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October 2, 1987

Carcinogenicity of Ethylene Oxide-Reply

JAMA. 1987;258(13):1733-1734. doi:10.1001/jama.1987.03400130047026

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