Cytotoxic Waste 101

Earlier this year ISWA published an Assessment of the Cytotoxic Waste Management in Western Balkan Countries.

13 Aug 2020 -

For waste professionals new to cytotoxic waste, or healthcare waste in general, ISWA's Healthcare Project Coordinator Jennifer MacDonald has written a brief summary of the report below.


What are cytotoxic drugs?

Cytotoxic drugs, also called antineoplastics, are a group of medicines containing chemicals that are toxic to cells. These drugs are administered to people with cancer and multiple sclerosis because they prevent the replication of growth cells.  Since abnormal cells causing these illnesses grow rapidly and uncontrollably, aggressive medication like cytotoxic drugs are used to impair and eradicate the cells.

What is cytotoxic waste?

Cytotoxic waste are materials, equipment, and residues that are contaminated by cytotoxic drugs. This includes syringes, vials, gloves, needles, masks, equipment, etc.

Why is this important?

While cytotoxic drugs can cure, they can also affect the body in ways that cannot be controlled. They have the capacity to destroy healthy cells as well as unhealthy ones and because their inability to target specific cells, they can produce a lot of side-effects.  Therefore, the handling of these drugs (and waste) poses a lot of danger and the proper precautions should be taken (e.g. segregation and proper disposal).

Where is it commonly found?

These types of wastes are generated at healthcare clinics and veterinary practices.
Why is it important?
The exposure to these drugs through skin contact, absorption, inhalation, ingestion, needle injuries may cause:


  • Hair loss, liver damage, vomiting,
  • Fetal loss in pregnant women and birth malformations in children of pregnant women,
  • Abnormal formations of cells,
    Alterations to normal blood cell count
  • And countless other side-effects.


Any discharge of cytotoxic waste into the environment can have disastrous ecological consequences in the form of persistent land, air, and water pollution.

How much is produced?

The Western Balkans has approximately 18 million citizens of which around 50.000 patients per year are treated with chemotherapy. This equates to 100 tons of hazardous cytotoxic waste generated through the process.

Where are some vulnerable hotspots?

Countries such as the Western Balkans face issues as they are countries in transition. Hazardous healthcare waste are generated in smaller rates but requires very expensive handing measures, treatment technologies, and administrative barriers. This is becoming a high priority issue in other low-middle income economies due to the rising burden of cancer, through overall global population growth as well as increased cancer incidence and mortality, and thereby increased use of chemotherapy treatment.
Shocking point from report:


"The WHO Blue Book cites a study from Finland observed increased incidence of spontaneous abortions during pregnancy and malformations in children of females with a history of working with anticancer agents. Similar results were found in studies from Canada and the United States of America."



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