Carcinogenicity of Ethylene Oxide-Reply

James F. Collins, PhD; Irva Hertz-Picciotto, MA, MPH; Raymond R. Neutra, MD, DrPH
JAMA. 1987;258(13):1733-1734. doi:10.1001/jama.1987.03400130047026.
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In Reply.—  We have no quarrel with Dr Weiss regarding ethylene oxide's critical importance in sterilization procedures. Our article should only make users more cautious in the application of ethylene oxide as a gas sterilant, including providing maximum protection of workers and safe outgassing of materials prior to use. Current understanding of carcinogenesis by a direct-acting carcinogen such as ethylene oxide suggests that a single-base change in one gene could lead to a mutation and possibly to cancer.Weiss states that 0.24 ppm is well below the effect level derived from any study. This is an equivalent continuous exposure derived from the 1.0-ppm time-weighted average maximum allowable occupational exposure. Distribution of radiolabeled ethylene oxide to several tissues and formation of 7-hydroxyethylguanine, a modified form of a nucleic acid base, were seen after a 75-minute exposure of mice to 1.15 ppm of ethylene oxide.1 With any toxic effect, the lack


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