Exposure Registries as a Prevention Tool for Occupational Cancers: Establishing a New Hazardous Drug Registry for Oncology Personnel

Public health registries collect and maintain demographic and health data on a cohort of people with a common disease or exposure. While disease registries have proliferated in recent decades, registries comprising persons with potentially hazardous exposures-known commonly as exposure registries-are rare. Occupational exposure registries allow for hazardous work exposures to toxicants, including carcinogens, to be systematically tracked to facilitate preventive and mitigating interventions for exposed workers. However, the virtual absence of such registries, combined with the fact that state-based cancer registries do not systematically collect occupational or other exposure information, hinders efforts to study the role of occupation in US cancer cases or undertake appropriate medical surveillance for exposed workers. Given the considerable, and under-recognized, risk of occupational cancer, exposure registries focused on workplace carcinogens could fill this gap. A recent initiative at the authors' home institution has established a national exposure registry of oncology personnel handling hazardous drugs, most notably antineoplastic drugs, many of which are themselves known human carcinogens. The registry aims to facilitate the comprehensive collection of data on exposure scenarios; aid in raising awareness of, and tracking compliance with, best practices in hazardous-drug handling to mitigate risks; and assess long-term cancer, reproductive, and other potentially exposure-associated health outcomes in this worker population. Occupational exposure registries are an underutilized tool in occupational health surveillance. The development of such a registry for hazardous drug exposures is a feasible and scalable model for registry development in other high-risk work environments.