{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:22:51Z","timestamp":1790565771302,"version":"4.1.0"},"reference-count":105,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nofer Institute of Occupational Medicine","award":["PNP_IMP_14_2022"],"award-info":[{"award-number":["PNP_IMP_14_2022"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: There is substantial evidence supporting the role of genetic alterations in chemically induced carcinogenesis. We analyzed the existing literature to gather data on genetic alterations linked to human carcinogens and their possible connection to genotoxic outcomes. The review emphasizes carcinogenic substances and occupational exposures identified as \u201ccarcinogenic to humans\u201d. In particular, we searched for studies describing genotoxic alterations linked to agents and occupational exposures for which the International Agency for Research on Cancer has found sufficient evidence of an association with bladder cancer. Methods: The review was carried out in compliance with the PRISMA standards. A comprehensive search of the PubMed database was conducted to identify studies published through March 2024. Results: We identified 60 studies that evaluated genetic alterations for 16 carcinogenic agents and occupations (such as aluminum production, 4-aminobiphenyl, auramine production, benzidine, chlornaphazine, cyclophosphamide, firefighters, magenta production, 2-naphthylamine, opium consumption, ortho-toluidine, painters, the rubber manufacturing industry, Schistosoma haematobium infection, X-radiation, gamma-radiation) in healthy humans. Conclusions: The genotoxic effects of chemical agents in healthy individuals have been well studied and characterized. Additionally, this review presents numerous studies concerning occupational exposure but not exclusively. Genotoxicity assessments have mainly been conducted on biological materials such as blood, peripheral blood lymphocytes, urine, and buccal epithelial cells. The most frequently examined genotoxic effects were DNA damage, chromosomal abnormalities, and micronuclei. Standardized data to clearly define a dose\u2013response relationship for predicting delayed health effects are still lacking.<\/jats:p>","DOI":"10.3390\/jcm14134492","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T05:53:13Z","timestamp":1750917193000},"page":"4492","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Genotoxicity Induced by Carcinogenic Agents or Occupational Exposure with Sufficient Evidence for Bladder Cancer"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4390-2042","authenticated-orcid":false,"given":"Edyta","family":"Kasperczyk","sequence":"first","affiliation":[{"name":"Department of Translational Research, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2940-0449","authenticated-orcid":false,"given":"Kateryna","family":"Tarhonska","sequence":"additional","affiliation":[{"name":"Department of Translational Research, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3946-3964","authenticated-orcid":false,"given":"Ewa","family":"Jablonska","sequence":"additional","affiliation":[{"name":"Laboratory of Molecular Markers and Biostatistics, Department of Chemical Safety, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"ref_1","unstructured":"Chhikara, B.S., and Parang, K. (2023). Global Cancer Statistics 2022: The trends projection analysis. Chem. Biol. Lett., 10."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.eururo.2023.03.029","article-title":"Epidemiology of Bladder Cancer in 2023: A Systematic Review of Risk Factors","volume":"84","author":"Jubber","year":"2023","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1016\/S0140-6736(22)01188-6","article-title":"Current best practice for bladder cancer: A narrative review of diagnostics and treatments","volume":"400","author":"Amin","year":"2022","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1080\/0284186X.2018.1518591","article-title":"Occupational variation in bladder cancer in Nordic males adjusted with approximated smoking prevalence","volume":"58","author":"Hadkhale","year":"2019","journal-title":"Acta Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Alouini, S. (2024). Risk Factors Associated with Urothelial Bladder Cancer. Int. J. Environ. Res. Public. Health, 21.","DOI":"10.3390\/ijerph21070954"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.cell.2011.02.013","article-title":"Hallmarks of cancer: The next generation","volume":"144","author":"Hanahan","year":"2011","journal-title":"Cell"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1289\/ehp.1509912","article-title":"Key Characteristics of Carcinogens as a Basis for Organizing Data on Mechanisms of Carcinogenesis","volume":"124","author":"Smith","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1080\/10937404.2019.1642593","article-title":"Development of a database on key characteristics of human carcinogens","volume":"22","author":"Bird","year":"2019","journal-title":"J. Toxicol. Environ. Health B Crit. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1080\/10937404.2019.1643536","article-title":"Key characteristics of 86 agents known to cause cancer in humans","volume":"22","author":"Krewski","year":"2019","journal-title":"J. Toxicol. Environ. Health B Crit. Rev."},{"key":"ref_10","unstructured":"(2025, May 15). IARC. Available online: https:\/\/publications.iarc.fr\/19."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1093\/jnci\/djr483","article-title":"Preventable exposures associated with human cancers","volume":"103","author":"Cogliano","year":"2011","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_12","unstructured":"(2025, May 15). IARC. Available online: https:\/\/monographs.iarc.who.int\/wp-content\/uploads\/2019\/07\/Classifications_by_cancer_site.pdf."},{"key":"ref_13","unstructured":"(2025, May 15). IARC. Available online: https:\/\/monographs.iarc.who.int\/agents-classified-by-the-iarc\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jclinepi.2021.02.003","article-title":"Updating guidance for reporting systematic reviews: Development of the PRISMA 2020 statement","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/0165-1218(85)90133-8","article-title":"Genetic monitoring of aluminum workers exposed to coal tar pitch volatiles","volume":"155","author":"Heussner","year":"1985","journal-title":"Mutat. Res."},{"key":"ref_16","first-page":"307","article-title":"DNA adducts in peripheral blood lymphocytes from aluminum production plant workers determined by 32P-postlabeling and enzyme-linked immunosorbent assay","volume":"99","author":"Schoket","year":"1993","journal-title":"Environ. Health Perspect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0048-9697(95)04492-J","article-title":"Biomonitoring of genotoxic exposure in aluminium plant workers by determination of DNA adducts in human peripheral blood lymphocytes","volume":"163","author":"Schoket","year":"1995","journal-title":"Sci. Total Environ."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S1383-5718(99)00126-6","article-title":"Biomonitoring of human genotoxicity induced by complex occupational exposures","volume":"445","author":"Schoket","year":"1999","journal-title":"Mutat. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"24","DOI":"10.5271\/sjweh.379","article-title":"Genotoxic exposures of potroom workers","volume":"25","author":"Carstensen","year":"1999","journal-title":"Scand. J. Work. Environ. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"351","DOI":"10.5271\/sjweh.445","article-title":"Influence of genetic polymorphisms of biotransformation enzymes on gene mutations, strand breaks of deoxyribonucleic acid, and micronuclei in mononuclear blood cells and urinary 8-hydroxydeoxyguanosine in potroom workers exposed to polyaromatic hydrocarbons","volume":"25","author":"Carstensen","year":"1999","journal-title":"Scand. J. Work. Environ. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0027-5107(01)00210-X","article-title":"Impact of metabolic genotypes on levels of biomarkers of genotoxic exposure","volume":"482","author":"Schoket","year":"2001","journal-title":"Mutat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1093\/mutage\/gei058","article-title":"Risk assessment of welders using analysis of eight metals by ICP-MS in blood and urine and DNA damage evaluation by the comet and micronucleus assays; influence of XRCC1 and XRCC3 polymorphisms","volume":"20","author":"Iarmarcovai","year":"2005","journal-title":"Mutagenesis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"122366","DOI":"10.1016\/j.envpol.2023.122366","article-title":"Assessment of urinary aromatic amines in Brazilian pregnant women and association with DNA damage: Influence of genetic diversity, lifestyle, and environmental and socioeconomic factors","volume":"335","author":"Souza","year":"2023","journal-title":"Environ. Pollut."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5084","DOI":"10.1073\/pnas.93.10.5084","article-title":"The impact of interindividual variation in NAT2 activity on benzidine urinary metabolites and urothelial DNA adducts in exposed workers","volume":"93","author":"Rothman","year":"1996","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_25","first-page":"1039","article-title":"Acidic urine pH is associated with elevated levels of free urinary benzidine and N-acetylbenzidine and urothelial cell DNA adducts in exposed workers","volume":"6","author":"Rothman","year":"1997","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1093\/carcin\/18.5.981","article-title":"Urinary mutagenicity as a biomarker in workers exposed to benzidine: Correlation with urinary metabolites and urothelial DNA adducts","volume":"18","author":"DeMarini","year":"1997","journal-title":"Carcinogenesis"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1191\/0960327102ht230oa","article-title":"Assessment of genotoxic damage in nurses occupationally exposed to antineoplastics by the analysis of chromosomal aberrations","volume":"21","author":"Burgaz","year":"2002","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.mrgentox.2005.07.008","article-title":"Evaluation of genotoxic effects induced by exposure to antineoplastic drugs in lymphocytes and exfoliated buccal cells of oncology nurses and pharmacy employees","volume":"587","author":"Cavallo","year":"2005","journal-title":"Mutat. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1007\/s00420-006-0111-x","article-title":"Evaluation of early DNA damage in healthcare workers handling antineoplastic drugs","volume":"80","author":"Ursini","year":"2006","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/mutage\/gem032","article-title":"Genotoxicity assessment in oncology nurses handling anti-neoplastic drugs","volume":"22","author":"Rekhadevi","year":"2007","journal-title":"Mutagenesis"},{"key":"ref_31","first-page":"6","article-title":"Assessment of Hematotoxicity and Genotoxicity among paint Workers in Assiut Governorate: A case control study. Egypt","volume":"8","author":"Maksoud","year":"2018","journal-title":"J. Forensic Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1002\/em.20147","article-title":"A multi-biomarker analysis of DNA damage in automobile painters","volume":"46","author":"Testa","year":"2005","journal-title":"Environ. Mol. Mutagen."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S1383-5718(00)00024-3","article-title":"Increased cytogenetic damage in outdoor painters","volume":"467","author":"Pinto","year":"2000","journal-title":"Mutat. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1615\/JEnvironPatholToxicolOncol.v27.i1.60","article-title":"Increased frequency of chromosomal aberrations in industrial painters exposed to lead-based paints","volume":"27","author":"Madhavi","year":"2008","journal-title":"J. Environ. Pathol. Toxicol. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1177\/0748233710375948","article-title":"Genotoxic damage in auto body shop workers","volume":"26","author":"Siebel","year":"2010","journal-title":"Toxicol. Ind. Health"},{"key":"ref_36","first-page":"52","article-title":"Occupational risk assessment of paint industry workers","volume":"15","author":"Dagostim","year":"2011","journal-title":"Indian. J. Occup. Environ. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"238","DOI":"10.3109\/15376516.2016.1158892","article-title":"Assessment of DNA damage in car spray painters exposed to organic solvents by the high-throughput comet assay","volume":"26","year":"2016","journal-title":"Toxicol. Mech. Methods"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1177\/0748233715597347","article-title":"DNA damage assessment in the lymphocytes of construction painters by comet assay","volume":"32","author":"Kianmehr","year":"2016","journal-title":"Toxicol. Ind. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"497","DOI":"10.3109\/15376516.2012.680621","article-title":"Cytogenetic biomonitoring of peripheral blood and oral mucosa cells from car painters","volume":"22","year":"2012","journal-title":"Toxicol. Mech. Methods"},{"key":"ref_40","first-page":"464","article-title":"Evaluation of oxidative and methylating DNA damage in painters occupationally exposed to organic solvents and paints","volume":"39","author":"Carvajal","year":"2019","journal-title":"Biomedica"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"116970","DOI":"10.1016\/j.envres.2023.116970","article-title":"Evaluation of genotoxicity, oxidative stress and immune parameters of auto-paint workers","volume":"237","author":"Cetintepe","year":"2023","journal-title":"Environ. Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Sisto, R., Cavallo, D., Ursini, C.L., Fresegna, A.M., Ciervo, A., Maiello, R., Paci, E., Pigini, D., Gherardi, M., and Gordiani, A. (2020). Direct and Oxidative DNA Damage in a Group of Painters Exposed to VOCs: Dose\u2014Response Relationship. Front. Public. Health, 8.","DOI":"10.3389\/fpubh.2020.00445"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4899","DOI":"10.1007\/s11033-023-08335-2","article-title":"Association of glutathione-S-transferase polymorphism with genetic damage in paint workers","volume":"50","author":"KanuPriya","year":"2023","journal-title":"Mol. Biol. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1038\/jes.2015.28","article-title":"Gene-specific promoter methylation is associated with micronuclei frequency in urothelial cells from individuals exposed to organic solvents and paints","volume":"26","author":"Tello","year":"2016","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_45","first-page":"519","article-title":"Urinary 8-hydroxydeoxyguanosine as a biomarker of oxidative DNA damage in workers exposed to ethylbenzene","volume":"55","author":"Chang","year":"2011","journal-title":"Ann. Occup. Hyg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"308","DOI":"10.2478\/s13382-011-0030-2","article-title":"Occupational risk assessment of oxidative stress and genotoxicity in workers exposed to paints during a working week","volume":"24","author":"Cassini","year":"2011","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.mrgentox.2012.02.007","article-title":"Evaluation of genotoxicity and oxidative damage in painters exposed to low levels of toluene","volume":"746","author":"Moro","year":"2012","journal-title":"Mutat. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12995-016-0123-8","article-title":"Quantification of cell-free DNA for evaluating genotoxic damage from occupational exposure to car paints","volume":"11","author":"Palma","year":"2016","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.21873\/invivo.11672","article-title":"Increased DNA Damage, Instability and Cytokinesis Defects in Occupationally Exposed Car Painters","volume":"33","author":"Silveira","year":"2019","journal-title":"Vivo"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1080\/19338244.2020.1783502","article-title":"DNA damage and inflammatory response in workers exposed to fuels and paints","volume":"76","author":"Brum","year":"2021","journal-title":"Arch. Environ. Occup. Health"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Cavallo, D., Ursini, C.L., Fresegna, A.M., Ciervo, A., Maiello, R., Buresti, G., Paci, E., Pigini, D., Gherardi, M., and Carbonari, D. (2021). Occupational Exposure in Industrial Painters: Sensitive and Noninvasive Biomarkers to Evaluate Early Cytotoxicity, Genotoxicity and Oxidative Stress. Int. J. Environ. Res. Public. Health, 18.","DOI":"10.3390\/ijerph18094645"},{"key":"ref_52","first-page":"e3646","article-title":"Biomarkers of susceptibility and effect in car painters exposed to organic solvents","volume":"51","author":"Herrera","year":"2020","journal-title":"Colomb. Med. (Cali)"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1007\/s11356-010-0319-x","article-title":"Elevated blood lead levels and cytogenetic markers in buccal epithelial cells of painters in India: Genotoxicity in painters exposed to lead containing paints","volume":"17","author":"Khan","year":"2010","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"103","DOI":"10.5271\/sjweh.2437","article-title":"Genotoxic hazards in the rubber industry","volume":"9","author":"Sorsa","year":"1983","journal-title":"Scand. J. Work. Environ. Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/0165-1218(92)90066-9","article-title":"Cytogenetic studies of workers from the rubber industry","volume":"279","author":"Sasiadek","year":"1992","journal-title":"Mutat. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/0165-7992(93)90104-4","article-title":"Sister-chromatid exchanges and cell-cycle kinetics in the lymphocytes of workers occupationally exposed to a chemical mixture in the tyre industry","volume":"302","author":"Sasiadek","year":"1993","journal-title":"Mutat. Res."},{"key":"ref_57","first-page":"543","article-title":"Biological monitoring of genotoxic hazard in workers of the rubber industry","volume":"104","author":"Moretti","year":"1996","journal-title":"Environ. Health Perspect."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S1383-5718(99)00129-1","article-title":"The frequency of induced premature centromere division in human populations occupationally exposed to genotoxic chemicals","volume":"445","author":"Major","year":"1999","journal-title":"Mutat. Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/S1383-5718(99)00125-4","article-title":"Biomonitoring of genotoxic risk in workers in a rubber factory: Comparison of the Comet assay with cytogenetic methods and immunology","volume":"445","author":"Vodicka","year":"1999","journal-title":"Mutat. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/S0009-2797(01)00183-1","article-title":"Assessment of butadiene exposure in synthetic rubber manufacturing workers in Texas using frequencies of hprt mutant lymphocytes as a biomarker","volume":"135\u2013136","author":"Ward","year":"2001","journal-title":"Chem. Biol. Interact."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1289\/ehp.011091249","article-title":"Assessment of 1,3-butadiene exposure in polymer production workers using HPRT mutations in lymphocytes as a biomarker","volume":"109","author":"Ammenheuser","year":"2001","journal-title":"Environ. Health Perspect."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1002\/em.10078","article-title":"Urothelial cell DNA adducts in rubber workers","volume":"39","author":"Vermeulen","year":"2002","journal-title":"Environ. Mol. Mutagen."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1136\/oem.60.2.97","article-title":"Exposure related mutagens in urine of rubber workers associated with inhalable particulate and dermal exposure","volume":"60","author":"Vermeulen","year":"2003","journal-title":"Occup. Environ. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1158\/1055-9965.EPI-07-2777","article-title":"Polycyclic aromatic hydrocarbon exposure, urinary mutagenicity, and DNA adducts in rubber manufacturing workers","volume":"17","author":"Peters","year":"2008","journal-title":"Cancer Epidemiol. Biomarkers Prev."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1093\/mutage\/geq049","article-title":"Cytogenetic and DNA damage on workers exposed to styrene","volume":"25","author":"Teixeira","year":"2010","journal-title":"Mutagenesis"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.toxlet.2011.04.019","article-title":"2-Naphthol levels and genotoxicity in rubber workers","volume":"213","author":"Talaska","year":"2012","journal-title":"Toxicol. Lett."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Santos, J., Gouveia, M.J., Vale, N., Delgado, M.e.L., Gon\u00e7alves, A., da Silva, J.M., Oliveira, C., Xavier, P., Gomes, P., and Santos, L.L. (2014). Urinary estrogen metabolites and self-reported infertility in women infected with Schistosoma haematobium. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0096774"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.mrfmmm.2004.08.002","article-title":"Are genetic polymorphisms in OGG1, XRCC1 and XRCC3 genes predictive for the DNA strand break repair phenotype and genotoxicity in workers exposed to low dose ionising radiations?","volume":"556","author":"Aka","year":"2004","journal-title":"Mutat. Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.mrgentox.2005.05.005","article-title":"Effect of ionizing radiation on the pteridine metabolic pathway and evaluation of its cytotoxicity in exposed hospital staff","volume":"585","author":"Engin","year":"2005","journal-title":"Mutat. Res."},{"key":"ref_70","first-page":"307","article-title":"Cytogenetic monitoring of medical staff professionally exposed to Gamma and X radiation","volume":"52","author":"Lalic","year":"2005","journal-title":"Neoplasma"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.mrgentox.2019.05.011","article-title":"DNA damage and gene expression changes in patients exposed to low-dose X-radiation during neuro-interventional radiology procedures","volume":"844","author":"Visweswaran","year":"2019","journal-title":"Mutat. Res. Genet. Toxicol. Environ. Mutagen."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"503237","DOI":"10.1016\/j.mrgentox.2020.503237","article-title":"Exposure of patients to low doses of X-radiation during neuro-interventional imaging and procedures: Dose estimation and analysis of \u03b3-H2AX foci and gene expression in blood lymphocytes","volume":"856\u2013857","author":"Visweswaran","year":"2020","journal-title":"Mutat. Res. Genet. Toxicol. Environ. Mutagen."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"111797","DOI":"10.1016\/j.mrfmmm.2022.111797","article-title":"Evaluation of natural chronic low dose radiation exposure on telomere length and transcriptional response of shelterin complex in individuals residing in Kerala coast, India","volume":"825","author":"Saini","year":"2022","journal-title":"Mutat. Res."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1002\/em.22523","article-title":"Genotoxic repercussion of high-intensity radiation (x-rays) on hospital radiographers","volume":"64","author":"Balasubramanian","year":"2023","journal-title":"Environ. Mol. Mutagen."},{"key":"ref_75","first-page":"Article","article-title":"Mapping the research landscape of bauxite by-products (red mud): An evolutionary perspective from 1995 to 2022","volume":"10","author":"Fernandez","year":"2024","journal-title":"Heliyon"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Silveira, N., Martins, M., Bezerra, A., and Araujo, F. (2021). Red Mud from the Aluminium Industry: Production, Characteristics, and Alternative Applications in Construction Materials\u2014A Review. Sustainability, 13.","DOI":"10.3390\/su132212741"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/annweh\/wxy112","article-title":"Elemental Carbon and Nitrogen Dioxide as Markers of Exposure to Diesel Exhaust in Selected Norwegian Industries","volume":"63","author":"Berlinger","year":"2019","journal-title":"Ann. Work Expo. Health"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/0165-1110(91)90010-S","article-title":"The genetic toxicology of ortho-toluidine","volume":"258","author":"Danford","year":"1991","journal-title":"Mutat. Res."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Suzuki, S., Gi, M., Komiya, M., Obikane, A., Vachiraarunwong, A., Fujioka, M., Kakehashi, A., Totsuka, Y., and Wanibuchi, H. (2023). Evaluation of the Mechanisms Involved in the Development of Bladder Toxicity following Exposure to Occupational Bladder Cancer Causative Chemicals Using DNA Adductome Analysis. Biomolecules, 14.","DOI":"10.3390\/biom14010036"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1080\/10937404.2019.1643539","article-title":"Overview of biological mechanisms of human carcinogens","volume":"22","author":"Birkett","year":"2019","journal-title":"J. Toxicol. Environ. Health-Part B-Crit. Rev."},{"key":"ref_81","unstructured":"IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2012). Chemical agents and related occupations. IARC Monogr. Eval. Carcinog. Risks Hum., 100, 9\u2013562."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/mutage\/geab025","article-title":"Follow-up genotoxicity assessment of Ames-positive\/equivocal chemicals using the improved thymidine kinase gene mutation assay in DNA repair-deficient human TK6 cells","volume":"36","author":"Sassa","year":"2021","journal-title":"Mutagenesis"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1136\/oemed-2020-106431","article-title":"Ongoing risk of bladder cancer among former workers at the last benzidine manufacturing facility in the USA","volume":"78","author":"Wang","year":"2021","journal-title":"Occup. Environ. Med."},{"key":"ref_84","first-page":"397","article-title":"The genetic toxicity of the human carcinogens benzidine and benzidine-based dyes: Chromosomal analysis in exposed workers","volume":"340C","author":"Mirkova","year":"1990","journal-title":"Prog. Clin. Biol. Res."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/0165-1110(92)90025-5","article-title":"DNA adduct formation by 12 chemicals with populations potentially suitable for molecular epidemiological studies","volume":"277","author":"Uziel","year":"1992","journal-title":"Mutat. Res."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s00345-007-0168-5","article-title":"Epidemiology of urinary bladder cancer: From tumor development to patient\u2019s death","volume":"25","author":"Zeegers","year":"2007","journal-title":"World J. Urol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/j.0954-6820.1969.tb07309.x","article-title":"Bladder tumours induced by chlornaphazine. A five-year follow-up study of chlornaphazine-treated patients with polycythaemia","volume":"185","author":"Thiede","year":"1969","journal-title":"Acta Med. Scand."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1136\/bmj.3.5724.684","article-title":"Cancer of the bladder in patients treated with chlornaphazine","volume":"3","author":"Laursen","year":"1970","journal-title":"Br. Med. J."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Ndaw, S., and Remy, A. (2023). Occupational Exposure to Antineoplastic Drugs in Twelve French Health Care Setting: Biological Monitoring and Surface Contamination. Int. J. Environ. Res. Public. Health, 20.","DOI":"10.3390\/ijerph20064952"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.envres.2017.10.044","article-title":"Genotoxicity assessment of a selected cytostatic drug mixture in human lymphocytes: A study based on concentrations relevant for occupational exposure","volume":"161","author":"Gajski","year":"2018","journal-title":"Environ. Res."},{"key":"ref_91","unstructured":"IARC (2023). IARC Publications Website\u2014Occupational Exposure as a Firefighter, IARC."},{"key":"ref_92","first-page":"389","article-title":"Tumours of the urinary bladder in workmen engaged in the manufacture and use of certain dyestuff intermediates in the British chemical industry. Part I. The role of aniline, benzidine, alpha-naphthylamine, and beta-naphthylamine. 1954","volume":"50","author":"Case","year":"1993","journal-title":"Br. J. Ind. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1002\/ijc.34244","article-title":"Opium use and risk of lung cancer: A multicenter case-control study in Iran","volume":"152","author":"Rashidian","year":"2023","journal-title":"Int. J. Cancer"},{"key":"ref_94","unstructured":"IARC (2010). IARC Publications Website\u2014Painting, Firefighting, and Shiftwork, IARC."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/01.jom.0000200938.96781.64","article-title":"Evaluation of occupational exposure to N-nitrosamines in a rubber-manufacturing industry","volume":"48","author":"Iavicoli","year":"2006","journal-title":"J. Occup. Environ. Med."},{"key":"ref_96","unstructured":"IARC (1982). IARC Publications Website\u2014The Rubber Industry, IARC."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Gouveia, M.J., Nogueira, V., Ara\u00fajo, B., G\u00e4rtner, F., and Vale, N. (2019). Inhibition of the Formation In Vitro of Putatively Carcinogenic Metabolites Derived from. Molecules, 24.","DOI":"10.3390\/molecules24213842"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.canlet.2015.01.018","article-title":"Estrogen-like metabolites and DNA-adducts in urogenital schistosomiasis-associated bladder cancer","volume":"359","author":"Gouveia","year":"2015","journal-title":"Cancer Lett."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1080\/09553002.2023.2267667","article-title":"Low-dose radiation from CT examination induces DNA double-strand breaks and detectable changes of DNA methylation in peripheral blood cells","volume":"100","author":"Wang","year":"2024","journal-title":"Int. J. Radiat. Biol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s10517-021-05227-y","article-title":"Methylation of Promoters of Apoptosis-Related Genes in Blood Lymphocytes of Workers Exposed to Occupational External Irradiation","volume":"171","author":"Isubakova","year":"2021","journal-title":"Bull. Exp. Biol. Med."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1056\/NEJMra0804615","article-title":"DNA damage, aging, and cancer","volume":"361","author":"Hoeijmakers","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1038\/nature07423","article-title":"Somatic mutations affect key pathways in lung adenocarcinoma","volume":"455","author":"Ding","year":"2008","journal-title":"Nature"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.toxlet.2003.12.042","article-title":"Cytogenetic biomarkers and genetic polymorphisms","volume":"149","author":"Norppa","year":"2004","journal-title":"Toxicol. Lett."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.csbj.2019.12.013","article-title":"The genomics of oxidative DNA damage, repair, and resulting mutagenesis","volume":"18","author":"Poetsch","year":"2020","journal-title":"Comput. Struct. Biotechnol. J."},{"key":"ref_105","unstructured":"OECD (2025, May 15). Guidance Document on Revisions to OECD Genetic Toxicology Test Guidelines. Available online: https:\/\/web-archive.oecd.org\/2015-09-02\/370899-Genetic%20Toxicology%20Guidance%20Document%20Aug%2031%202015.pdf."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4492\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:58:21Z","timestamp":1760032701000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":105,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134492"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134492","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]}}}