Antimony Trioxide

Antimony Trioxide

Antimony Trioxide Profile

Antimony Trioxide Profile

General Information

Antimony trioxide (Sb2O3) is a slightly soluble, white crystalline powder.[1] It is produced by smelting antimony-containing ores[1] or reacting antimony trichloride with water.[2] Antimony is not abundant in the earth’s crust.[3] Antimony trioxide may also be referred to as diantimony trioxide (DAT), antimony oxide, or in manufacturing as antimony white.[4] There are numerous other synonyms and product names; see the Hazardous Substances Data Bank (HSDB) for more information.[4]

Antimony trioxide was last classified by the International Agency for Research on Cancer (IARC) in 1989 as Group 2B, possibly carcinogenic to humans, based on inadequate evidence in humans and sufficient evidence in animals.[1] Antimony trioxide is a respiratory carcinogen in female rats.[1]

The epidemiological literature on exposure to antimony trioxide is not extensive and is limited by difficulty in controlling for confounding variables. Recent reviews of studies report excesses of lung cancer in antimony exposed smelter workers, but factors such as smoking, exposures to PAHs and other metals (e.g. arsenic), were not appropriately controlled.[2,5]

Antimony trioxide has also been linked to pneumoconiosis, bronchitis, and airway inflammation.[3] Digestive and neurologic symptoms have been reported from high levels of exposure, but causal relationships have not been established.[3] An early study reported that exposure is associated with an increase in spontaneous abortions, premature birth, and slow growth rates in offspring.[6] The study’s control of confounding variables and exposure assessment techniques, however, were unclear.[7]

Regulations and Guidelines

Occupational exposure limits (OEL)[8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]

Canadian JurisdictionsSubstanceOEL (mg/m3)
Canada Labour CodeSb2O3, production
Sb & its compounds
ALARA 
0.5
ABSb2O3, production
Sb & its compounds
 
0.5
BC, MB, ON, NB, NL, PEI, NSSb2O3, production
Sb & its compounds
ALARA 
0.5
SK, NT, NUSb2O3
Sb & its compounds
 
0.5; 1.5 [stel]
QCSb2O3
Sb & its compounds
Sb2O3 production (as SB)
0.5 
0.5
ALARA
YTSb2O3 production (as SB)0.5 
0.5; 0.75 [stel]
Other JurisdictionsSubstanceOEL (mg/m3)
ACGIH 2020 TLVSb2O3, production
Sb & its compounds
ALARA 
0.5
mg/m3 = milligrams per cubic meter
ALARA = as low as reasonably achievable
stel = short term exposure limit (15 min. maximum)
ACGIH = American Conference of Governmental Industrial Hygienists
TLV = threshold limit value

Canadian environmental guidelines and standards*

JurisdictionLimitYear
Canadian and Ontario Drinking Water Guidelines
(Antimony)
0.006 mg/L2017[23]
2016[24]
BC’s Contaminated Sites Regulation, BC Reg 375/96Sets soil standards for the protection of human health for antimony:
Agricultural and low density residential sites: 250 μg/g
Urban park and high density residential sites: 500 μg/g
Commercial sites: 1,500 μg/g
Industrial sites: 40,000 μg/g

 

Drinking water: 6 μg/L

2017[25]
Ontario Ambient Air Quality CriteriaAnnual: 0.12 µg/m3
24-hour: 0.6 µg/m3
2016[26]
Ontario’s Air Pollution – Local Air Quality Regulation Standards24-hour standard: 25 µg/m3; Prohibited discharge into the air if the concentration of antimony trioxide exceeds the standard2020[27]
Quebec’s Clean Air Regulation1 year limit: 0.17 µg/m3 (antimony, metal and compounds); Prohibited discharge into the air if the concentration of antimony trioxide exceeds the standard2011[28]
*Standards are legislated and legally enforceable, while guidelines (including Ontario ambient air quality criteria) describe concentrations of contaminants in the environment (e.g. air, water) that are protective against adverse health, environmental, or aesthetic (e.g. odour) effects

Canadian agencies/organizations

AgencyDesignation/PositionYear
Health CanadaDSL – high priority substance
(greatest potential for exposure)
2006[29]
Challenge to IndustryBatch 92010[30]
National Classification System for Contaminated SitesRank = “High hazard”, potential human carcinogen (antimony)2008[31]
Cosmetic Ingredient HotlistNot permitted2004[32]
PMRA List of formulantsList 4B: List 4B contains formulants, some of which may be toxic, for which there are sufficient data to reasonably conclude that the specific use pattern of the pest control product will not adversely affect public health and the environment2018[33]
Environment Canada’s National Pollutant Release InventoryNPRI Part (Threshold Category): 1A, Reportable to NPRI if manufactured, processed, or otherwise used at quantities greater than: 10 tonnes (for antimony and its compounds)2016[34]
DSL = domestic substance list

Antimony trioxide was not included in other Canadian government guidelines, standards, or chemical listings reviewed.

 

Main Uses

Antimony trioxide is mainly used as a chemical synergist in chlorinated and brominated flame-retardants, increasing the retardants’ effectiveness.[35] Flame retardants containing antimony trioxide are used widely in producing textiles, plastics, rubber, and paints.[1]

Antimony trioxide is the main catalyst used to produce polyethylene terephthalate (PET) and polyester fibers. PET is commonly used in plastic packaging for water and soft drinks.[35] It is also used as a pigment and/or clarifying agent in certain glasses and ceramics.[36] As of 1995, antimony trioxide gained popularity as an additive in optical glass, replacing arsenious oxide.[37]

Antimony metal increases hardness and strength in lead alloys and is used in lead storage batteries, solder, sheet and pipe metal, bearings, castings, and pewter.[3] Antimony trioxide is produced when elemental antimony is heated and/or oxidized.[3]

Canadian Production and Trade

Antimony trioxide is primarily used to create household flame retardants and plastic (polyethylene terephthalate).[38]

Antimony is naturally occurring in the Cordilleran (west coast) and Appalachian (east coast) regions of Canada.[39] Approximately 401 tonnes of antimony is mined in Canada annually, and it is considered a “critical mineral for the economic success of Canada”.[39,40] China, Belgium and France are the highest exporters globally, each exporting over 10,000 tonnes annually.[41]

At full capacity, Beaver Brook Antimony Mine Inc. in Newfoundland will mine approximately 160,000 tones of antimony per year.[42,43] Operations were temporarily suspended in November 2020 due to the COVID-19 pandemic however mining resumed at the end of September 2021.[42]

Production and trade

ActivityQuantityYear
Canadian Production76 t2013[44]
Export:109 t (of ‘antimony oxides’)2021[45]
Import:2,395 t (of ‘antimony oxides’)2021[45]
t = tonne

Environmental Exposures Overview

The main source of exposure to antimony trioxide for the general population is through dermal contact with household items that contain flame retardants, such as paint, mattress covers and furniture upholstery.[46] However, Environment Canada reports that exposures from this pathway are low.[46]

Other sources of environmental exposure include food, drinking water, and air.[3,46] Overall, levels of antimony trioxide in water are low due to its poor solubility in water.[46] Higher levels of exposure may occur around smelters, incinerators, and near combustion of petroleum and coal products.[3] Higher levels of exposure to antimony trioxide have also been associated with smokers and those exposed to secondhand smoke.[47]

Searches of Environment Canada’s National Pollutant Release Inventory (NPRI) and the US Consumer Product Information Database yielded the following results on current potential for exposure to antimony trioxide in Canada:

NPRI and US Consumer Product Information Database

NPRI 2015[48]
Substance name: ‘Antimony and its compounds’
CategoryQuantityIndustry
Released into Environment2.9 tNon-ferrous metal (except aluminum)
production and smelting,
petroleum and coal product manufacturing,
Metal ore mining,
Other electrical equipment manufacturing,
oil and gas extraction (46 facilities)
Disposed of508 t
Sent to off-site recycling184 t
t = tonne
US Consumer Products 2016[49]
Search Term# ProductsProduct Type
‘Antimony oxide’26Insulation (solid or fibre form)

Occupational Exposures Overview

Inhalation is the most important route of occupational exposure, however oral and dermal contact are also a concern.[3]

CAREX Canada estimates that approximately 8,700 Canadians are exposed to antimony trioxide in the workplace. The primary industrial groups exposed are public administration, followed by glass and glass product manufacturing. In terms of occupations, the largest exposed groups are police officers (exposed in firing ranges), welders and related machine operators, artisans and craftspersons, and glass forming and finishing machine operators and glass cutters.

Other workers likely to be exposed include those involved in: antimony trioxide production; antimony processing, smelting, and packaging of antimony compounds; production of ceramics and alloys that contain Sb2O3; and manufacture and application of flame retardants.[36]

Workers in facilities that recycle lead-acid batteries may also be exposed to antimony.[50] Firefighters and other emergency workers may be exposed when materials containing antimony trioxide as a fire retardant combust.[36] Exposures may also occur for workers involved producing PET bottles, where antimony trioxide is used as the main catalyst.

For more information, see the occupational exposure estimate for antimony trioxide.

Sources

Photo: Wikimedia Commons, Rob Lavinsky

1. International Agency for Research on Cancer (IARC). Monograph summary, Volume 47 (1989) (PDF)
3. Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for antimony and its compounds (1992) (PDF)
4. US National Library of Medicine. PubChem (Search term: ‘Antimony trioxide’)
5. De Boeck M, Kirsch-Volders M, Lison D. “Cobalt and antimony: Genotoxicity and carcinogenicity” Mutat Res 2003;533:135-152.
6. Belyaeva, A.P. “The effect of antimony on reproduction.” Gig. Truda. Prof. Zabol. 1976;11(1):32-37.
7. US Environmental Protection Agency (EPA). Provisional Peer Reviewed Toxicity Values for Antimony Trioxide (2008)  (PDF)
11. The Canadian Legal Information Institute (CanLII) Manitoba Regulation 217/2006 Workplace Safety and Health Regulation (2022)
13. Government of Newfoundland and Labrador. Regulation 5,12 Occupational Health and Safety Regulations (2018)
14. Government of the Northwest Territories. Occupational Health and Safety Regulations, R-039-2015 (2020) (PDF)
16. The Canadian Legal Information Institute (CanLII). Government of Nunavut’s Occupational Health and Safety Regulations, Nu Reg 003-2016 (2010)
18. Government of Prince Edward Island. Occupational Health and Safety Act Regulations Chapter 0-1 (2013) (PDF)
20. The Canadian Legal Information Institute (CanLII) The Occupational Health and Safety Regulations, 1996 (2022)
21. The Canadian Legal Information Institute (CanLII). Yukon’s Occupational Health Regulations, O.I.C. 1986/164 (2020) (PDF)
22. Occupational Safety and Health Administration (OSHA). Annotated PELs (2020)
24. The Canadian Legal Information Institute (CanLII). Ontario Drinking Water Quality Standards, O Reg 169/03 (2020)
25. Government of British Columbia. Contaminated Sites Regulation B.C. Reg. 375/96 (2021)
26. Ontario Ministry of the Environment and Climate Change. Ontario’s Ambient Air Quality Criteria (2019)
27. Health Canada. Cosmetic Ingredients Hotlist (2019)
28. Government of Canada. List of Permitted Food Additives (2017)
29. Health Canada. Prioritization of the DSL (2006)
30. Government of Canada. List of all Challenge Substances (2010)
31. Canadian Council of Ministers of the Environment (CCME). National Classification System for Contaminated Sites (2008) (PDF)
32. Health Canada. Cosmetic Ingredient Hotlist (2019)
34. Environment and Climate Change Canada. National Pollutant Release Inventory (NPRI) Facility Search (2022)
35. International Antimony Association (i2a). Antimony Trioxide (ATO) (2014)
36. National Toxicology Program (NTP). Brief Review of Toxicology Literature; Antimony Trioxide (2005) (PDF)
37. Camford Information Services Inc. CPI Product Profiles: Antimony Trioxide (1995)
39. The Canadian Encyclopedia. Antimony (2016)
40. Natural Resources Canada. Critical minerals (2021)
41. World Integrated Trade Solution. Antimony oxides exports by country in 2019 (2019)
42. Government of Newfoundland and Labrador. Mining in Newfoundland and Labrador (2021) (PDF)
45. International Trade Centre. TradeMap (Free subscription required)
48. Environment and Climate Change Canada. National Pollutant Release Inventory (NPRI) Facility Search (Substance name: (NA – 01) Antimony (and its compounds))
49. Consumer Product Information Database (CPID).What’s in it? (2022) (Search term: ‘Antimony trioxide’)

     

Other Resources

  1. Agency for Toxic Substances and Disease Registry (ATSDR). ToxFAQs Sheet: Antimony (1995)
  2. Shotyk W, Krachler M, Chen B. “Contamination of Canadian and European bottled waters with antimony from PET containers.” J Environ Monit 2006;8:288-292.
  3. Krachler M, Zheng J, Koerner R, Zdanowicz C, Fisher D, Shotyk W. “Increasing atmospheric antimony contamination in the northern hemisphere: snow and ice evidence from Devon Island, Arctic Canada.” J Environ Monit 2005;7:1169 – 1176.

Subscribe to our newsletters

The CAREX Canada team offers two regular newsletters: the biannual e-Bulletin summarizing information on upcoming webinars, new publications, and updates to estimates and tools; and the monthly Carcinogens in the News, a digest of media articles, government reports, and academic literature related to the carcinogens we’ve classified as important for surveillance in Canada. Sign up for one or both of these newsletters below.

CAREX Canada

School of Population and Public Health

University of British Columbia
Vancouver Campus
370A - 2206 East Mall
Vancouver, BC  V6T 1Z3
CANADA

© 2025 CAREX Canada
Simon Fraser University

As a national organization, our work extends across borders into many Indigenous lands throughout Canada. We gratefully acknowledge that our host institution, the University of British Columbia Point Grey campus, is located on the traditional, ancestral, and unceded territories of the xʷməθkʷəy̓əm (Musqueam) people.

Antimony Trioxide – Occupational Exposures

Antimony Trioxide Occupational Exposures

Antimony Trioxide Occupational Exposures

Overview

Inhalation is the most important route of occupational exposure, however oral and dermal contact are also a concern.[1] CAREX Canada estimates that approximately 8,700 Canadians are exposed to antimony trioxide in the workplace.

READ MORE...

The primary industrial groups exposed are public administration, followed by glass and glass product manufacturing. In terms of occupations, the largest exposed groups are police officers (exposed in firing ranges), welders and related machine operators, artisans and craftspersons, and glass forming and finishing machine operators and glass cutters.

Other workers likely to be exposed include those involved in: antimony trioxide production; antimony processing, smelting, and packaging of antimony compounds; production of ceramics and alloys that contain Sb2O3; and manufacture and application of flame retardants.[2] Workers in facilities that recycle lead-acid batteries may also be exposed to antimony.[3] Firefighters and other emergency workers may be exposed when materials containing antimony trioxide as a fire retardant combust.[2] Exposures may also occur for workers involved producing PET bottles, where antimony trioxide is used as the main catalyst.

Prevalence Estimate

Results show that 8,700 Canadians are exposed to antimony trioxide in their workplaces; 78% of these workers are male. The largest industrial groups exposed are public administration (where police officers are captured), glass and glass products manufacturing, textile product mills, and plastic product manufacturing.

When exposure is examined by occupation, the largest exposed groups are police officers (exposed in firing ranges, 3,900 workers exposed) and welders and related machine operators (2,400 workers exposed). Other important jobs are artisans and craftspersons (370 workers exposed) and workers in glass forming and cutting (360 workers exposed).

The number of workers exposed to antimony trioxide decreased by approximately 1,000 workers from 2006 to 2016 (an 11% decrease). This was primarily driven by a decrease in the total number of artisans.

Workers exposed to antimony trioxide by industry in 2016

Workers exposed to antimony trioxide by region in 2016

Click the second tab to view total number of workers exposed.

* = < 50 workers
Methods and Data

Our Occupational Approach page outlines the general approach used to calculate prevalence and exposure level estimates for workplace exposures.

Data Sources

Data used in developing the occupational estimates for antimony trioxide were collected from several sources:

  1. The Canadian Workplace Exposure Database (CWED) contains over 600 measurements for antimony trioxide exposure. These measurements were collected during the years 1981 to 2004 in Ontario and British Columbia workplaces.
  2. Canadian and US scientific peer reviewed publications that addressed antimony trioxide exposure in Canada and the United States.
  3. Grey literature including technical reports from governments and international bodies.

Prevalence Estimate Method

CAREX defines exposure to antimony trioxide as inhalation and/or dermal exposure at work to levels above those encountered in the general environment.

To determine the number of workers potentially exposed to antimony trioxide at work, CAREX occupational exposure experts used methods previously established in other peer-reviewed CAREX projects in Europe. A series of steps were taken to assign exposure proportions to occupations and industries at risk of exposure to antimony trioxide.

Sources

1. Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for antimony and its compounds (1992) (PDF)
2. National Toxicology Program (NTP). Brief Review of Toxicology Literature; Antimony Trioxide (2005) (PDF)

Subscribe to our newsletters

The CAREX Canada team offers two regular newsletters: the biannual e-Bulletin summarizing information on upcoming webinars, new publications, and updates to estimates and tools; and the monthly Carcinogens in the News, a digest of media articles, government reports, and academic literature related to the carcinogens we’ve classified as important for surveillance in Canada. Sign up for one or both of these newsletters below.

CAREX Canada

School of Population and Public Health

University of British Columbia
Vancouver Campus
370A - 2206 East Mall
Vancouver, BC  V6T 1Z3
CANADA

© 2025 CAREX Canada
Simon Fraser University

As a national organization, our work extends across borders into many Indigenous lands throughout Canada. We gratefully acknowledge that our host institution, the University of British Columbia Point Grey campus, is located on the traditional, ancestral, and unceded territories of the xʷməθkʷəy̓əm (Musqueam) people.

Antimony Trioxide – Resources

Antimony Trioxide Resources

Package summaries

Publications

Videos

Exposure Reduction

Our team has performed a detailed scan of exposure control resources and assembled a compilation of key publications and resources. These are organized by type of exposure (environmental or occupational) and by specificity (general or carcinogen-specific). Please visit our Exposure Reduction Resources page to view.

We also recommend exploring the Prevention Policies Directory, a freely-accessible online tool offering information on policies related to cancer and chronic disease prevention. Providing summaries of the policies and direct access to the policy documents, the Directory allows users to search by carcinogen, risk factor, jurisdiction, geographical location, and document type. For questions about this resource, please contact a member of the Prevention Team at the Canadian Partnership Against Cancer at [email protected].

Subscribe to our newsletters

The CAREX Canada team offers two regular newsletters: the biannual e-Bulletin summarizing information on upcoming webinars, new publications, and updates to estimates and tools; and the monthly Carcinogens in the News, a digest of media articles, government reports, and academic literature related to the carcinogens we’ve classified as important for surveillance in Canada. Sign up for one or both of these newsletters below.

CAREX Canada

School of Population and Public Health

University of British Columbia
Vancouver Campus
370A - 2206 East Mall
Vancouver, BC  V6T 1Z3
CANADA

© 2025 CAREX Canada
Simon Fraser University

As a national organization, our work extends across borders into many Indigenous lands throughout Canada. We gratefully acknowledge that our host institution, the University of British Columbia Point Grey campus, is located on the traditional, ancestral, and unceded territories of the xʷməθkʷəy̓əm (Musqueam) people.

Antineoplastic Agents

Antineoplastic Agents

Antineoplastic Agents Profile

OTHERS  MULTIPLE CLASSIFICATIONS (IARC 1, 2A, 2B)

Numerous IARC Monographs (details under General Information)

Antineoplastic Agents Profile

QUICK SUMMARY

  • A group of drugs that are used to treat various cancers
  • Associated cancers: Cancers of the breast, lung, ovary, liver, and bladder; cancers of the hematopoietic system
  • Most important routes of exposure: Inhalation, skin contact, ingestion, needle stick injury
  • Uses: Prevent the growth and spread of tumor cells
  • Occupational exposures: Approx. 79,000 Canadians are exposed at work, primarily pharmacy staff (pharmacists, technicians, and assistants) and nurses
  • Environmental exposures: Via drinking water, results are inconclusive; also from cancer treatment for patients
  • Fast fact: Antineoplastic agents are increasingly used as treatments for cancer and other conditions.

General Information

Antineoplastic agents, also referred to as chemotherapy drugs or cytotoxic drugs, are the most common type of systemic drug therapy to treat cancer.[1] These drugs interfere with cancer cells’ ability to grow and spread in a variety of ways. They are administered to treat chemo-sensitive cancers (e.g. testicular cancer), as adjuvant therapy (i.e. in conjunction with surgery or radiation), as maintenance therapy (i.e. to prevent relapse and improve survival), or as palliative treatment (i.e. to reduce symptoms and improve quality of life).[1]

Different antineoplastic agents have been classified by the International Agency for Research on Cancer (IARC) as Group 1 (carcinogenic to humans), Group 2A (probably carcinogenic to humans), or Group 2B (possibly carcinogenic to humans) based on varying strengths of evidence of carcinogenicity in animal and human studies, as well as mechanistic considerations.[2,3,4,5,6,7]

A number of adverse health effects are associated with exposure to antineoplastic agents in humans and animals. These include gastrointestinal problems, kidney damage, neurotoxicity, bone marrow suppression, hair loss, and reproductive problems after long-term use.[8]

In addition, patients receiving antineoplastic agents as therapeutic treatments are at increased risk of cancer and other health outcomes. CAREX Canada does not review this exposure circumstance because these treatments are often a necessary medical intervention with tangible benefits for patients. Conversely, workers handling antineoplastic agents are at risk of adverse health outcomes with no positive impact on their well-being.

IARC Classification of antineoplastic agents[9,10]

IARC Classification GroupAntineoplastic Agent
1 (Carcinogenic to humans)Arsenic trioxide
Melphalan
Thiotepa
Busulfan
Chlorambucil
Cyclophosphamide
Etoposide
Tamoxifen
2A (Probably carcinogenic to humans)Azacitidine
Cisplatin
Procarbazine
Teniposide
Carmustine
Adriamycin
Lomustine
2B (Possibly carcinogenic to humans)Amsacrine
Streptozotocin
Daunomycin
Bleomycin
Mitomycin
Mitoxantrone

Regulations and Guidelines

Occupational Exposure Limits (OEL)

No occupational exposure limits for Canada or any other international bodies were located.

Classifications under the Canadian Environmental Protection Act (CEPA)

AgentDesignationDate added
AdriamycinDSL* – high priority substance with lowest potential for exposure2006[11]
ChlorambucilDSL* – high priority substance2004[11]
CisplatinNDSL**1998[11]
CyclophosphamideDSL* – high priority substance2004[11]
MelphalanDSL* – high priority substance2004[11]
*The Domestic Substances List (DSL) is an inventory of approximately 23,000 substances manufactured in, imported into, or used in Canada on a commercial scale. The DSL is the sole standard against which a substance is judged to be “new” to Canada.[12,13]

**The Non-Domestic Substances List (NDSL) is an inventory of substances included in the EPA’s Toxic Substances Control Act (TSCA), but not on Canada’s DSL.[13]

Adriamycin, chlorambucil, cisplatin, cyclophosphamide, and melphalan were not included in other Canadian government chemical listings reviewed.[14]

Main Uses

Antineoplastic agents are drugs used to treat cancer and other conditions such as rheumatoid arthritis and psoriasis.[15]

Canadian Production and Trade

Major Canadian importers of antineoplastic agents in 2020 include Astrazeneca Canada Inc., Janssen Inc., Pfizer Canada ULU, and Teva Canada Limited.[16] The total value of imports is approximately $929 million Canadian dollars.[16]

Occupational Exposures Overview

Occupational exposure to antineoplastic agents may occur directly via dermal contact, inhalation, ingestion, accidental injection, or indirectly via contact with contaminated surfaces and objects.[17] This can occur in hospitals, where antineoplastic agents are handled in shipping and receiving areas, prepared in pharmacies, administered in wards, and contacted through sanitary services such as laundry, cleaning, and waste handling.[18] Exposure can also occur outside of hospitals in workplaces such as community pharmacies, veterinary care facilities, and home care settings.[19]

CAREX Canada estimates that approximately 79,000 Canadians are exposed to antineoplastic agents at work; most exposures occur in the moderate category. In addition, over 75% of exposed workers are female.

Exposure to antineoplastic agents was not estimated by industry per se, but by setting. The largest number of workers exposed were in non-hospital settings, with a substantial proportion working in hospitals.

Occupations at risk of exposure to antineoplastic agents include community pharmacy workers (including pharmacists, technicians, and assistants), hospital nurses (including nurses and licensed nurse practitioners), and hospital pharmacy workers (including pharmacists, technicians, and assistants).

For more information, see the occupational exposure estimate for antineoplastic agents.

Sources

1. Pham T, Holle L. Cancer Therapy: Prescribing and Administration Basics. Burlington, MA: Jones & Bartlett Learning. (2015)
2. International Agency for Research on Cancer (IARC). IARC Monograph, Volume 26 (1987) (PDF)
3. International Agency for Research on Cancer (IARC). IARC Monograph, Volume 100C (2012) (PDF)
4. International Agency for Research on Cancer (IARC). IARC Monograph, Volume 100A (2012) (PDF)
5. International Agency for Research on Cancer (IARC). IARC Monograph, Volume 50 (1990) (PDF)
6. International Agency for Research on Cancer (IARC). IARC Monograph, Supplement 7 (1987) (PDF)
7. International Agency for Research on Cancer (IARC). IARC Monograph, Volume 76 (2000) (PDF)
8. US National Library of Medicine. PubChem
9. International Agency for Research on Cancer (IARC). Agents Classified by the IARC Monographs, Volumes 1–117 (2016) (PDF)
10. National Institute for Occupational Safety and Health (NIOSH). List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings (2016)
11. Environment and Climate Change Canada. Domestic Substance list: Search Engine for Chemicals, biochemicals, polymers and biopolymers published in the Canada Gazette (2022) (Search terms: ‘23214-92-8’; ‘305-03-3’; ‘15663-27-1′; ’50-18-0’; ‘148-82-3’)
12. Environment and Climate Change Canada. Domestic Substances List (2015) (PDF)
13. Environment and Climate Change Canada. Search Engine for Chemicals and Polymers (2022) (Search term: “23214-92-8 and 15663-27-1”)
14. Environment and Climate Change Canada. CEPA List of Toxic Substances (1999)
15. National Toxicology Program (NTP). 14th Report on Carcinogens for Chlorambucil (2016)
17. National Institute for Occupational Safety and Health (NIOSH). NIOSH Workplace Safety and Health Topic: Occupational Exposure to Antineoplastic Agents (2015)
18. Hon C-Y, Teschke K, Chu W, Demers P, Venners S. “Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals.” Journ of Occup and Environ Hygiene 2013;10(7):374–83.
19. Meijster T, Fransman W, Veldhof R, Kromhout H. “Exposure to antineoplastic drugs outside the hospital environment.” Ann Occup Hyg 2006;50(7): 657–64.

Subscribe to our newsletters

The CAREX Canada team offers two regular newsletters: the biannual e-Bulletin summarizing information on upcoming webinars, new publications, and updates to estimates and tools; and the monthly Carcinogens in the News, a digest of media articles, government reports, and academic literature related to the carcinogens we’ve classified as important for surveillance in Canada. Sign up for one or both of these newsletters below.

CAREX Canada

School of Population and Public Health

University of British Columbia
Vancouver Campus
370A - 2206 East Mall
Vancouver, BC  V6T 1Z3
CANADA

© 2025 CAREX Canada
Simon Fraser University

As a national organization, our work extends across borders into many Indigenous lands throughout Canada. We gratefully acknowledge that our host institution, the University of British Columbia Point Grey campus, is located on the traditional, ancestral, and unceded territories of the xʷməθkʷəy̓əm (Musqueam) people.

Antineoplastic Agents – Occupational Exposures

Antineoplastic Agents Occupational Exposures

Antineoplastic Agents Occupational Exposures

Overview

Occupational exposure to antineoplastic agents may occur directly via dermal contact, inhalation, ingestion, accidental injection, or indirectly via contact with contaminated surfaces and objects.[1] This can occur in hospitals, where antineoplastic agents are handled in shipping and receiving areas, prepared in pharmacies, administered in wards, and contacted through sanitary services such as laundry, cleaning, and waste handling.[2] Exposure can also occur outside of hospitals in workplaces such as community pharmacies, veterinary care facilities, and home care settings.[3]

READ MORE...

CAREX Canada estimates that approximately 79,000 Canadians are exposed to antineoplastic agents at work; most exposures occur in the moderate category. In addition, over 75% of exposed workers are female.

Exposure to antineoplastic agents was not estimated by industry per se, but by setting. The largest number of workers exposed were in non-hospital settings, with a substantial proportion working in hospitals.

Occupations at risk of exposure to antineoplastic agents include community pharmacy workers (including pharmacists, technicians, and assistants), hospital nurses (including nurses and licensed nurse practitioners), and hospital pharmacy workers (including pharmacists, technicians, and assistants).

Prevalence Estimate

Results show that approximately 79,000 Canadians are occupationally exposed to antineoplastic agents; over 75% are female. The largest occupational group exposed to antineoplastic agents is pharmacy staff (pharmacists, technicians, and assistants), with 49,000 workers exposed. Of these, 34,000 workers are based in community settings.

When examining exposure further by work setting, 43,000 workers (55% of all exposed) are located in non-hospital settings; the remaining 36,000 are exposed in hospitals.

The number of workers exposed to antineoplastic agents increased by approximately 4,000 workers from 2011 to 2016 (a 5% increase). This was primarily driven by an increase in the number of exposed nurses.

 

Level of exposure

In total, approximately 79,000 Canadians are exposed to antineoplastic agents in their workplaces. Exposure levels were developed differently across occupations and are shown here as a simplified summary. The majority of workers exposed to antineoplastic agents are in the moderate exposure category.

Workers exposed to antineoplastic agents by exposure level in 2016

Level of Exposure by Occupation

Identifying occupations with 1) workers exposed to high levels of antineoplastic agents, 2) a larger number of workers exposed to antineoplastic agents, or 3) workers who may not be adequately covered by exposure controls is important in guiding cancer prevention efforts to prioritize exposed groups and target resources most effectively.

The table below shows the number of workers exposed by occupation and relative level of exposure to antineoplastic agents. The majority of workers exposed to antineoplastic agents are in the moderate exposure category.

These results highlight occupations with the greatest number of workers exposed, as well as varying levels of exposure frequency and exposure controls within and between occupations and work settings.

Depending on the goals of a prevention campaign, exposure reduction in the largest occupational group might be a useful strategy, or reducing exposure to those at highest risk of exposure could be seen as a priority.

Methods and Data

Our Occupational Approach page outlines the general approach used to calculate prevalence and exposure level estimates for workplace exposures.

Data Sources

Data used to develop the occupational estimates for antineoplastic agents were collected from several sources:

  1. Peer-reviewed publications that addressed exposure to antineoplastic agents in Canada, the United States and the European Union;
  2. Canadian Census data that provided the number of workers for specific occupations;
  3. Human Resources databases that outlined occupation-specific demographics and practice areas;
  4. Reports from professional bodies that included the number of workers for specific occupations;
  5. Grey literature including technical reports from governments and international bodies; and

Prevalence Estimate Method

CAREX defined exposure to antineoplastic agents as the potential for worker contact with antineoplastic agents, either by working with the drugs directly or via contact with contaminated surfaces, patients, or bodily fluids. This included contact via different exposure pathways, and via different drug formulations.

To determine the number of workers potentially exposed to antineoplastic agents at work, CAREX occupational exposure experts combined baseline worker numbers with an estimate of exposure prevalence. The estimate of exposure prevalence was selected for exposure scenarios that were similar to those described in the peer reviewed or grey literature.

Exposure Level Method

CAREX used tailored methods to create relative exposure level categories by occupation and work location*. For antineoplastic agents, these categories are:

Category 1: Low Exposure

A group of workers (people in the same job category and industry) is put in this exposure category for the following reasons:

  1. Frequency of exposure is low, AND
  2. Control of exposure is high

Category 2: Moderate Exposure

A group of workers is put in this exposure category for one of these two groups of reasons:

  1. Frequency of exposure is low, AND
  2. Control of exposure is low

OR

  1. Frequency of exposure is high, AND
  2. Control of exposure is high

Category 3: High Exposure

A group of workers is put in this exposure category for the following reasons:

  1. Frequency of exposure is high, AND
  2. Control of exposure is low

 

*Definitions

A. Frequency of Exposure

HighDaily to weekly
LowMonthly to yearly

B. Control of Exposure

High2 or more of the following are observed:
  • Industry awareness of health hazard
  • Exposure controls, e.g. handling protocols, protective clothing
  • Environmental/medical monitoring of workplaces/workers
Low1 or fewer of the following are observed:
 Control of Exposure
LowHigh
Frequency of ExposureLowMODERATE EXPOSURELOW EXPOSURE
HighHIGH EXPOSUREMODERATE EXPOSURE
Sources

1. National Institute for Occupational Safety and Health (NIOSH). NIOSH Workplace Safety and Health Topic: Occupational Exposure to Antineoplastic Agents (2015)
2. Hon C-Y, Teschke K, Chu W, Demers P, Venners S. “Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals.” Journ of Occup and Environ Hygiene 2013;10(7):374–83.
3. Meijster T, Fransman W, Veldhof R, Kromhout H. “Exposure to antineoplastic drugs outside the hospital environment.” Ann Occup Hyg 2006;50(7): 657–64.

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As a national organization, our work extends across borders into many Indigenous lands throughout Canada. We gratefully acknowledge that our host institution, the University of British Columbia Point Grey campus, is located on the traditional, ancestral, and unceded territories of the xʷməθkʷəy̓əm (Musqueam) people.