Bleomycin and scuba diving: where is the harm?

Testicular cancer is the most frequent malignant disease in men aged 15–40 years. Due to its sensitivity to chemotherapeutic drugs, most patients, including those with widespread metastatic disease, can now be cured. Bleomycin is an essential component of the most effective chemotherapy regimen for testicular cancer—ie, bleomycin, etoposide, and cisplatin [BEP].1 However, bleomycin is feared for its induction of bleomycin-induced pneumonitis (BIP), which is sometimes fatal.2 After reports in the 1980s of perioperative complications that were ascribed to bleomycin, high inspired-oxygen fractions during anaesthesia were avoided, as were high inspired-oxygen fractions under hyperbaric circumstances, such as scuba diving.