Journal
RISK ANALYSIS
Volume 25, Issue 6, Pages 1589-1594Publisher
WILEY
DOI: 10.1111/j.1539-6924.2005.00685.x
Keywords
heterogeneity; risk; stochastic cancer model; premalignant cells
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Persons with exactly the same genetic background, behavior, environment, etc. may have differences in cancer risk due to a different number of cells on the way to malignancy. These differences are estimated quantitatively by using the two-stage clonal expansion model. For liver cancer the estimated relative risk for persons without intermediate cells at age 40 is less than 10% when compared to the risk of the total population, while the top 0.1% risk group has a more than 100-fold risk compared to the population. The risk of the 1% percentile in risk is more than 100-fold of the risk of the more than 95% persons without intermediate cells. The number of intermediate (premalignant) cells in the risk groups cannot be calculated from incidence data only because they depend strongly on a nonidentifiable parameter. But under plausible assumptions, less than about 1,000 intermediate cells are present at age 40 even in high-risk persons.
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