Radiation in complex exposure situations. Assessing health risks at low levels from concomitant exposures to radiation and chemicals

Health effects from exposures to ionizing radiation are in general the result of complex multi-step reaction chains involving changes and responses on the level of molecules, cells, tissues and organisms. In environmental low dose exposure situations ionizing radiation only contributes a small fraction to the life-long attack on DNA by other exogenous and endogenous genotoxins. Nevertheless, efforts to assess and quantify deleterious effects at low exposure levels are directed mainly towards radiation as a single isolated agent, and rarely towards the concomitant presence of other natural and anthropogenic toxicants. Only these combined exposures may lead to observable health risk effects. In addition they might differ from those expected from simple addition of the individual risks due to interaction. The existing data base on combined effects is rudimentary, mainly descriptive and rarely covers exposure ranges large enough to make direct inferences to present day low dose exposure situations. Therefore, any risk assessment will have to consider the question whether combined effects, i.e. interaction between two or more agents will influence the health outcome from specific exposure situations in such a way that predictions derived from simple standard exposure situations would have to be revised. In view of the multitude of possible interactions between the large number of potentially harmful agents in the human environment, descriptive approaches will have to be supplemented by the use of mechanistic models for critical health endpoints such as cancer. Agents will have to be grouped depending on their physical or chemical mode of action at the molecular and cellular level, to generalize and predict the outcome of combined exposures at low exposure levels and the possibility of interactions. (author)