Editing Chemotherapy (section)

=== Occupational monitoring ===
A [[Workplace health surveillance|medical surveillance]] program must be established. In case of exposure, occupational health professionals need to ask for a detailed history and do a thorough physical exam. They should test the urine of the potentially exposed worker by doing a [[urine dipstick]] or microscopic examination, mainly looking for blood, as several antineoplastic drugs are known to cause bladder damage.<ref name=":0" />

Urinary mutagenicity is a marker of exposure to antineoplastic drugs that was first used by Falck and colleagues in 1979 and uses bacterial mutagenicity assays. Apart from being nonspecific, the test can be influenced by extraneous factors such as dietary intake and smoking and is, therefore, used sparingly. However, the test played a significant role in changing the use of horizontal flow cabinets to vertical flow biological safety cabinets during the preparation of antineoplastic drugs because the former exposed health care workers to high levels of drugs. This changed the handling of drugs and effectively reduced workers' exposure to antineoplastic drugs.<ref name=":0" />

Biomarkers of exposure to antineoplastic drugs commonly include urinary [[platinum]], [[methotrexate]], urinary [[cyclophosphamide]] and [[ifosfamide]], and urinary metabolite of [[5-Fluorouracil|5-fluorouracil]]. In addition to this, there are other drugs used to measure the drugs directly in the urine, although they are rarely used. A measurement of these drugs directly in one's urine is a sign of high exposure levels and that an uptake of the drugs is happening either through inhalation or dermally.<ref name=":0" /> &nbsp;