Application of the two-stage clonal expansion model in characterizing the joint effect of exposure to two carcinogens

In this paper, we describe application of the two-stage clonal expansion model to characterize the joint effect of exposure to two carcinogens. This biologically based model of carcinogenesis provides a useful framework for the quantitative description of carcinogenic risks and for defining agents that act as initiators, promoters, and completers. Depending on the mechanism of action, the agent-specific relative risk following exposure to two carcinogens can be additive, multiplicative, or supramultiplicative, with supra-additive relative risk indicating a synergistic effect between the two agents. Maximum-likelihood methods for fitting the two-stage clonal expansion model with intermittent exposure to two carcinogens are described and illustrated, using data on lung-cancer mortality among Colorado uranium miners exposed to both radon and tobacco smoke