giraud, 34295 Montpellier, France

The constant increase in cancer diagnoses in Europe naturally leads to an increase of the treatment of these diseases, that is, chemotherapy and radiation therapy, alone or in various combinations. Chemotherapy involves the use of antineoplastic agents that are toxic for cells. Some of them have been classified by the International Agency for Research on Cancer as certain human carcinogens (azathioprine, chlorambucil, cyclophosphamide, etoposide combined with cisplatin and bleomycin, melphalan, semustine, tamoxifen, thiotepa), probable human carcinogens (adriamycin, lomustine, carmustine, cisplatin, chlorozotocin, etoposide, procarbazine, and teniposide), or possible human carcinogens (amsacrine, bleomycin, dacarbazine, daunomycin, methylthiouracil, merphalan, mitomycin C, mitoxantrone, and thiouracil). While preparation of the solutions for administration to patients necessarily entails waste (through, for example, accidental spillage, unused treatments, contaminated equipment), it is controlled relatively easily. During treatment, however, a high proportion (up to 70%) of some of these drugs is excreted in urine, feces and sweat (into patients’ garments), sometimes for several days. This waste is much more difficult to control. Some of it is concentrated in hospital sewage, but in view of the increase in outpatient cancer treatment and in the use of these drugs for veterinary treatment, all municipal sewage may be contaminated. Is there a risk to the fauna and the flora associated with the presence of these drugs in hospital effluent? How do these drugs behave at sewage treatment plants? Can these drugs be detected in surface water, ground water, and potable water ? Is there a risk for humans associated with pollution by these drugs ? The available information allows us to answer these questions, at least in part, and demonstrates a potential risk linked to the discharge of these drugs into our environment.