Two-Event Model for Carcinogenesis: Biological, Mathematical, and Statistical Considerations

A two-mutation model for carcinogenesis is reviewed. General principles in fitting the model to epidemiologic and experimental data are discussed, and some examples are given. A general solution to the model with time-dependent parameters is developed, and its use is illustrated by application to data from an experiment in which rats exposed to radon developed lung tumors.     

Multistage Models of Carcinogenesis: An Approximation for the Size and Number Distribution of Late-Stage Clones

Multistage models have become the basic paradigm for modeling carcinogenesis. One model, the two-stage model of carcinogenesis, is now routinely used in the analysis of cancer risks from exposure to environmental chemicals. In its most general form, this model has two states, an initiated state and a neoplastic state, which allow for growth of cells via a simple linear birth-death process. In all analyses done with this model, researchers have assumed that tumor incidence is equivalent to the formation of a single neoplastic cell and the growth kinetics in the neoplastic state have been ignored. Some researchers have discussed the impact of this assumption on their analyses, but no formal methods were available for a more rigorous application of the birth-death process. In this paper, an approximation is introduced which allows for the application of growth kinetics in the neoplastic state. The adequacy of the approximation against simulated data is evaluated and methods are developed for implementing the approximation using data on the number and size of neoplastic clones.     

Modeling Lifetimes by a Stochastic Process Hitting a Critical Point

First hitting times arise naturally in survival analysis where the underlying stochastic counting process represents the strength of the health of an individual. The patient experiences a clinical endpoint when this process reaches a critical point for the first time. We propose a very flexible and unified first hitting time density function in a stochastic carcinogenesis counting process, and its mathematical properties are investigated. The Poisson and negative binomial first hitting time models are addressed and two examples with real data are presented.     

Biological Models of Carcinogenesis and Quantitative Cancer Risk Assessment

Biologically-based models of carcinogenesis were originally developed to explain certain quanti-tative phenomena associated with carcinogenesis, and to provide a framework within which questions regarding the process could be addressed. Some limitations in the use of these models for quantitative cancer risk assessment are discussed.     

Extending the Stochastic Two-Stage Model of Carcinogenesis to Include Self-Regulation of the Nonmalignant Cell Population

One of the challenges of introducing greater biological realism into stochastic models of cancer induction is to find a way to represent the homeostatic control of the normal cell population over its own size without complicating the analysis too much to obtain useful results. Current two-stage models of carcinogenesis typically ignore homeostatic control. Instead, a deterministic growth path is specified for the population of "normal" cells, while the population of "initiated" cells is assumed to grow randomly according to a birth-death process with random immigrations from the normal population. This paper introduces a simple model of homeostatically controlled cell division for mature tissues, in which the size of the nonmalignant population remains essentially constant over time. Growth of the nonmalignant cell population (normal and initiated cells) is restricted by allowing cells to divide only to fill the "openings" left by cells that die or differentiate, thus maintaining the constant size of the nonmalignant cell population. The fundamental technical insight from this model is that random walks, rather than birth-and-death processes, are the appropriate stochastic processes for describing the kinetics of the initiated cell population. Qualitative and analytic results are presented, drawn from the mathematical theories of random walks and diffusion processes, that describe the probability of spontaneous extinction and the size distribution of surviving initiated populations when the death/differentiation rates of normal and initiated cells are known. The constraint that the nonmalignant population size must remain approximately constant leads to much simpler analytic formulas and approximations, flowing directly from random walk theory, than in previous birth-death models.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hormesis Without Cell Killing

Stochastic two-stage clonal expansion (TSCE) models of carcinogenesis offer the following clear theoretical explanation for U-shaped cancer dose-response relations. Low doses that kill initiated (premalignant) cells thereby create a protective effect. At higher doses, this effect is overwhelmed by an increase in the net number of initiated cells. The sum of these two effects, from cell killing and cell proliferation, gives a U-shaped or J-shaped dose-response relation. This article shows that exposures that do not kill, repair, or decrease cell populations, but that only hasten transitions that lead to cancer, can also generate U-shaped and J-shaped dose-response relations in a competing-risk (modified TSCE) framework where exposures disproportionately hasten transitions into carcinogenic pathways with relatively long times to tumor. Quantitative modeling of the competing effects of more transitions toward carcinogenesis (risk increasing) and a higher proportion of transitions into the slower pathway (risk reducing) shows that a J-shaped dose-response relation can occur even if exposure increases the number of initiated cells at every positive dose level. This suggests a possible new explanation for hormetic dose-response relations in response to carcinogenic exposures that do not have protective (cell-killing) effects. In addition, the examples presented emphasize the role of time in hormesis: exposures that monotonically increase risks at younger ages may nonetheless produce a U-shaped or J-shaped dose-response relation for lifetime risk of cancer.     

A Nonidentifiability Aspect of the Two-Stage Model of Carcinogenesis

This paper discusses identifiability of the two-stage birth-death-mutation model of carcinogenesis. It is shown that the homogeneous version of the model is nonidentifiable; the same is all the more evident for its nonhomogeneous versions. This result implies that the model parameters cannot be uniquely estimated from time-to-tumor observations.