Genotoxicity Biomarkers in Healthcare Workers Occupationally Exposed to Antineoplastic Drugs: A Systematic Review and Meta-Analysis

Introduction

Healthcare workers involved in preparation and administration of antineoplastic drugs face chronic low-level exposure to human carcinogens as classified by the International Agency for Research on Cancer. Despite established safety protocols including personal protective equipment and closed-system drug transfer devices, studies confirm that ongoing exposure persists. Although genotoxic effects in this occupational field are biologically possible, the evidence is still inconsistent and not completely synthesized across various contexts, protection levels, and biomarker endpoints.

Methods

This systematic review and meta-analysis is being conducted following PRISMA 2020 guidelines. The basis of this review if formed by literature searches of PubMed and Scopus from 2015 to 2026, combining terms for antineoplastic drug exposure, healthcare workers, and genotoxicity biomarkers. Eligibility of studies report on micronucleus frequency, chromosomal aberrations, or DNA strand breaks measured by comet assay in occupationally exposed workers. Risk of bias is assessed using the Newcastle-Ottawa Scale. Heterogeneous outcome formats across studies are converted to a common scale and pooled using a random-effects model.

Results

Preliminary search identified studies reporting elevated genotoxicity biomarker frequencies in exposed workers compared to controls across genotoxicity endpoints including micronucleus frequency, chromosomal aberrations, and DNA strand breaks. Effect magnitude varied substantially across settings, with studies reporting high compliance with personal protective equipment and closed-system drug transfer devices consistently showing attenuated or absent genotoxic effects. Differences in protective equipment use and handled drug mixtures appear to contribute substantially to heterogeneity across studies.

Conclusions

Healthcare workers who handle antineoplastic medications are consistently at risk for genotoxicity. The degree of preventative measures in place is inversely correlated with the effect magnitude. These findings highlight a critical gap between existing safety guidelines and real-world protection, contributing to the evidence base for mandatory implementation of closed-system drug transfer devices and standardised biological monitoring in oncology settings.