NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Airtable.

More information on this database on the NERDB page

On the website we will publish from this month on regular updates on new disease – exposure combinations we added to the database. Currently, we have 235 entries. Ordered by year in which the abstract is published

unknown year6

Last new entries

Christine Roussel, Kristine L. Witt Peter B. Shaw, Thomas H. Connor Meta-analysis of chromosomal aberrations as a biomarker of exposure in healthcare workers occupationally exposed to antineoplastic drugs Mutat Res. 2019 Jul – Sep;781:207-217.

Many anti-neoplastic drugs used to treat cancer, particularly alkylating agents and topoisomerase inhibitors, are known to induce genetic damage in patients. Elevated levels of chromosomal aberrations, micronuclei, and DNA damage have been documented in cancer patients. Elevations in these same biomarkers of genetic damage have been reported in numerous studies of healthcare workers, such as nurses and pharmacists, who routinely handle these drugs, but results vary across studies. To obtain an overall assessment of the exposure effect, we performed a meta-analysis on data obtained from peer-reviewed publications reporting chromosomal aberration levels in healthcare workers exposed to antineoplastic drugs. A literature search identified 39 studies reporting on occupational exposure to antineoplastic drugs and the measurement of chromosomal aberrations in healthcare workers. After applying strict inclusion criteria for data quality and presentation, data from 17 studies included in 16 publications underwent meta-analysis using Hedges’ bias-corrected g and a random-effects model.

Results showed the level of chromosomal aberrations in healthcare workers exposed to antineoplastic drugs was significantly higher than in controls. The standardized mean differences (difference of means divided by within sd) from all studies were pooled, yielding a value 1.006 (unitless) with p<0.001. Thus, in addition to the documented genotoxic effects of antineoplastic drugs in cancer patients, this meta-analysis confirmed a significant association between occupational exposure to antineoplastics during the course of a normal workday and increases in chromosomal aberrations in healthcare workers. Based on the studies reviewed, we were unable to accurately assess whether appropriate use of protective measures might reduce the incidence of genetic damage in healthcare workers. However, given the potential for increased cancer risk linked to increases in chromosomal aberrations, the results of this study support the need to limit occupational exposure of healthcare workers to antineoplastic drugs as much as possible.

Photo of 272447 from Pixabay

Jalilian, H., Ziaei, M., Weiderpass, E., Rueegg, C.S., Khosravi, Y. and Kjaerheim, K. (2019), Cancer incidence and mortality among firefighters. Int. J. Cancer, 145: 2639-2646.

Firefighters are exposed to both known and suspected carcinogens. This study aims to systematically review the literature on the association of firefighting occupation and cancer incidence and mortality, overall and for specific cancer sites. A systematic review using PubMed, Embase, and Web of Science was performed up to January 1, 2018. The researchers extracted risk estimates of cancers and calculated summary incidence risk estimates (SIRE), summary mortality risk estimates (SMRE), and their 95% confidence intervals (CI). Publication bias and risk of bias in individual studies were assessed using Begg’s and Egger’s tests and the Newcastle-Ottawa scale (NOS), respectively. In total, they included 50 papers in the review and 48 in the meta-analysis.

We found significantly elevated SIREs for cancer of the colon (1.14; CI 1.06 to 1.21), rectum (1.09; CI 1.00 to 1.20), prostate (1.15; CI 1.05 to 1.27), testis (1.34; CI 1.08 to 1.68), bladder (1.12; CI 1.04 to 1.21), thyroid (1.22; CI 1.01 to 1.48), pleura (1.60; CI 1.09 to 2.34), and for malignant melanoma (1.21; CI 1.02 to 1.45).

We found significant SMREs of 1.36 (1.18 to 1.57) and 1.42 (1.05 to 1.90) for rectal cancer and Non-Hodgkin’s lymphoma, respectively. Considering the significantly elevated risk of some cancers in this occupational group, we suggest improving preventive measures and securing adequate and relevant medical attention for this group. Further studies with more accurate and in-depth exposure assessments are indicated.

Heck JE, He D, Contreras ZA, et al Parental occupational exposure to benzene and the risk of childhood and adolescent acute lymphoblastic leukaemia: a population-based study Occupational and Environmental Medicine 2019;76:527-529.


Only a small number of studies have reported on the association of parental occupational exposure to benzene and risk of childhood and adolescent leukemias. The researchers examined associations with acute lymphoblastic leukemia (ALL) in this population-based study in Denmark.
Benzene was largely banned from Danish workplaces after 1975, thus this case-control study focused on the immediately prior years. Pediatric cancer cases (<age 20) were ascertained from the Danish Cancer Registry among children born 1968-1974, and controls were selected from population records. Paternal occupation within the 3 months’ preconception and maternal pregnancy occupation were identified from nationwide pension fund records. Blinded, the researchers assigned benzene exposure using a job-exposure matrix that had been developed for the Danish population. The risk for ALL was estimated using conditional logistic regression. In an exploratory analysis, other cancers were explored with at least five case parents exposed.

There were 217 employed case fathers and 169 employed case mothers, of which 22 (10.1%) and 11 (6.5%), respectively, were exposed to benzene (vs 6.7% and 2.9% of control fathers and mothers). Most exposed parents worked as machine or engine mechanics, or in the shoe industry. Maternal occupational exposure to benzene in pregnancy was related to increased risk of ALL in offspring (adjusted OR=2.28, 95% CI 1.17 to 4.41), while paternal preconceptional benzene exposure was not as strongly associated (adjusted OR=1.40, 95% CI 0.88 to 2.22). The researchers conclude that the study supports an increased risk for ALL with parental occupational benzene exposure.

Steenland K, Barry V, Anttila A, et al Cancer incidence among workers with blood lead measurements in two countries Occupational and Environmental Medicine 2019;76:603-610

The object of this article was to study carcinogenicity of inorganic lead, classified as ‘probably carcinogenic’ to humans by the International Agency for Research on Cancer (brain, lung, kidney, and stomach). The researchers conducted internal and external analyses for cancer incidence in two cohorts of 29 874 lead-exposed workers with past blood lead data (Finland, n=20 752, Great Britain=9122), with 6790 incident cancers. Exposure was the maximum measured blood lead. The combined cohort had a median maximum blood lead of 29 μg/dL, a mean first blood lead test of 1977, and was 87% male. Significant (p<0.05) positive trends, using the log of maximum blood lead, were found for brain cancer (malignant), Hodgkin’s lymphoma, lung cancer, and rectal cancer, while a significant negative trend was found for melanoma. Borderline significant positive trends (0.05≤p≤0.10) were found for oesophageal cancer, meningioma, and combined malignant/benign brain cancer. Categorical analyses reflected these trends. Significant interactions by country were found for lung, brain, and oesophageal cancer, with Finland showing strong positive trends, and Great Britain showing modest or no trends. Larynx cancer in Finland also showed a positive trend (p=0.05). External analyses for high exposure workers (maximum blood lead >40 μg/dL) showed a significant excess for lung cancer in both countries combined, and significant excesses in Finland for brain and lung cancer. The Great Britain data were limited by small numbers for some cancers and limited variation in exposure. The researchers conclude that they found strong positive incidence trends with increasing blood lead levels, for several outcomes in the internal analysis. Two of these, lung and brain cancer, were sites of a priori interest.