Modelling of carcinogenesis and low-dose hypersensitivity: an application to lung cancer incidence among atomic bomb survivors.

Lung cancer incidence among the atomic bomb survivors from Hiroshima and Nagasaki was analysed with the two-step clonal expansion (TSCE) model of carcinogenesis. For the baseline incidence, a new set of model parameters is introduced, which can be determined with a higher precision than the parameter sets previously used. The effect of temporal changes in the smoking behaviour on the lung cancer incidence is modelled by allowing initiation, inactivation and division rates of intermediate cells to depend on the year of birth. The TSCE model is further developed by implementing low-dose hypersensitivity in the survival of lung epithelial cells. According to the model fit to the data, the acute gamma exposure of the atomic bomb survivors does not only result in the conventional initiating effect, but also in a promoting effect for lung cancer. Compared to the model in which radiation acts merely on initiation, the new model is in better agreement with the age-at-exposure dependence in the data, and it does not predict an unexpected increase of the excess relative risk (ERR) at 40 years after exposure. According to the new model, the ERR at low doses increases non-linearly with dose, especially during the first 10 years after exposure to older persons.