Dose-response assessment stochastic responses

Dose-Response Assessment for Chemicals That Cause Stochastic Effects. For hazardous chemicals that do not have a threshold in the dose-response relationship, which is currently believed to... 

Although dose-response assessments for deterministic and stochastic effects are discussed separately in this Report, it should be appreciated that many of the concepts discussed in Section 3.2.1.2 for substances that cause deterministic effects apply to substances that cause stochastic effects as well. The processes of hazard identification, including identification of the critical response, and development of data on dose-response based on studies in humans or animals are common to both types of substances. Based on the dose-response data, a NOAEL or a LOAEL can be established based on the limited ability of any study to detect statistically significant increases in responses in exposed populations compared with controls, even though the dose-response relationship is assumed not to have a threshold. Because of the assumed form of the dose-response relationship, however, NOAEL or LOAEL is not normally used as a point of departure to establish safe levels of exposure to substances causing stochastic effects. This is in contrast to the common practice for substances causing deterministic effects of establishing safe levels of exposure, such as RfDs, based on NOAEL or LOAEL (or the benchmark dose) and the use of safety and uncertainty factors. 

Given the different approaches to dose-response assessment and the different measures of response normally used for radionuclides and chemicals that cause stochastic effects, estimates of responses from exposure to the two types of substances clearly are not equivalent, and the correspondence of the estimated frequency of responses to the frequency that might actually be experienced differs substantially. Specifically, if the results of experiments indicating chemical-induced stochastic responses in animals are assumed to be indicative of stochastic responses in humans, estimates of responses for chemicals could be considerably more conservative (pessimistic) than estimates for radionuclides. This difference is primarily the result of... 

However, given the current state of knowledge and methods of dose-response assessment for substances that cause stochastic responses, there appear to be important technical and institutional impediments to the use of either incidence or fatalities exclusively. Data on radiation-induced cancer incidence and chemical-induced cancer fatalities for use at the low doses and dose rates relevant to health protection are not readily available, and current regulatory guidance calls for calculation of cancer incidence for hazardous chemicals. Since use of a common measure of response for all substances that cause stochastic responses may not be practical in the near term, both measures (fatalities for radionuclides and incidence for hazardous chemicals) could be used in the interest of expediency. The primary advantage of this approach is that the measures of stochastic response for radionuclides and hazardous chemicals would be based on the best available information from studies in humans and animals, and it would involve the fewest subjective modifying factors. This approach also would be the easiest to implement. 

Estimates of Probability Coefficients for Carcinogens. The nominal probabilities of a stochastic response (primarily cancers) per unit dose used in risk assessments, which are referred to in this Report as probability coefficients, normally differ for radionuclides and chemical carcinogens in regard to the degree of conservatism incorporated in the assumed values and the number of organs or tissues at risk that are taken into account. 

Two types of responses from exposure to hazardous substances, called stochastic or deterministic,5 are of concern in risk assessment. The two types of responses are distinguished by the characteristic features of the dose-response relationship, i.e., the relationship between the dose of a hazardous substance and the probability (or frequency) of a response. 

Dose-Response Relationships. The primary objective of this study is to set forth the foundations of a risk-based waste classification system that applies to hazardous chemicals and radionuclides. Most aspects of the risk assessment process that provide the basis for establishing this system are conceptually the same for chemicals and radionuclides, although the specific data (e.g., solubilities) may differ. One important exception is the assumed relationship of the probability of a response to a unit dose of a substance that causes stochastic effects, which is called the dose-response relationship There are important conceptual differences in the way this relationship has been defined and used for hazardous chemicals and radionuclides, and these differences could pose a major impediment to development of a risk-based waste classification system that applies to both types of substances on a consistent basis. These differences are elucidated in the following section. 

UCL takes into account measurement uncertainty in the study used to estimate the dose-response relationship, such as the statistical uncertainty in the number of tumors at each administered dose, but it does not take into account other uncertainties, such as the relevance of animal data to humans. It is important to emphasize that UCL gives an indication of how well the model fits the data at the high doses where data are available, but it does not indicate how well the model reflects the true response at low doses. The reason for this is that the bounding procedure used is highly conservative. Use of UCL has become a routine practice in dose-response assessments for chemicals that cause stochastic effects even though a best estimate (MLE) also is available (Crump, 1996 Crump et al., 1976). Occasionally, EPA will use MLE of the dose-response relationship obtained from the model if human epidemiologic data, rather than animal data, are used to estimate risks at low doses. MLEs have been used nearly universally in estimating stochastic responses due to radiation exposure. 

In spite of uncertainties in the dose-response relationship for radiation discussed above, it is generally believed that radiation risks in humans can be assessed with considerably greater confidence than risks from exposure to most hazardous chemicals that cause stochastic effects. The state of knowledge of radiation risks in humans compared with risks from exposure to chemicals that cause stochastic effects is discussed further in Section 4.4.2. 

Stochastic responses from exposure to radionuclides and hazardous chemicals generally are of concern in health protection of the public and in classifying waste. Of the three differences in approaches to dose-response assessment identified above, the most important is the use of a best estimate (MLE) of the dose-response relationship for radionuclides but upper-bound estimates (UCLs) for hazardous chemicals that cause stochastic effects. UCL in the dose-response relationship for chemicals that cause stochastic effects normally exceeds MLE by a factor of 5 to 100 or more. If this difference... 

This option does not appear to be advantageous for either radionuclides or chemicals that cause stochastic responses. In radiation protection, total detriment is used mainly to develop the tissue weighting factors in the effective dose (see Section 3.2.2.3.3), but ICRP and NCRP have continued to emphasize fatal responses as the primary health effect of concern in radiation protection and radiation risk assessments. Since total detriment is based on an assumption that fatalities are the primary health effect of concern, the same difficulties described in the previous section would occur if this measure of response were used for chemicals that induce stochastic responses. Other disadvantages of using total detriment include that detriment is not a health-effect endpoint experienced by an exposed individual and the approach to weighting nonfatal responses in relation to fatalities is somewhat arbitrary. Furthermore, total detriment is not as simple and straightforward to understand as either incidence or fatalities. 

The use of MLEs of probability coefficients for radionuclides but UCLs for chemicals that induce stochastic responses is the most important issue that would need to be resolved to achieve a consistent approach to estimating risks for the purpose of waste classification. For some chemicals, the difference between MLE and UCL can be a factor of 100 or more. The difference between using fatalities or incidence as the measure of response is unlikely to be important. Use of the linearized, multistage model to extrapolate the dose-response relationship for chemicals that induce stochastic effects, as recommended by NCRP, should be reasonably consistent with estimates of the dose-response relationship for radionuclides, and this model has been used widely in estimating probability coefficients in chemical risk assessments. The difference in the number of organs or tissues that are taken into account, although it cannot be reconciled at the present time, should be unimportant. 

In many respects, the foundations and framework of the proposed risk-based hazardous waste classification system and the recommended approaches to implementation are intended to be neutral in regard to the degree of conservatism in protecting public health. With respect to calculations of risk or dose in the numerator of the risk index, important examples include (1) the recommendation that best estimates (MLEs) of probability coefficients for stochastic responses should be used for all substances that cause stochastic responses in classifying waste, rather than upper bounds (UCLs) as normally used in risk assessments for chemicals that induce stochastic effects, and (2) the recommended approach to estimating threshold doses of substances that induce deterministic effects in humans based on lower confidence limits of benchmark doses obtained from studies in humans or animals. Similarly, NCRP believes that the allowable (negligible or acceptable) risks or doses in the denominator of the risk index should be consistent with values used in health protection of the public in other routine exposure situations. NCRP does not believe that the allowable risks or doses assumed for purposes of waste classification should include margins of safety that are not applied in other situations. 

The use of Monte Carlo and other stochastic analytical methods to characterize the distribution of exposure and dose-response relationships is increasing (IPCS, 2001a). The Monte Carlo method uses random numbers and probability in a computer simulation to predict the outcome of exposure. These methods can be important tools in risk characterization to assess the relative contribution of uncertainty and variability to a risk estimate. 

For radiation protection purposes, the biological effects of ionizing radiation are grouped into two main categories, the stochastic and deterministic effects. In both cases, the effects are related to the absorbed doses. Therefore, the knowledge on the dose-response relationships is essential for risk assessment. 

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