Ethylene Oxide Exposure and Risk of Breast Cancer in Hospitals: A Cross-Sectional Study in Hungary

György Ungváry1, Péter Rudnai2, Imre Nagy3, Éva Szakmáry3, Veronika Morvai4,
Mária Groszmann5, Zoltán Virágh2, Márta Bakacs6, and Ilona Molnár7

1 Department of Occupational and Environmental Health, Semmelweis University, Budapest, Hungary (Previous address: Fodor József National Center for Public Health, Budapest, Hungary)
2 National Institute of Environmental Health, Budapest, Hungary
3 National Institute of Occupational Health, Budapest, Hungary
4 Department of Occupational and Environmental Health, Semmelweis University, Budapest, Hungary (Previous address: 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary)
5 Hungarian Labour Inspectorate, Budapest, Hungary (Previous address: Office of Chief Medical Officer, Budapest, Hungary)
6 National Center for Health Care Audit and Inspection, Budapest, Hungary (Previous address: National Institute of Environmental Health, Budapest, Hungary)
7 Small-area Public Health Institute, Kecskemét, Hungary (Previous address: Office of Chief Medical Officer of the National Public Health Service, Budapest, Hungary)

Corresponding author: Prof. György Ungváry
    Budapest H-1450, PO Box 22, Hungary
    E-mail: ungvary@omfi.hu

CEJOEM 2008, Vol.14. No.2.: 125-135

Key words:
ethylene oxide, breast cancer, sterilizers, health staff, x-ray exposure

Abstract:
Background: Between 1986 and 1998 eight cases of breast cancer and six cases of other malignant tumours were recorded among 200 female employees in the Paediatric and the Premature Babies Wards of a county hospital in Hungary. Eight of the 14 patients died. The tumours were suspected to be of occupational origin, due to exposure to ethylene oxide (ETO) in the workplace atmosphere, coming from the improperly operated sterilizers. As the operation of the sterilizers was similarly improper in the majority of the Hungarian hospitals, it was presumed that a study involving all hospitals in Hungary could verify the relationship between ETO exposure and breast cancer. Therefore a country-wide survey was initiated.
    Methods: The relationship between the frequency of breast cancer among female workers employed longer than 0.1 year in ETO exposure and the improper operation of ethylene oxide sterilizers in 190 hospitals of Hungary was studied in 1999 by a questionnaire-interview method. Altogether 6,585 female workers participated in the study; the participation was voluntary. Among the subjects 940 was exposed only to ETO, 1011 to ETO + potential X-ray exposure, 1689 only to potential X-ray exposure and 2945 were not exposed to any of these factors, respectively. During the statistical analysis of the collected data Chi square test, Mann-Whitney test and logistic regression were performed.
    Results: ETO exposure significantly increased the frequency of breast tumours 10-20 years after the start of the exposure. There was a significant relationship between the frequency of breast tumours and the duration of ETO exposure, and additionally, the improper placing and operation of the sterilizers which were the source of ETO exposure.
    Conclusion: It is concluded that one of the target organs of the malignant changes caused by ETO exposure is the breast. Besides the information on the concentration of ETO in the working atmosphere, occupational origin of the disease was supported by the latency period of at least 10 years and the exposure time of several years. Breast cancer of health staff (physicians, nurses, sterilizing staff) working in ETO exposure has been regarded as an occupational disease in Hungary.

Received: 06 July 2008
Accepted: 08 September 2008
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