Assessing susceptibility from early-life exposure to carcinogens.Cancer risk assessment methods currently assume that children and adults are equally susceptible to exposure to chemicals. We reviewed available scientific literature to determine whether this was scientifically supported. We identified more than 50 chemicals causing cancer after perinatal perinatal /peri·na·tal/ (-na´t'l) relating to the period shortly before and after birth; from the twentieth to twenty-ninth week of gestation to one to four weeks after birth. per·i·na·tal adj. exposure. Human data are extremely limited, with radiation exposures showing increased early susceptibility at some tumor sites. Twenty-seven rodent rodent, member of the mammalian order Rodentia, characterized by front teeth adapted for gnawing and cheek teeth adapted for chewing. The Rodentia is by far the largest mammalian order; nearly half of all mammal species are rodents. studies for 18 chemicals had sufficient data after postnatal postnatal /post·na·tal/ (-na´t'l) occurring after birth, with reference to the newborn. post·na·tal adj. Of or occurring after birth, especially in the period immediately after birth. and adult exposures to quantitatively estimate potential increased susceptibility from early-life exposure, calculated as the ratio of juvenile to adult cancer potencies for three study types: acute dosing, repeated dosing, and lifetime dosing. Twelve of the chemicals act through a mutagenic mutagenic inducing genetic mutation. mode of action. For these, the geometric mean (mathematics) geometric mean - The Nth root of the product of N numbers. If each number in a list of numbers was replaced with their geometric mean, then multiplying them all together would still give the same result. ratio was 11 for lifetime exposures and 8.7 for repeat exposures, with a ratio of 10 for these studies combined. The geometric mean ratio for acute studies is 1.5, which was influenced by tissue-specific results [geometric mean ratios for kidney, leukemia leukemia (l kē`mēə), cancerous disorder of the blood-forming tissues (bone marrow, lymphatics, liver, spleen) characterized by excessive production of immature or mature , liver, lymph, mammary mammary /mam·ma·ry/ (mam´ah-re) pertaining to the mammary gland, or breast. mam·ma·ry adj. Of or relating to a breast or mamma. mammary pertaining to the mammary gland. , nerve, reticular tissue reticular tissue n. Connective tissue in which reticular fibers form a branching network usually having a network of reticular cells associated with the fibers. Also called retiform tissue. , thymic thymic /thy·mic/ (thi´mik) pertaining to the thymus. thy·mic adj. Of or relating to the thymus. thymic pertaining to the thymus. lymphoma, and uterus/vagina > 1 (range, 1.6-8.1); forestomach, harderian gland Harderian gland the part of the third eyelid that lies between the cartilage of the third eyelid and the cornea. , ovaries Ovaries The female sex organs that make eggs and female hormones. Mentioned in: Choriocarcinoma ovaries (ō´v , and thyroid < 1 (range, 0.033-0.45)]. Chemicals causing cancer through other modes of action indicate some increased susceptibility from postnatal exposure (geometric mean ratio is 3.4 for lifetime exposure, 2.2 for repeat exposure). Early exposures to compounds with endocrine activity sometimes produce different tumors after exposures at different ages. These analyses suggest increased susceptibility to cancer from early-life exposure, particularly for chemicals acting through a mutagenic mode of action. Key words: cancer, children, early-life exposure, exposure, mode of action, risk assessment, susceptible populations. doi:10.1289/ehp.7667 available via http://dx.doi.org/[Online 7 April 2005] ********** The cancer database used by the U.S. Environmental Protection Agency Environmental Protection Agency (EPA), independent agency of the U.S. government, with headquarters in Washington, D.C. It was established in 1970 to reduce and control air and water pollution, noise pollution, and radiation and to ensure the safe handling and (EPA EPA eicosapentaenoic acid. EPA abbr. eicosapentaenoic acid EPA, n.pr See acid, eicosapentaenoic. EPA, n. ) and other agencies for risk assessment for exposure to carcinogens Carcinogens Substances in the environment that cause cancer, presumably by inducing mutations, with prolonged exposure. Mentioned in: Colon Cancer, Rectal Cancer focuses on adults and adult exposures. Much cancer epidemiology comes from occupational studies and rodent cancer studies, which were designed to last approximately a lifetime (2 years) beginning after sexual maturity. Cancer risks from childhood exposures to chemicals are generally analyzed using methods based on exposure to adults, which assumes chemicals are equally potent for inducing risks of exposures in both early life and later life. Animal and human data suggest that further analysis is warranted to determine whether early-life exposure results in increased susceptibility to cancer compared with adult exposures (Anderson et al. 2000; National Research Council 1993). There is extensive literature demonstrating that exposures early in life (i.e., transplacental transplacental /trans·pla·cen·tal/ (-plah-sen´tal) through the placenta. trans·pla·cen·tal adj. Relating to or involving passage through or across the placenta. or in utero in utero (in u´ter-o) [L.] within the uterus. in u·ter·o adj. In the uterus. in utero adv. , early postnatal, and lactational) in animals can result in the development of cancer (reviewed in Anderson et al. 2000; Della Porta Della Porta. For persons thus named use Porta. and Terracini 1969; Druckrey 1973; Rice 1979; Rice and Ward 1982; Toth 1968; Vesselinovitch 1983; Vesselinovitch et al. 1979a). However, except for data on radiation and prenatal exposure to diethylstilbesterol (DES), there are virtually no human data adequate for quantitative analysis Quantitative Analysis A security analysis that uses financial information derived from company annual reports and income statements to evaluate an investment decision. Notes: . Standard animal bioassays generally begin dosing after the animals are 6-8 weeks of age, when many organs and systems are relatively mature, although substantial growth in body size continues thereafter. Reviews comparing perinatal carcinogenesis car·ci·no·gen·e·sis n. The production of cancer. carcinogenesis production of cancer. biological carcinogenesis viruses and some parasites are capable of initiating neoplasia. bioassays with standard bioassays for a limited number of chemicals (McConnell 1992; U.S. EPA 1996) have concluded that the same tumor sites usually are observed after either perinatal or adult exposure, and that perinatal exposure in conjunction with adult exposure usually increases the incidence of tumors or reduces the latent period latent period n. 1. The period elapsing between the application of a stimulus and the obvious response, such as the contraction of a muscle. 2. before tumors are observed. There is limited evidence to inform the mode(s) of action leading to differences in tumor type and tumor incidence after early-life exposure compared with exposure later in life. Differences in the capacity to metabolize me·tab·o·lize v. 1. To subject to metabolism. 2. To produce by metabolism. 3. To undergo change by metabolism. metabolize to subject to or be transformed by metabolism. and clear chemicals at early ages can result in larger or smaller internal doses of the active agent(s), either increasing or decreasing risk (Ginsberg et al. 2002; Renwick 1998). Mechanistic mech·a·nis·tic adj. 1. Mechanically determined. 2. Of or relating to the philosophy of mechanism, especially one that tends to explain phenomena only by reference to physical or biological causes. data supporting early-life susceptibility to DNA DNA: see nucleic acid. DNA or deoxyribonucleic acid One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes. damaging mutagenic chemicals include increased formation of DNA adducts after exposure to vinyl chloride vinyl chloride or chloroethylene Colourless, flammable, toxic gas (H2C=CHCl), belonging to the family of organic compounds of halogens. It is produced in very large quantities and used principally to make PVC, as well as in other syntheses and in (Laib et al. 1989; Morinello et al. 2002a, 2002b), increased induction of micronuclei in fetal tissues (Hayashi et al. 2000), and increased mutations in brains of transgenic trans·ge·nic adj. 1. Of, relating to, or being an organism whose genome has been altered by the transfer of a gene or genes from another species or breed: transgenic mice. 2. mice exposed to ethylnitrosourea (ENU ENU English (USA) ENU N-ethyl-N-nitrosourea ENU Ethyl Nitrosourea ENU East North Up (navigational coordinate system) ENU European Network of the Unemployed ; Slikker et al. 2004). The neonatal mouse model for carcinogenesis, which uses two doses before weaning weaning, n the period of transition from breast feeding to eating solid foods. weaning the act of separating the young from the dam that it has been sucking, or receiving a milk diet provided by the dam or from artificial sources. followed by observation of tumors at 1 year, shows carcinogenic carcinogenic having a capacity for carcinogenesis. responses for mutagenic carcinogens (Flammang et al. 1997; Fujii 1991; McClain et al. 2001). Current understanding of biologic processes involved in carcinogenesis leads to a reasonable expectation that children are more susceptible to some carcinogenic agents than adults (Anderson et al. 2000; Birnbaum and Fenton 2003; Ginsberg 2003; Miller et al. 2002; Scheuplein et al. 2002). Several aspects potentially lead to increased childhood susceptibility. More frequent cell division during development can result in enhanced fixation of mutations because of the reduced time available for repair of DNA lesions, and clonal expansion of mutant cells gives a larger population of mutants (Slikker et al. 2004). Some components of the immune system immune system Cells, cell products, organs, and structures of the body involved in the detection and destruction of foreign invaders, such as bacteria, viruses, and cancer cells. Immunity is based on the system's ability to launch a defense against such invaders. are net fully functional during development (Holladay and Smialowicz 2000; Holsapple et al. 2003). Hormonal systems operate at different levels during various life stages (Anderson et al. 2000). Induction of developmental abnormalities may result in a predisposition predisposition /pre·dis·po·si·tion/ (-dis-po-zish´un) a latent susceptibility to disease that may be activated under certain conditions. pre·dis·po·si·tion n. 1. to carcinogenic effects later in life (Birnbaum and Fenton 2003; Fenton and Davis 2002). Finally, theoretical analyses suggest that differential susceptibility would depend, in part, on the mode of action [i.e., at what step in the cancer process(es) the chemical was acting] and that the lifetime average daily dose may underestimate or overestimate o·ver·es·ti·mate tr.v. o·ver·es·ti·mat·ed, o·ver·es·ti·mat·ing, o·ver·es·ti·mates 1. To estimate too highly. 2. To esteem too greatly. the cancer risk when exposures are time dependent (Goddard and Krewski 1995; Murdoch et al. 1992). We reviewed the available scientific literature to determine the extent of potential increased susceptibility from early-life exposure. We evaluated potential susceptibility by individual study and tumor type rather than a combined analysis of all data by certain categories (e.g., gender) (Hattis et al. 2004). Further supporting evidence from ionizing radiation i·on·i·zing radiation n. High-energy radiation capable of producing ionization in substances through which it passes. Ionizing radiation is given in the Appendix (http:// ehp.niehs.nih.gov/docs/2005/7667/app.pdf). Although there is evidence showing that prenatal exposures can result in tumors later in life (Anderson et al. 2000; Birnbaum and Fenton 2003; Diwan Noun 1. diwan - a Muslim council of state divan privy council - an advisory council to a ruler (especially to the British Crown) 2. diwan - a collection of Persian or Arabic poems (usually by one author) divan et al. 1992; Hatch et al. 1998; Waalkes et al. 2003), this analysis focuses only on exposures in animals occurring postnatally up to approximately 5-8 weeks of age. Materials and Methods Procedures Data sources for animal studies. We identified initial studies for consideration through review articles and a search of the National Toxicology Program National Toxicology Program Environment A program that conducts toxicologic tests on substances frequently found at the EPA's National Priorities List sites, which have the greatest potential for human exposure database (NTP (Network Time Protocol) A TCP/IP protocol used to synchronize the real time clock in computers, network devices and other electronic equipment that is time sensitive. It is also used to maintain the correct time in NTP-based wall and desk clocks. 2003). A literature search was conducted using key words and MeSH headings from the PubMed database (PubMed 2004) from studies identified in the available reviews. The chemicals considered and then included for quantitative evaluation are listed in Table 1 and in Supplementary Table S1 (http://ehp.niehs.nih. gov/docs/2005/7667/sup.pdf). We reviewed abstracts or papers to determine if a study provided information that could be used for quantitative analysis based on the following criteria: * Exposure groups at different postnatal ages in the same study or same laboratory, if not concurrent (to control a large number of potential cross-laboratory experimental variables including pathologic examinations) * Same strain/species (to eliminate strain-specific responses confounding confounding when the effects of two, or more, processes on results cannot be separated, the results are said to be confounded, a cause of bias in disease studies. confounding factor age-dependent responses) * Approximately the same dose within the limits of diets, and drinking water drinking water supply of water available to animals for drinking supplied via nipples, in troughs, dams, ponds and larger natural water sources; an insufficient supply leads to dehydration; it can be the source of infection, e.g. leptospirosis, salmonellosis, or of poisoning, e.g. intakes that obviously can vary with age (to eliminate dose-dependent responses confounding age-dependent responses). * Similar or identical period for tumor expression after exposures at different ages--variations of around 10-20% in time to sacrifice are acceptable arising from sacrifice at > 1 year for all groups exposed at different ages, where early-life exposure can occur up to about 7 weeks (to control for confounding differential periods for tumor expression with age-dependent changes in tumor incidences). * Postnatal exposure for juvenile rats and mice at ages younger than the standard 6-8 week start for bioassays; studies that have postnatal exposure were included even if they also involved prenatal exposure, but studies with only prenatal (in utero) exposures are not part of the present analysis. * "Adult" rats and mice exposure beginning at approximately 6-8 weeks of age, that is, comparable with the age at initiation of a standard cancer bioassay Bioassay A method for the quantitation of the effects on a biological system by its exposure to a substance, as well as the quantitation of the concentration of a substance by some observable effect on a biological system. . Studies in other species were used as supporting evidence, because they are relatively rare and the determination of the appropriate comparison ages across species is not simple. * Number of affected animals and total number of animals examined must be available or reasonably reconstructed for control, young, and adult groups (i.e., studies reporting only percent response or not including a control group would be excluded unless a reasonable estimate of historical background for the strain was obtainable). Supplementary Tables $2 and $3 (http:// ehp.niehs.nih.gov/docs/2005/7667/supp.pdf) include information used for the calculations. Pertinent information on species, sex, dosing regimen, and tumor incidence is given. The literature includes studies that can be divided roughly into three types of exposure scenarios (Figure 1): repeated exposures for the early postnatal to juvenile period compared with chronic later-life dosing; lifetime (i.e., combined perinatal and adult) exposure compared with chronic later-life dosing; and acute exposures such as a single intraperitoneal or subcutaneous injection Noun 1. subcutaneous injection - an injection under the skin injection, shot - the act of putting a liquid into the body by means of a syringe; "the nurse gave him a flu shot" for both early-life and later-life dosing. [FIGURE 1 OMITTED] Evaluating the mode of action of carcinogens. Chemicals were classified into categories based on evaluating the mode of action using a weight-of-evidence approach. Determination of carcinogens that are operating by a mutagenic mode of action entails evaluation of short-term testing results for genetic end points, metabolic profiles, physicochemical physicochemical /phys·i·co·chem·i·cal/ (fiz?i-ko-kem´ik-il) pertaining to both physics and chemistry. phys·i·co·chem·i·cal adj. 1. Relating to both physical and chemical properties. properties, and structure-activity relationship Structure-activity relationship is the traditional Practices of Medicinal chemistry which try to modify the effect or the potency of Bioactive chemical compound by modifying its Chemical structure. (SAR (Segmentation And Reassembly) The protocol that converts data to cells for transmission over an ATM network. It is the lower part of the ATM Adaption Layer (AAL), which is responsible for the entire operation. See AAL. SAR - segmentation and reassembly ) analyses in a weight-of-evidence approach (Dearfield et al. 1991; U.S. EPA 1986, 1991; Waters et al. 1999), as has been done for several chemicals (e.g., Dearfield et al. 1999; McCarroll et al. 2002; U.S. EPA 2000). Key data for a mutagenic mode of action may be evidence that the carcinogen carcinogen: see cancer. carcinogen Agent that can cause cancer. Exposure to one or more carcinogens, including certain chemicals, radiation, and certain viruses, can initiate cancer under conditions not completely understood. or a metabolite metabolite, organic compound that is a starting material in, an intermediate in, or an end product of metabolism. Starting materials are substances, usually small and of simple structure, absorbed by the organism as food. is DNA reactive and/or has the ability to bind to to contract; as, to bind one's self to a wife s>. See also: Bind DNA. Also, mutagenic carcinogens usually produce positive effects in multiple test systems for different genetic end points, particularly gene mutations, and in tests performed in vivo in vivo /in vi·vo/ (ve´vo) [L.] within the living body. in vi·vo adj. Within a living organism. in vivo adv. that generally are supported by positive tests in vitro in vitro /in vi·tro/ (in ve´tro) [L.] within a glass; observable in a test tube; in an artificial environment. in vi·tro adj. In an artificial environment outside a living organism. . Additionally, carcinogens may be identified as operating via a mutagenic mode of action if they have properties and SAILs similar to those of established mutagenic carcinogens. Those with a mutagenic mode of action are identified in Table 1. Quantitative Methods To estimate the potential difference in susceptibility between early-life and adult exposure, we calculated the ratio of the estimated cancer potency from early-life exposure compared with the estimated cancer potency from adult exposure. The cancer potency, was estimated from a one-hit model, or a restricted form of the Weibuli model, which is commonly used to estimate cumulative incidence for tumor onset. The genera genera, in taxonomy: see classification. ] form of the equation is as follows: P(dose) = P(0) + [1 - P(0)] [1 - exp exp abbr. 1. exponent 2. exponential (-cancer potency x dose)]. Juvenile and adult cancer potencies and the ratio of the two were calculated by fitting this model to the data for each age group. The model fit depended upon the design of the experiment that generated the data. Two designs need to be handled separately: repeat and acute exposure and lifetime exposures. For the first case, the model equations are as follows: [MATHEMATICAL EXPRESSION A group of characters or symbols representing a quantity or an operation. See arithmetic expression. NOT REPRODUCIBLE IN ASCII ASCII or American Standard Code for Information Interchange, a set of codes used to represent letters, numbers, a few symbols, and control characters. Originally designed for teletype operations, it has found wide application in computers. ], [1] where subscripts A and J refer to the adult and juvenile period, respectively; [lambda] is the natural logarithm Natural logarithm Logarithm to the base e (approximately 2.7183). of the juvenile:adult cancer potency ratio potency ratio Pharmacology The ratio of the effect of a member of a particular family of drugs–eg, corticosteroids or analgesics, to that of a benchmark agent ; [P.sub.0] is the fraction of control animals with the particular tumor type being modeled; [P.sub.x] is the fraction of animals exposed in age period x with the tumor; [m.sub.A] is the cancer potency, the rate of accumulation of "hits" per unit of time for adults; and [[delta].sub.x] is the duration or number of exposures during age period x. For a substantial number of data sets (acute exposures), [[delta].sub.j] = [[delta].sub.A] = 1. We are interested in determining [lambda], which is the logarithm logarithm (lŏg`ərĭthəm) [Gr.,=relation number], number associated with a positive number, being the power to which a third number, called the base, must be raised in order to obtain the given positive number. of the estimated ratio of juvenile to adult cancer potencies, a measure of potential susceptibility for early-life exposure. For the lifetime exposures, the model equations need to take into account that exposures were initiated in the juvenile period continue through the adult period. The model equations for the fraction of animals exposed only as adults with tumors in this design is the same as in the first design, but the fraction of animals whose first exposure occurred in the juvenile period is [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII]. [2] All symbols in Equation 2 have the same interpretation as their counterparts in Equation 1, but now [[delta].sub.j] includes the duration of exposure during the juvenile period as well as the subsequent adult period. Parameters [m.sub.A] and [lambda] in these models were estimated using Bayesian methods (e.g., see Carlin car·line or car·lin n. Scots A woman, especially an old one. [Middle English kerling, from Old Norse, from karl, man.] and Louis 2000), and all inferences about the ratios were based on the marginal posterior distribution of [lambda]. The data for estimating each ratio were in the form of numbers of animals tested and number affected for each of control, juvenile-exposed, and adult-exposed animals, and duration of exposure for each of the juvenile-exposed and adult-exposed groups. A few data sets had separate control groups for the juvenile-exposed and adult-exposed groups, and Equations 1 and 2 were modified accordingly. The likelihood for the parameters [m.sub.A] and [lambda] in the model was the product of three (or four, if there were two control groups) binomial probabilities: the number of animals with tumors in the adult control group, in the juvenile control group, in the juvenile-exposed group, and in the adult-exposed group. The prior for [P.sub.0] (the fraction of control animals with a particular rumor) was right triangular, which assumes incidences should be relatively low. The effect of exposure in adults is quantified by the extra risk, Q, where the probability that an animal has a tumor is [P.sub.0] + (1 - [P.sub.0]) Q. So, from Equation 1, Q was given a uniform prior on the interval (0,1), reflecting total ignorance about the extra risk of adult exposure. Finally, the prior for [lambda] was Gaussian with mean 0 (corresponding to a median or geometric mean ratio of 1) and standard deviation In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. of 3. The prior for the log ratio has some influence over the posterior estimates for the ratio of juvenile to adult potency. The magnitude of that influence depends on the amount of support in the data for different values of the log ratio. This potential influence is further discussed with illustrations in the Appendix (http://ehp.niehs. nih.gov/docs/2005/7667/app.pdf). To examine the sensitivity of the estimates to choice of the prior, values were re-estimated using a prior with a larger standard deviation. This was initially chosen to be 9, but for some of the lifetime exposure and acute exposure studies, a standard deviation of 9 led to numerical problems integrating the posterior, so a prior with a standard deviation of 6 was used in these cases. Sensitivity to the choice of prior was evaluated by looking at changes of individual log ratios and their variances and through differences in geometric means. The posterior distribution for the unknown parameters in these models is the product of the likelihood from the data and the priors (the "unnormalized" prior), divided by a normalization In relational database management, a process that breaks down data into record groups for efficient processing. There are six stages. By the third stage (third normal form), data are identified only by the key field in their record. constant that is the integral of the unnormalized prior over the ranges of all the parameters. This normalization constant was computed using numerical integration In numerical analysis, numerical integration constitutes a broad family of algorithms for calculating the numerical value of a definite integral, and by extension, the term is also sometimes used to describe the numerical solution of differential equations. , as were posterior means and variances and marginal posterior quantiles for the log ratio [lambda]. All numerical computations were carried out in the R statistical programming language (version 1.8.1; R Development Core Team 2003). This method produced a posterior mean of ratio of the early-life to adult cancer potency, which is an estimate of the potential susceptibility of early-life exposure to carcinogens. Ratios > 1 indicated greater susceptibility from early-life exposure. Ratios < 1 indicated less susceptibility from early-life exposure. Summaries of the individual ratios from each of the dose groups from the different experiments for different groupings were also calculated (e.g., for all acute mutagenic chemicals). The summary ratios were constructed from the individual ratios within a group by inverse variance-weighting the means of each ratio. The individual means were weighted by using reciprocals of posterior variances, so ratios with more variance were given less weight in the summary ratios. Exponentiating the resulting variance-weighted mean yielded variance-weighted geometric means of ratios. Results A review of the literature identified several hundred references reporting more than 50 chemicals able to cause cancer after perinatal exposure in animals [Supplementary Table S1 (http://ehp.niehs.nih.gov/docs/ 2005/7667/supp.pdf)]. Often, these studies demonstrated carcinogenesis after perinatal exposure but did not directly compare exposures in adults. A large number of studies address in utero exposures only. Studies across laboratories often varied in their use of animal strains [e.g., for 3'-azido-3'-deoxythymidine (AZT AZT or zidovudine (zīdō`vy dēn'), drug used to treat patients infected with the human immunodeficiency virus (HIV), which causes AIDS; also called ) studies, Diwan et al. (1999)
used CD-1 mice, whereas the National Toxicology Program (NTP 1999) used
B6C3[F.sub.1] mice] or had different periods of tumor follow-up (e.g.,
tamoxifen tamoxifen (təmŏk`sĭfĕn'), synthetic hormone used in the treatment of breast cancer. Introduced in 1978, tamoxifen is used to prevent recurrences of cancer in women who have already undergone surgery to remove their tumors. and uterine uterine /uter·ine/ (u´ter-in) pertaining to the uterus. u·ter·ine adj. Of, relating to, or in the region of the uterus. tumors in Carthew et al. 2000). Because of these factors, many of these chemicals in Supplementary Table S1 (http://ehp.niehs.nih.gov/docs/2005/7667/ supp.pdf) were not evaluated quantitatively. Studies assessing radiation in animals exist, but lack of uniformity regarding radiation doses, gestational age ges·ta·tion·al age n. See estimated gestational age. Gestational age The estimated age of a fetus expressed in weeks, calculated from the first day of the last normal menstrual period. at exposure, and the animal strains used make it difficult to make comparisons across studies (Preston et al. 2000). Some of the studies that did not have sufficient information for quantitative evaluation provide important supporting information for early-life susceptibility. Increased multiplicity of colon tumors was observed after earlier versus later azoxymethane exposures (Paulsen et al. 2003). Shortened mammary tumor For mammary tumors in humans, see . A mammary tumor is a tumor originating in the mammary gland. It is a common finding in older female dogs and cats that are not spayed, but they are found in other animals as well. latency after estradiol estradiol /es·tra·di·ol/ (es?trah-di´ol) (es-tra´de-ol) the most potent estrogen in humans; pharmacologically, it is often used in the form of its esters (e.g., e. cypionate, e. exposure occurred for exposures between 8 and 18 weeks as opposed to exposures earlier or later in life (Yang et al. 2003), consistent with results for dimethylbenz[a]anthracene anthracene (ăn`thrəsēn), C14H10, solid organic compound derived from coal tar. It melts at 218°C; and boils at 354°C;. (DMBA DMBA 9,10-Dimethylbenz-A-Anthracene ; Meranze et al. 1969). Notable examples exist of developmental windows leading to cancer susceptibilities that were not observable in adults. Several potent estrogens Estrogens Hormones produced by the ovaries, the female sex glands. Mentioned in: Acne, Polycystic Ovary Syndrome estrogens (es´trōjenz), n. , including DES, tamoxifen, and genistein, produce uterine tumors with early postnatal exposures of mice, although there also appear to be strain-dependent differences in the tumor sites in adult mice (Gass et al. 1964; Greenman et al. 1990; Newbold et al. 1990, 1997, 2001). Developmental susceptibilities are believed to play a key role in effects observed with saccharin saccharin (săk`ərĭn), C7H5NSO3, white, crystalline, aromatic compound. It was discovered accidentally by I. Remsen and C. Fahlberg in 1879. Pure saccharin tastes several hundred times as sweet as sugar. (Cohen cohen or kohen (Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. et al. 1995; Whysner and Williams 1996) and ascorbate a·scor·bate n. A salt of ascorbic acid. ascorbate a compound or derivative of ascorbic acid. See also sodium ascorbate. (Cohen et al. 1998; NTP 1983), with bladder tumors arising only when early-life exposures occurred; studies with other food additives food additives, substances added to foods by manufacturers to prevent spoilage or to enhance appearance, taste, texture, or nutritive value. By quantity, the most common food additives are flavorings, which include spices, vinegar, synthetic flavors, and, in the did not find cancers after either adult-only or combined early-life and adult exposures (U.S. EPA 1996). Finally, central nervous systems tumors appear highly dependent upon exposures to ENU and several other chemicals during appropriate developmental windows, particularly prenatally, as observed in several species including rat, mouse, and opossum opossum (əpŏs`əm, pŏs`–), name for several marsupials, or pouched mammals, of the family Didelphidae, native to Central and South America, with one species extending N to the United States. (Jurgelski et al. 1979; Rice 1979; Rice and Ward 1982). Quantitative Evaluation of the Database Studies (or groups of studies from a single laboratory on a given chemical) that provided quantitative data were identified for 18 chemicals [Table 1; Supplementary Tables $2, $3 (http://ehp.niehs.nih.gov/docs/2005/7667/ supp.pdf)]. Nine chemicals involved repeated exposures during early postnatal and adult life stages, eight chemicals had lifetime exposure starting in the juvenile period and adult-only exposure, and eight chemicals used acute exposures (typically single doses) at different ages (Table 1). Some studies evaluated single tissues for tumors (e.g., only liver), whereas others evaluated multiple tissues. Mice, rats, or both species and sometimes multiple strains were tested. Carcinogens with a Mutagenic Mode of Action The most informative database on early-life-stage susceptibility exists for chemicals with a well accepted mutagenic mode of action and includes both acute-exposure and repeated-exposure studies involving periods of perinatal and/or chronic exposure. Repeat and lifetime exposure studies of mutagenic chemicals. Studies comparing repeated dosing for early postnatal, juvenile, adult time periods, or lifetime exposures exist for six mutagens [benzidine benzidine /ben·zi·dine/ (ben´zi-den) a carcinogen and toxin once widely used as a test for occult blood. ben·zi·dine n. , diethylnitrosamine (DEN), 3-methylcholanthrene, safrole saf·role n. A colorless or pale yellow oily liquid, C10H10O2, derived from oil of sassafras and other essential oils and used in making perfume and soap. , urethane urethane (yoor´ithān´), n ethyl carbamate used as an anesthetic agent for laboratory animals, formerly used as a hypnotic in humans. , and vinyl chloride; Tables 1, 2, 3; Supplementary Table S4 (http://ehp. niehs.nih.gov/docs/2005/7667/supp.pdf)]. DEN and urethane also had acute-dosing studies. These chemicals all require metabolic activation to the active carcinogenic form. For the repeated-dosing studies, the ratios of juvenile to adult cancer potency ranged from 0.12 to 111 with a geometric mean ratio of 11 (Tables 1, 2, 4; Figure 2). For the lifetime studies, the ratios ranged from 0.18 to 79 with a geometric mean of 8.7 [Tables 3, 4; Supplementary Table S5 (http://ehp.niehs. nih.gov/docs/2005/7667/supp.pdf); Figure 2]. The geometric mean combining the repeated and lifetime data for six chemicals was 10 (Table 4). Calculations based upon even broader, less informative prior distributions (e.g., SD = 6 or 9) gave higher estimates for the geometric means, 17 and 20, for repeated and lifetime studies, respectively, and wider ranges (0.0011-115.2 for repeated-dosing studies, 0.0014-157.78 for lifetime studies). The prior estimates appear to have a greater influence on the estimates of [lambda] (natural log of the ratio of juvenile to adult cancer potency) from the lifetime study designs, reflecting the relative insensitivity to this parameter, as described further in the Appendix (http://ehp.niehs.nih.gov/ docs/2005/7667/app.pdf). For benzidine and safrole, there was a notable sex difference, with high liver one who indulges in a rich diet. See also: High tumor incidence observed for early postnatal exposures of male, but not female, mice. [FIGURE 2 OMITTED] Acute-dosing studies of mutagenic chemicals. Acute-dosing studies are available for eight mutagenic chemicals that were administered to mice or rats (benzo[a]pyrene, dibenzanthracene, DEN, DMBA, dimethylnitrosamine dimethylnitrosamine a potent hepatoxin in herring meal. Chronic poisoning causes changes reminiscent of neoplasia and the substance is now regarded as a carcinogen. , ENU, N-methylnitrosourea [MNU MNU Menu (Fine Name Extension) MNU MidAmerica Nazarene University (Christian liberal arts university) MNU Manitoba Nurses Union (Canadian Union) ], and urethane; Table 1). Except for ENU and MNU, these compounds require metabolic activation to their active carcinogenic forms. Early acute exposures often resulted in higher potency, with increased early susceptibilities up to 178-fold (ratios of juvenile to adult potencies range from 0.011 to 178; geometric mean, 1.5) [Figure 2; Table 4; Supplementary Table S6 (http://ehp.niehs.nih.gov/docs/ 2005/7667/supp.pdf]. Use of a broader prior distribution for [lambda] (natural log of the ratio of juvenile to adult cancer potency) had no effect on the overall geometric mean (1.5) because the data highly informed the posterior distributions, although the range of individual ratios changed (0.00008-2,055). in studies comparing exposures on specific postnatal days 1, 15, and 42, general age-dependent declines in susceptibility of tumor response were observed, for example, benzo[a]pyrene (liver tumors), DEN (liver tumors), ENU (liver and nervous system tumors), and urethane (liver and lung tumors). Although generally the ratios for day 1 and day 15 time points were higher than those for later time points, in several cases similar tumor incidence was observed at both of these early times [e.g., ENU-induced kidney tumors kidney tumor 1 Kidney cancer, see there 2 Wilms' tumor, see there ; Supplementary Table S6 (http://ehp.niehs.nih.gov/docs/2005/7667/ supp.pdf)]. Although the degree of susceptibility generally declines with age, there are exceptions, such as for pubertal pubertal pertaining to or emanating from puberty. pubertal period the period approaching puberty when gonadal function, accessory sex gland function and behavior develop to the point where reproduction is possible. periods of tissue development. Meranze et al. (1969) reported 8% mammary tumors after a single dose of DMBA at < 2 weeks of age, 56% if given once to animals between 5 and 8 weeks of age, and 15% when given once to 26-week-old rats. Thus, a ratio of 7.1 is obtained when comparing susceptibilities of 5- to 8-week-old and 26-week-old rats compared with a ratio of 0.2 when comparing the exposure at 2 weeks versus 26 weeks [Table 4; Supplementary Table S6 (http://ehp.niehs.nih.gov/docs/2005/7667/ supp.pdf)]. A similar effect was observed by Russo et al. (1979; Supplementary Table S3 (http://ehp.niehs.nih.gov/docs/2005/7667/ supp.pdf). This observation corresponds well with pubertal development of the mammary tissue, with ovarian ovarian /ovar·i·an/ (o-var´e-an) pertaining to an ovary or ovaries. ovarian pertaining to an ovary. ovarian agenesis function commencing between 3 and 4 weeks [after the < 2-week time point in the Meranze et al. (1969) study[, and mammary ductal growth and branching occurring such that it is approximately two-thirds complete by week 5, consistent with the 5- to 8-week sensitive period of Meranze et al. (Silberstein 2001). Early-life susceptibility of different tissues varies substantially in the acute studies (Table 4). It should be noted that the target tissues and tissues evaluated vary with chemical, so the number of chemicals for which data are available varies for each tissue. Several tissues have geometric mean ratios > 1, including kidney, leukemia, liver, lymph, mammary, nerve, reticular tissue, thymic lymphoma, and uterus/vagina. Some of these, such as the nerve and mammary tumors, appear to have a very specific window of susceptibility, and the ratios were much higher if the exposure occurred during this window. Tissues with mean ratios < 1 include forestomach, harderian gland, ovaries, and thyroid. Lung has a geometric mean of 1. Many of the studies produced very high lung tumor responses regardless of age, so the results are difficult to interpret, as illustrated by the dose-response data with urethane in Rogers (1951), in which the increased early susceptibility is only apparent when the dose is low. The large numbers of studies with high lung tumor responses at all ages are a major contributor to the differences in the geometric means for the acute and repeated-dosing studies. Carcinogens with modes of action other than mutagenicity mutagenicity /mu·ta·ge·nic·i·ty/ (-je-nis´it-e) the property of being able to induce genetic mutation. mutagenicity the property of being able to induce genetic mutation. . Studies comparing tumors observed at the same sites after early postnatal and chronic adult exposures in a single protocol were available for six chemicals that do not act through a mutagenic mode of action [amitrole amitrole, aminotrazole a nitrothiazole derivative used in the treatment and prevention of histomoniasis of turkeys. Excessive dosage causes infertility and renal and hepatic disease. , dichlorodiphenyltrichloroethane di·chlo·ro·di·phen·yl·tri·chlo·ro·eth·ane n. DDT. (DDT DDT or 2,2-bis(p-chlorophenyl)-1,1,1,-trichloroethane, chlorinated hydrocarbon compound used as an insecticide. First introduced during the 1940s, it killed insects that spread disease and feed on crops. ), dieldrin dieldrin: see insecticides. , ethylene thiourea thiourea a goitrogenic agent used in industry as a photographic fixative. Mode of action is as for thiouracil. (ETU ETU Electrical Trades Union ETU Ethylene Thiourea (pesticide & fungicide) ETU European Taekwondo Union ETU Educational Technology Unit ETU Elementary Time Unit (SIM card timing unit) ), diphenylhydantoin diphenylhydantoin see phenytoin. phenytoin (diphenylhydantoin) Dilantin-125, Dilantin Infatabs Pharmacologic class: Hydantoin derivative Therapeutic class: Anticonvulsant (DPH DPH Diploma in Public Health. DPH abbr. 1. Diploma in Public Health 2. Doctor of Public Health 3. Doctor of Public Hygiene ), polybrominated biphenyls polybrominated biphenyls see biphenyl. (PBB PBB: see polybrominated biphenyl. ); Table 5]. These chemicals cause tumors through several different, not necessarily well-defined, modes of action. For example, thyroid hormone Thyroid hormone Any of the chemical messengers produced by the thyroid gland, including thyrocalcitonin, a polypeptide, and thyroxine and triiodothyronine, which are iodinated thyronines. See Hormone, Thyrocalcitonin, Thyroid gland, Thyroxine disruption by ETU causes thyroid tumors; some PBBs act through the aryl hydrocarbon receptor The Aryl hydrocarbon receptor (AhR) is member of the family of basic-helix-loop-helix transcription factors. AhR is a cytosolic transcription factor that is normally inactive, bound to several co-chaperones. , whereas other PBBs are phenobarbital-like pleiotrophic inducers of liver enzymes and liver tumors. Three of these studies evaluated only mouse liver tumors (amitrole, DDT, dieldrin), whereas the other three evaluated a large number of tissues in both mice and rats (ETU, DPH, PBB). No acute-dosing studies were identified for these agents; such protocols are generally considered largely nonresponsive for modes of action other than mutagenicity and potent estrogenicity (e.g., DES). For five chemicals (amitrole, DDT, dieldrin, PBB, DPH), the same tumors were observed from early and/or adult exposures, although the studies for amitrole, DDT, and dieldrin evaluated the animals only for liver tumors. With ETU, no tumors in mice or rats were observed after perinatal exposure alone (except a small, non statistically significant increase in male rat thyroid tumors), whereas thyroid tumors were observed in adult rats and thyroid, liver, and pituitary tumors Pituitary Tumors Definition Pituitary tumors are abnormal growths on the pituitary gland. Some tumors secrete hormones normally made by the pituitary gland. in adult mice. Analysis of the incidence of tumors per time of exposure suggests early-life-stage susceptibilities. The range of ratios of juvenile to adult cancer potencies is similar for the repeated-dosing studies (0.06-13.3; geometric mean, 2.2; Table 5) and lifetime-dosing studies [0.15-36; geometric mean, 3.4; Supplementary Table S5 (http://ehp.niehs.nih.gov/docs/2005/ 7667/supp.pdf)]. Use of the broader prior for [lambda] (natural log of the ratio of juvenile to adult cancer potency) gave similar results for the repeated-dosing studies (0.00043-13.8; geometric mean, 2.9) and a greater variability in posterior estimates for lifetime studies (0.001466.4; geometric mean, 7.1). These ranges are similar to those for chemicals with a mutagenic mode of action, although the means and maximums are somewhat lower. Liver tumors are common to these chemicals. The range of the magnitudes of liver tumor ratios also is similar for the repeated-dosing studies (0.06-13.3; geometric mean, 2.6; Table 5) and lifetime-dosing studies [0.15-36; geometric mean, 5.8; Supplementary Table S5 (http:// ehp.niehs.nih.gov/docs/2005/7667/supp.pdf)]. Discussion The database overall is of modest size (particularly compared with the number of chemicals that have been studied in adult occupational epidemiologic studies epidemiologic study A study that compares 2 groups of people who are alike except for one factor, such as exposure to a chemical or the presence of a health effect; the investigators try to determine if any factor is associated with the health effect or chronic bioassays). Information on different life-stage susceptibilities to cancer risks for humans exists for ionizing radiation [Appendix (http://ehp.niehs.nih. gov/docs/2005/7667/app.pdf)]. The effects on cancer induction by chemical mutagens at different life stages are derived from laboratory animal studies. Although the induction of cancer by ionizing radiation and chemical mutagens are not identical processes, both involve direct damage to DNA as critical causal steps in the process. In both cases, the impacts of early exposure can be greater than the impacts of later exposures. As indicated in Table 5 and Supplementary Tables S7-S10 (http://ehp.niehs.nih.gov/docs/2005/7667/ supp.pdf), A-bomb survivors exhibit different life-stage dependencies at different tumor sites, although there are apparent differences at some sites. However, it is clear that the total radiation-related tumor incidence showed a general slow decline with age at exposure. The mutagenic chemical studies in rodents similarly support a general decline in cancer risk with age of exposure and similarly show differences for individual tumor sites. In general, the first 2 or 3 postnatal weeks in mice and rats appeared to be the most sensitive. Analyses of the difference in cancer risk from exposures during different lifetime periods ideally need to address both the period of potential susceptibility and the magnitude of the susceptibility. Available studies used a variety of different study designs [Supplementary Tables S2, S3 (http://ehp.niehs.nih.gov/docs/ 2005/7667/supp.pdf)], which can be valuable because they provide different information. However, variations in study design can result in a lack of comparability across chemicals and can limit information on the consistency of effects with different chemicals acting through different modes of action. The acute-dosing (largely single-dose) studies are valuable because they involve identical exposures with explicitly defined doses and time periods demonstrating that differential tumor incidences arise exclusively from age-dependent susceptibility. The repeated-dosing studies with exposures during early postnatal or adult lifetime provide useful information on the relative impact of repeated exposures at different life stages and may be more likely to have exposure occur during a window of susceptibility, if there is one. One notable difference in study designs was that studies with repeated early postnatal exposures were included in the analysis even if they also involved earlier maternal and/or prenatal exposure, whereas studies addressing only prenatal exposure were not otherwise a part of this analysis. The impact of this is limited because it applies to the lifetime safrole study and the studies with PBB, DPH, and ETU. Another notable difference among studies involved the tissues that were evaluated for tumors: some studies focused on a single tissue, particularly liver, whereas others evaluated multiple tissues. This analysis assumes that the doses animals received during the different periods of repeated dose studies were similar. This assumption is a limitation because these studies involved exposures via lactation lactation Production of milk by female mammals after giving birth. The milk is discharged by the mammary glands in the breasts. Hormones triggered by delivery of the placenta and by nursing stimulate milk production. , drinking water, diet, or inhalation, which potentially deliver different doses at different life stages. However, the range of the magnitudes of the tumor incidence ratios of juvenile to adult exposures is similar for the repeated-dosing studies for chemicals with a mutagenic mode of action [0.12-111; geometric mean, 11; Tables 2, 4; Supplementary Table S5 (http://ehp.niehs.nih.gov/docs/2005/ 7667/supp.pdf), lifetime-dosing studies [0.28-79; geometric mean, 8.7; Tables 3, 4; Supplementary Table S5 (http://ehp.niehs. nih.gov/docs/2005/7667/supp.pdf)], and acute-dosing studies [0.01-178; geometric mean, 1.5; Table 4; Supplementary Tables S5, S6 (http://ehp.niehs.nih.gov/docs/2005/ 7667/supp.pdf)], suggesting that differences in dosing are not the sole determinant of the increased incidence of early tumors. Because these comparisons include chemicals with different tissue specificities, it is useful to consider the liver as a target organ target organ n. A tissue or organ that is affected by a specific hormone. target organ, n the organ or body part whose activity levels demonstrate change in the course of biofeedback. affected by all these chemicals; in so doing, even greater consistency is observed. The range of the magnitudes of the liver tumor potency ratios of juvenile to adult exposures of mutagenic chemicals is similar for the repeated-dosing studies (geometric mean, 41.8; range, 0.12-111; Table 2), lifetime-dosing studies (geometric mean, 14.9; range, 0.47-79; Table 3), and acute-dosing studies (geometric mean, 8.1; range, 0.1-40; Table 4). In some cases, windows of susceptibility could occur prenatally. For example, it is plausible that the major window of susceptibility for lung is during in utero development, so sensitivity of the lung tissue would have been missed in this analysis (Miller 2004). The acute studies exposures are largely by subcutaneous subcutaneous /sub·cu·ta·ne·ous/ (sub?ku-ta´ne-us) beneath the skin. sub·cu·ta·ne·ous adj. Abbr. s.c., SQ Located, found, or placed just beneath the skin; hypodermic. or intraperitoneal injection, which historically have not been considered relevant routes of environmental exposure for human cancer risk assessment by the U.S. EPA. For purposes of comparing age-dependent susceptibilities with tumor development tumor development A multistep process that occurs over yrs in which a tissue accumulates genetic hits that eventually translate into a neoplasm with metastatic potential. See One-hit, two-hit model. , these data are highly relevant. The injection route typically alters the pharmacokinetic time courses of the parent compound and the metabolites Metabolites Substances produced by metabolism or by a metabolic process. Mentioned in: Interactions compared with oral or other exposures because of altered kinetics kinetics: see dynamics. Kinetics (classical mechanics) That part of classical mechanics which deals with the relation between the motions of material bodies and the forces acting upon them. of absorption and metabolism. However, for these compounds and the systemic organ effects observed, there are several pharmacokinetic reasons to believe that the age-dependent trends would be similar with other routes of exposure. These compounds are expected to be reasonably well absorbed orally, comparable with injection routes, and largely require metabolic activation, so partial or complete absence of first-pass metabolism in the injection studies would be similar to or underestimate metabolic activation compared with oral exposure. These studies provide the clearest demonstrations of periods of differential susceptibility because the exposure rate is constant at the different ages. The information on life-stage susceptibility for chemicals inducing cancers through other than mutagenic modes of action is more varied, showing an increase in potency from perinatal exposure (e.g., PBBs induced liver tumors in female rats), no effect of combined perinatal and adult exposure (e.g., DPH liver tumors in rats), and different tumors from perinatal exposure versus adult exposure (e.g., DES, ascorbate). These variations are likely a result of the modes of action of these chemicals and the pharmacokinetic differences in doses during different periods of life. An important factor that complicates the interpretation of the results for other modes of action is that these studies, except those with DDT and dieldrin, involved dietary feeding initially to the mother, which potentially could increase or decrease the dose received by the pups. Because of the maternal dosing during pregnancy and lactation, the extent to which offspring received similar doses during different early and adult life stages is particularly uncertain for DPH, ETU, and PBBs. Thus, these studies provide suggestive evidence that early life stages can be more sensitive to exposures to chemical causing cancer through a variety of modes of action other than mutagenicity. However, the studies with ETU indicate that this is not necessarily the case for all modes of action. No single-dose studies for chemicals with a nonmutagenic mode of action were evaluated that were directly comparable with the single-dose studies with mutagens. There are important demonstrations of chemicals causing different tumor types with early-life-stage exposures compared with those for adults, for example, tamoxifen and DES (Carthew et al. 1996, 2000; Gass et al. 1964; Newbold et al. 1990, 1997). In addition, studies with in utero exposure to atrazine atrazine a triazine herbicide; it is not poisonous at levels of intake likely to be encountered in agriculture. atrazine Toxicology A nonphytoestrogenic herbicide. See Phytoestrogen. (Fenton and Davis 2002), DES, arsenic (Waalkes et al. 2003), and genistein (Newbold et al. 2001) indicate that early-life exposures to compounds can alter susceptibility of endocrine and reproductive organs Reproductive organs The group of organs (including the testes, ovaries, and uterus) whose purpose is to produce a new individual and continue the species. Mentioned in: Choriocarcinoma . There is an actively growing database from which to consider issues of childhood exposure and cancer for compounds acting through the estrogen receptor estrogen receptor A protein of a superfamily of nuclear receptors for small hydrophilic ligands–eg, steroid hormones, thyroid hormone, vitamin D, retinoids; the presence of ERs in breast CA generally is associated with a better prognosis, as they respond to or other mechanisms of endocrine disruption. The ability to estimate with any accuracy the juvenile to adult cancer potency ratio depends on the experimental design used. The lifetime design has less ability to distinguish increased susceptibility from early-life exposure than the other study designs, as is more thoroughly explained with an example in the Appendix (http://ehp.niehs.nib.gov/docs/2005/7667/app.pdf). The proper measure of relative potency of an exposure in the juvenile period relative to an exposure in the adult period is the ratio of doses in the two periods that give the same incidence of tumors. However, most of the data sets used in this report contained only one non-control dose, precluding the extensive dose-response modeling that would be required to estimate this ratio of doses. However, this analysis largely considered chemicals for which a mutagenic mode of action has been established and for which a linear, no-threshold dose-response function is assumed for the low-dose range being considered for risk assessment, and comparing potencies can be shown to be the same as comparing doses. This is illustrated in the Appendix (http://ehp.niehs.nih.gov/docs/ 2005/7667/app.pdf). Conclusions In summary, the existing animal database supports the conclusion that there can be greater susceptibility for the development of tumors as a result of exposures early in life to chemicals acting through a mutagenic mode of action. Thus, a risk assessment approach using estimates from chronic studies with appropriate modifications to address the impact of early-life-stage exposure appears feasible. The U.S. EPA has recently released guidelines for multiplying an extra factor to the cancer potency for chemicals with a mutagenic mode of action for exposures that occur during childhood. The proposed factors are 10 for exposures to children between 0 and 2 years of age, and 3 for exposures to children between 2 and 15 years of age. The factor of 10 is based on the data derived from this analysis, and the factor of 3 represents a decline in potency expected to occur as children mature (U.S. EPA 2005). For chemicals acting through a nonmutagenic mode of action, the available data suggest that a range of approaches needs to be developed over time for addressing cancer risk estimates from childhood exposures. Development of such approaches requires additional research to provide an expanded scientific basis for their support, including additional research and the possible development of new toxicity testing protocols that consider early-life-stage dosing. Address correspondence to T.J. Woodruff, U.S. EPA, 75 Hawthorne St., PPA-1, San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden , CA 94105 USA. Telephone: (415) 947-4277. Fax: (415) 947-3519. E-mail: woodruff.tracey@epa.gov * Present address: International Agency for Research on Cancer The International Agency for Research on Cancer (IARC, or CIRC in its French acronym) is an intergovernmental agency forming part of the World Health Organisation of the United Nations. Its main offices are in Lyon, France. , Lyon, France. Supplementary tables are available on the EHP website (http://ehp.niehs.nih.gov/docs/2005/7667/supp.pdf). An Appendix is also available on the EHP website (http://ehp.niehs.nih.gov/docs/2005/7667/app.pdf). We thank D. Bennett for work in leading the initial efforts for this work, B. Wood for support, and J. Preston and S. Fenton for helpful reviews of the document. Special thanks to R. Castorina, N. Choksi, R. Brown, E.P. Donovan, N. Bekarian, and B. Hurley for their efforts in compiling the underlying information. This document does not constitute U.S. EPA policy. 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Table 1. List of chemicals considered in the quantitative
analysis for which there are both early-life and adult
exposure reported in the same animal experiment.
Chemical References
Amitrole Vesselinovitch 1983
Benzidine Vesselinovitch et al. 1975b
Benzo[a]pyrene Vesselinovitch et al. 1975a
Dibenzanthracene Law 1940
Dichlorodiphenyltrichloroethane Vesselinovitch et al. 1979a
Dieldrin Vesselinovitch et al. 1979a
Diethylnitrosamine Peto et al. 1984
Vesselinovitch et al. 1984
Dimethylbenz[a]anthracene Meranze et al.1969
Pietra et al. 1961
Walters 1966
Dimethylnitrosamine Hard 1979
Diphenylhydantoin, 5,5- Chhabra et al. 1993b
Ethylnitrosourea Naito et al. 1981
Vesselinovitch et al. 1974
Vesselinovitch 1983
Ethylene thiourea Chhabra et al. 1992
3-Methylcholanthrene (a) Klein 1959
N-Methylnitrosourea Terracini and Testa 1970
Terracini et al. 1976
Polybrominated biphenyls Chhabra et al. 1993a
Safrole Vesselinovitch et al. 1979a
Urethane Chieco-Bianchi et al. 1963
Choudari Kommineni et al. 1970
De Benedictis et al. 1962
Fiore-Donati et al. 1962
Klein 1966
Liebelt et al. 1964
Rogers 1951
Vinyl chloride Maltoni et al. 1984
Mutagenic
mode of
Chemical Study type action
Amitrole Repeat dosing
Benzidine Repeat dosing X
Benzo[a]pyrene Acute exposure X
Dibenzanthracene Acute exposure X
Dichlorodiphenyltrichloroethane Repeat dosing
Lifetime exposure
Dieldrin Repeat dosing
Lifetime exposure
Diethylnitrosamine Lifetime exposure X
Acute exposure
Dimethylbenz[a]anthracene Acute exposure X
Acute exposure
Acute exposure
Dimethylnitrosamine Acute exposure X
Diphenylhydantoin, 5,5- Repeat dosing
Lifetime exposure
Ethylnitrosourea Acute exposure X
Acute exposure
Acute exposure
Ethylene thiourea Repeat dosing
Lifetime exposure
3-Methylcholanthrenea Repeat dosing X
N-Methylnitrosourea Acute exposure
Acute exposure X
Polybrominated biphenyls Repeat dosing
Lifetime exposure
Safrole Repeat dosing
Lifetime exposure X
Urethane Acute exposure X
Acute exposure
Acute exposure
Acute exposure
Acute exposure
Lifetime exposure
Acute exposure
Acute exposure
Vinyl chloride Repeat dosing
X, chemicals with a mutagenic mode of action. The chemicals listed
here are from the list of more than 50 chemicals found to have
carcinogenic effects from prenatal or postnatal exposures
in animals [Supplementary Table S1
(http://ehp.niehs.nih.gov/does/2005/7667/supp.pdf)].
(a) Formerly known as 20-methylcholanthrene.
Table 2. Ratio of early-life to adult cancer potencies for
studies with repeat exposures of juvenile and adult animals
to mutagenic chemicals.
Species,
Compound strain Sex Dose
Benzidine Mice Male
(B6C3[F.sub.1]) Female
3-Methyl- Mice Male 0.25 mg/g
cholanthrene (a) (albino) Female 0.25 mg/g
Male 0.25 mg/g
Female 0.25 mg/g
Male 0.25 mg/g
Female 0.25 mg/g
Safrole Mice Male
(B6C3
[F.sub.1]) Female
Vinyl Rats Male 10,000 ppm
chloride (b) (Sprague- Female 10,000 ppm
Dawley) Male 10,000 ppm
Female 10,000 ppm
Male 10,000 ppm
Female 10,000 ppm
Male 10,000 ppm
Female 10,000 ppm
Male 10,000 ppm
Female 10,000 ppm
Male 10,000 ppm
Female 10,000 ppm
Male 10,000 ppm
Female 10,000 ppm
Male 10,000 ppm
Female 10,000 ppm
Male 10,000 ppm
Female 10,000 ppm
Species,
Compound strain Tumor
Benzidine Mice Liver
(B6C3[F.sub.1]) Liver
3-Methyl- Mice Hepatoma
cholanthrene (a) (albino) Hepatoma
Forestomach
Forestomach
Skin
Skin
Safrole Mice Liver
(B6C3 Liver
Vinyl [F.sub.1]) Liver angiosarcoma
chloride (b) Rats Liver angiosarcoma
(Sprague- Zymbal gland
Dawley) Zymbal gland
Leukemia
Leukemia
Nephroblastomas
Nephroblastomas
Angiosarcomas
other sites
Angiosarcomas
other sites
Angiomas and fibromas
other sites
Angiomas and fibromas
other sites
Hepatoma
Hepatoma
Skin carcinomas
Skin carcinomas
Neuroblastoma
Neuroblastoma
Ratio of juvenile to
adult cancer potency
Species, Geometric
Compound strain mean 2.5%
Benzidine Mice 111 64
(B6C3[F.sub.1]) 0.16 0.004
3-Methyl- Mice 33 7.4
cholanthrene (a) (albino) 7.7 1.1
0.91 0.39
1.5 0.58
1.8 0.048
1.5 0.023
Safrole Mice 46 16
(B6C3 0.12 0.002
Vinyl [F.sub.1]) 7.4 0.035
chloride (b) Rats 30 8.7
(Sprague- 0.27 0.0022
Dawley) 0.15 0.0014
21 0.026
0.29 0.0019
0.17 0.0015
0.24 0.0017
0.25 0.0017
0.32 0.0019
1.4 0.0045
0.52 0.0024
34 8.2
55 8.4
0.41 0.0024
0.31 0.0019
0.20 0.0016
0.14 0.0014
Ratio of juvenile to
adult cancer potency
Species,
Compound strain Median 97.5%
Benzidine Mice 110 198
(B6C3[F.sub.1]) 0.22 1.1
3-Methyl- Mice 30 268
cholanthrene (a) (albino) 7.1 85
0.91 2.1
1.5 4.2
2.1 22
1.8 21
Safrole Mice 44 198
(B6C3 0.18 1.1
Vinyl [F.sub.1]) 11 62
chloride (b) Rats 29 121
(Sprague- 0.4 5.4
Dawley) 0.19 4.5
37 514
0.35 17
0.21 6.2
0.29 11
0.30 12
0.38 20
2.36 47
0.63 41
32 218
53 513
0.56 15
0.37 19
0.24 8.5
0.18 4.4
Species,
Compound strain Reference
Benzidine Mice Vesselinovitch
(B6C3[F.sub.1])
3-Methyl- Mice Klein 1959
cholanthrene (a) (albino)
Safrole Vesselinovitch
Vinyl Maltoni et al.
chloride (b)
(a) Formerly known as 20-methylcholanthrene. (b) Results for 6,000
ppm are similar to those for 10,000 ppm and are given in
Supplementary Table S4 (http://ehp.niehs.nih.gov/docs/200517667/
supp.pdf).
Table 3. Ratio of early-life to adult cancer potencies for
studies with lifetime exposures starting with juvenile and
adult, for chemicals acting through a mutagenicmode of action.
Species,
Compound strain Sex Dose
Diethylnitrosamine Rats Multiple
(Colworth)
Safrole Mice Male
(B6C3[F.sub.1]) Female
Urethane Mice Male 2.5 [micro]g/g/bw
(B6A[F.sub.1]/J) Female 2.5 [micro]g/g/bw
Ratio of juvenile to
adult cancer potency
Geometric
Compound Tumor mean 2.5% Median 97.5%
Diethylnitrosamine Liver 2.8 0.0093 5.6 23
Esophagus 0.18 0.0015 0.23 4.8
Safrole Liver 46 3.7 50 253
Liver 1.9 0.007 4.0 23
Urethane Liver 79 0.36 102 1,064
Liver 0.47 0.0022 0.55 43
Compound References
Diethylnitrosamine Peto et al. 1984
Safrole Vesselinovitch et al. 1979b
Urethane Klein 1966
bw, body weight.
Table 4. Summary of quantitative estimates of ratio of
early-life to adult cancer potencies.
No. of Geometric
Dose Tissue chemicals mean ratio
Chemicals with mutagenic mode of action
Repeated 4 10.5
Lifetime 3 8.7
Combined repeated and lifetime 6 10.4
Acute
Combined (all tissues) 8 1.5
Forestomach 3 0.076
Harderian 2 0.48
Kidney 2 1.6
Leukemia 1 5.9
Liver 5 8.1
Lung 7 1.1
Lymph 2 1.8
Mammary
Week 5 vs. week 26 1 7.1
Week 2 vs. weeks 5-8 or 26 1 0.071
Nerve 2 2.3
Nerve (day 1 comparison) 2 10
Ovarian 1 0.033
Reticular tissue 1 6.5
Thymic lymphoma 1 2.8
Thyroid 1 0.05
Uterine/vaginal 1 1.6
Day 1 (all tissues) 7 1.7
Day 15 (all tissues) 3 1.5
Chemicals with nonmutagenic mode of action
Repeated 6 2.2
Lifetime 5 3.4
Range of No. of
Dose Tissue ratios ratios
Chemicals with mutagenic mode of action
Repeated 0.12-111 45
Lifetime 0.18-79 6
Combined repeated and lifetime 0.12-111 51
Acute
Combined (all tissues) 0.01-178 268
Forestomach 0.01-1.9 32
Harderian 0.06-0.8 20
Kidney 0.17-7.1 18
Leukemia 5.1-6.7 2
Liver 0.10-40 70
Lung 0.04-178 77
Lymph 1.1-2.7 3
Mammary
Week 5 vs. week 26 NA 1
Week 2 vs. weeks 5-8 or 26 NA 2
Nerve 0.24-64 10
Nerve (day 1 comparison) 0.24-64 3
Ovarian 0.01-0.13 3
Reticular tissue 2.0-8.6 2
Thymic lymphoma 1.0-7.9 6
Thyroid 0.03-0.08 2
Uterine/vaginal 0.03-8.6 3
Day 1 (all tissues) 0.01-178 127
Day 15 (all tissues) 0.06-52 74
Chemicals with nonmutagenic mode of action
Repeated 0.06-13 22
Lifetime 0.15-36 38
NA, not applicable.
Table 5. Ratio of early-life to adult cancer potencies
for studies with repeated exposures of juvenile and
adult animals to nonmutagenic chemicals.
Species,
Compound strain Sex Dose Tumor
Amitrole Mice Male 500 Liver
(B6C3[F.sub.1]) Female 500 Liver
DDT Mice Male 150 Liver
(B6C3[F.sub.1])
Dieldrin Mice Male 10 Liver
(B6C3[F.sub.1])
DPH Rats Male 630 Liver
(F344/N) Female 630 Liver
Mice Male 210 Liver
(B6C3[F.sub.1]) Female 210 Liver
ETU Rats Male 90 Thyroid
(F344/N) Female 90 Thyroid
Mice Male 330 Liver
(B6C3[F.sub.1]) Female 330 Liver
Male 330 Thyroid
Female 330 Thyroid
Male 330 Pituitary
Female 330 Pituitary
PBB Rats Male 10 Liver
(F344/N) Female 10 Liver
Male 10 Mononuclear cell
leukemia
Female 10 Mononuclear cell
leukemia
Mice Male 30 Liver
(B6C3[F.sub.1]) Female 30 Liver
Ratio of juvenile to
adult cancer potency
Species, Geometric
Compound strain mean 2.5% Median 97.5%
Amitrole Mice 13 5.1 14 30
(B6C3[F.sub.1]) 0.14 0.0013 0.18 3.9
DDT Mice 1.3 0.0044 2.5 25
(B6C3[F.sub.1])
Dieldrin Mice 0.75 0.0031 1.2 27
(B6C3[F.sub.1])
DPH Rats 0.40 0.0024 0.54 16
(F344/N) 0.24 0.0017 0.29 12
Mice 1.5 0.0040 2.4 71
(B6C3[F.sub.1]) 1.3 0.0056 2.6 15
ETU Rats 0.37 0.0029 0.61 5.4
(F344/N) 0.23 0.0018 0.30 7.0
Mice 0.091 0.0011 0.12 1.9
(B6C3[F.sub.1]) 0.057 0.0010 0.081 0.65
0.41 0.0022 0.52 25
0.40 0.0024 0.55 16
0.32 0.0019 0.38 22
0.24 0.0018 0.32 6.9
PBB Rats 0.59 0.0041 1.1 6.6
(F344/N) 0.063 0.0009 0.079 1.2
0.79 0.0035 1.4 18
0.21 0.0017 0.28 6.0
Mice 3.9 1.9 3.9 7.5
(B6C3[F.sub.1]) 1.0 0.37 1.05 2.1
Species,
Compound strain References
Amitrole Mice Vesselinovitch 1983
(B6C3[F.sub.1])
DDT Mice Vesselinovitch et al. 1979 (a)
(B6C3[F.sub.1])
Dieldrin Mice Vesselinovitch et al. 1979 (a)
(B6C3[F.sub.1])
DPH Rats Chhabra et al. 1993 (b)
(F344/N)
Mice
(B6C3[F.sub.1])
ETU Rats Chhabra et al. 1992
(F344/N)
Mice
(B6C3[F.sub.1])
PBB Rats Chhabra et al. 1993 (a)
(F344/N)
Mice
(B6C3[F.sub.1])
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