‘Everywhere Chemicals’

Phthalates, which can interfere with hormonal activity in women and men, have been associated with a range of health outcomes, including poor semen quality and increased risks for childhood asthma, type 2 diabetes, and certain types of cancers, including breast and prostate.2-4

These “everywhere chemicals,” as they have been called, are used in a range of products, including food storage containers, personal care products such as soaps and lotions, toys, and furniture.5  


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About 10 years ago, studies began to report that medications, both prescription and over the counter, may be an important source of exposure to phthalates, which are added to drugs to give them controlled-release properties, for children and adults in the United States.6

Over-the-counter drugs are more common in the United States than in Denmark and may be another source of phthalate exposure, Dr Ahern said.

Recently, he and his colleagues found that women in Denmark who received prescriptions for medications containing the phthalate DBP may have a nearly 2-fold higher risk of developing estrogen receptor-positive breast cancer.4

The current study is the first to look at cancer risk associated with phthalate exposure in children, based on either drug prescriptions or levels of phthalate metabolites in urine, according to the researchers.

A Move Toward Phthalate-Free Medications

The researchers found that children born in the later years of the study period were less likely to have received phthalate-containing medication, suggesting that phthalate-free formulations were becoming more common.

A similar trend is probably happening in the United States, Dr Ahern said. For example, in 2012, the US Food and Drug Administration limited the use of DBP as an inactive ingredient in products regulated by the Center for Drug Evaluation and Research.7

If it is possible to formulate medications without phthalates, pharmaceutical manufacturers should try to do that, said Leonardo Trasande, MD, director of the NYU Langone Center for the Investigation of Environmental Hazards in New York, New York, who was not involved in the current study.

The shift away from phthalates in medications may have to be led by pharmacies, spurred by concerned patients, similar to how the movement for bisphenol A (BPA)-free baby bottles was driven by bottle makers who were essentially an intermediate group responding to consumer pressure, Dr Trasande said.

“We are seeing this momentum for food packaging, as phthalates get to be more of a mainstream issue,” Dr Trasande said.

Disclosures: Dr Ahern and Dr Trasande reported having no relevant conflicts of interest. The study was supported by the Saint Baldrick’s Foundation. Please see the original reference for a full list of disclosures.

References

  1. Ahern TP, Spector LG, Damkier P, et al. Medication-associated phthalate exposure and childhood cancer incidence. J Natl Cancer Inst. 2022;djac045. doi:10.1093/jnci/djac045
  2. Eales J, Bethel A, Galloway T, et al. Human health impacts of exposure to phthalate plasticizers: An overview of reviews. Environ Int. 2022;158:106903. doi:10.1016/j.envint.2021.106903
  3. Chuang SC, Chen HC, Sun CW, et al. Phthalate exposure and prostate cancer in a population-based nested case-control study. Environ Res. 2020;181:108902. doi:10.1016/j.envres.2019.108902
  4. Ahern TP, Broe A, Lash TL, et al. Phthalate exposure and breast cancer incidence: A Danish nationwide cohort study. J Clin Oncol. 2019;37(21):1800-1809. doi:10.1200/JCO.18.02202
  5. National Institute of Environmental Health Sciences. Phthalates: The everywhere chemical. Accessed March 14, 2022.
  6. Hernández-Díaz S, Mitchell AA, Kelley KE, Calafat AM, Hauser R. Medications as a potential source of exposure to phthalates in the U.S. population. Environ Health Perspect. 2009;117(2):185-189. doi:10.1289/ehp.11766
  7. US Food and Drug Administration. Limiting the use of certain phthalates as excipients in CDER-regulated products. Published December 2012. Accessed March 14, 2022.

This article originally appeared on Cancer Therapy Advisor