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Meta-Analysis
. 2020 Jan 14;17(2):523.
doi: 10.3390/ijerph17020523.

Extent of Primary DNA Damage Measured by the Comet Assay in Health Professionals Exposed to Antineoplastic Drugs: A Systematic Review and Meta-Analysis

Vincenza Gianfredi  1   2 , Daniele Nucci  3 , Cristina Fatigoni  1 , Tania Salvatori  1 , Milena Villarini  1 , Massimo Moretti  1
Affiliations
Meta-Analysis

Extent of Primary DNA Damage Measured by the Comet Assay in Health Professionals Exposed to Antineoplastic Drugs: A Systematic Review and Meta-Analysis

Vincenza Gianfredi et al. Int J Environ Res Public Health. .

Abstract

Background: Antineoplastic drugs (ANDs) are a broad group of chemicals showing, at the same time, carcinogenic effects. The potential, albeit true, risk of side effects cannot be accepted, especially if resulting from occupational exposure. The aim of this study was to evaluate the association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals.

Methods: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/Medline, Web of Science, and Scopus were used to perform the literature search. The databases were examined in July 2019. Sub-group, moderator, and cumulative analyses were conducted. The trim and fill method was used in the case of potential publication bias.

Results: Twenty studies were included in the qualitative analysis, and 19 in quantitative evaluation. The pooled effect size was 1.27 [(95% confidence interval (CI) = 0.66-1.88), p = 0.000] based on 1569 subjects. The moderator analysis by duration of exposure showed a positive association between duration of exposure and primary DNA damage.

Conclusions: This systematic review clearly shows a significant association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. Considering these results, health professionals should be warned against this potential occupational risk.

Keywords: antineoplastic drugs; comet assay; health personnel; occupational exposure; single-cell gel-electrophoresis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the selection process.
Figure 2
Figure 2
(a) Forest plot, (b) funnel plot, and (c) publication year plot of the meta-analysis assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs). ES, effect size; CI, confidence interval.
Figure 3
Figure 3
(a) Forest plot and (b) funnel plot of the meta-analysis assessing the comet assay on buccal cells among professionals occupationally exposed to antineoplastic drugs (ANDs).
Figure 4
Figure 4
(a) Forest plot and (b) funnel plot (after trim and fill method) of the meta-analysis assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs), only including studies with a quality score (QS) ≥16.
Figure 5
Figure 5
Forest plot of the sub-group analysis by gender assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs). F, female, M, male.
Figure 6
Figure 6
Forest plot of the sub-group analysis by protective equipment used assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs). (a) Without any equipment or at least gloves and masks; (b) using at least gloves, masks, and air-flow cabinet.
Figure 6
Figure 6
Forest plot of the sub-group analysis by protective equipment used assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs). (a) Without any equipment or at least gloves and masks; (b) using at least gloves, masks, and air-flow cabinet.
Figure 7
Figure 7
Forest plot of the sub-group analysis by work task (including only studies where controls were other health professionals different from nurses) assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs).
Figure 8
Figure 8
Forest plot of sub-group analysis by continent, assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs).
Figure 9
Figure 9
Cumulative analysis by (a) year of publication (descending order) and (b) effect size (ES) (from the smallest to the biggest) assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs).
Figure 9
Figure 9
Cumulative analysis by (a) year of publication (descending order) and (b) effect size (ES) (from the smallest to the biggest) assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs).
Figure 10
Figure 10
(a) Moderator analysis by year of publication (the first group consisted of studies until 2004, the second between 2005 and 2010, and the third after 2010 until today); (b) meta-regression analysis by duration of exposure; and (c) meta-regression analysis by mean age of exposed groups, assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs).
Figure 10
Figure 10
(a) Moderator analysis by year of publication (the first group consisted of studies until 2004, the second between 2005 and 2010, and the third after 2010 until today); (b) meta-regression analysis by duration of exposure; and (c) meta-regression analysis by mean age of exposed groups, assessing the comet assay on lymphocytes cells among professionals occupationally exposed to antineoplastic drugs (ANDs).
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