Environmental impact of cytotoxic drugs that pass through patients

A handful of life-saving cytotoxic chemotherapy drugs exit cancer patients as active dangerous chemicals.  Septic systems and wastewater treatments plants cannot remove them so dangerous chemicals migrate intact into our lakes, rivers and ponds.  Active chemotherapy chemicals in our water are a problem for all living organisms but they are a profound disaster for humans, other mammals and fish.  Cytotoxic chemicals work by causing DNA breaks and mutation, triggering tumors and other abnormalities.  They are genotoxic and classified as Contaminates of Emerging Concern (CEC).

In the USA, most rural areas and many suburban areas rely on septic systems to clean their household wastewater before it is released into the surrounding waters.  As many also obtain their drinking water from local wells, it is critical that any substance that can injure family members is removed or destroyed before it gets to the drinking water.

Cape Cod in Massachusetts has been noted as an area of concern for several reasons.  Over 80% of the households on Cape Cod are entirely dependent on onsite septic systems to protect their ponds and drinking water.  Its highly porous soil results in the region’s designation as a sole source aquifer.  This means that all drinking water sources are hydraulically linked to septic systems wastewater discharge.  The geology means that toxins are flushed down toilets will end up in one of the Cape Cod’s many freshwater ponds, lakes and streams. They will also end up in the local drinking water.   

More than a decade ago, residents and visitors to Cape Cod noticed an increase in tumors in Brown Bullhead fish with turmorcatfish pulled from the Ashumet Pond, a kettle pond in Mashpee, Cape Cod.  The water in this pond is from rain water and ground water.  As some of this ground water passes under the Massachusetts Military Reservation, Cape Cod (MMR, formerly Otis Air Force Base), it was assumed the fish were damaged by the improper disposal of hazardous chemicals on the military base.  The U.S. Geological Survey conducted a study starting in 2002 to determine the rate of tumors and mutated Red Blood Cell DNA in the Ashumet Pond Brown Bullhead fish.  They compared the fish in Ashumet Pond to fish from two other regional ponds: Santuit Pond, Mashpee/Barnstable, Cape Cod and Great Herring Pond, Plymouth, Massachusetts.  All three ponds receive their water supply from rainwater and local groundwater of which some is wastewater system effluent.  In Plymouth, Massachusetts some of the local household wastewater is treated in a municipal wastewater treatment plant. No households in Mashpee have access to municipal wastewater treatment and instead depend on septic systems.

The U.S. Geologic Survey scientists were surprised to find that not only did the fish from Ashumet Pond have extremely high levels of damage but the fish from Santuit Pond showed nearly as many tumors and Red Blood Cell DNA damage all caused by a genotoxic material in their environment.

In fact, when they compared the levels of tumors in the Ashumet and Santuit with fish from other waters in the U.S. and Canada, they discovered the damage in these ponds’ fish ranked with some of the worsts seen in the U.S. and Canada.


The type of damage in the fish was unusual and could not be traced to the chemicals coming from the MMR (formerly Otis).  Instead the authors noted that others have demonstrated that the type of red blood cell mutations seen was comparable to that seen in Brown Bullhead catfish injected with cyclophosphamide, a cytotoxic chemotherapy treatment used breast cancer, lung cancer and multiple types of lymphoma.


The Upper Cape Cod region of Massachusetts suffers from a elevate level of a wide range of cancers.  Unfortunately 3/4 of the towns on Cape Cod have breast cancer rates 15% higher than the rest of Massachusetts.  Childhood cancer rates on Cape Cod have also been found to be 19% higher than expected.

The environmental trigger forsuch increases is not known but as many of these cancer patients are treated as out-patients (receive chemotherapy infusion and return home same day), large quantities of active cytotoxic chemicals are being discarded into the Cape Cod environment.  What effects will these genotoxic chemicals in our recreational and drinking water have on the cancer rates in our future and more importantly, in our children’s’ future?

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