Smoking and radiation joint effectsâ€”These analyses focused on the joint effects of radiation and smoking in terms of risks relative to attained age, gender, and birth cohort-specific baseline rates for non-smokers with no radiation exposure

Questions about the joint effect of radiation and smoking are generally framed in terms of a choice between simple additive and multiplicative models

The analysis by Pierce et al, which found a pattern for the joint effect that was qualitatively similar to ours, rejected a simple multiplicative model but not a simple additive model

Under our fitted generalized multiplicative model the joint effect appears to be supermultiplicative for light- to moderate-smokers but additive or even sub-additive for heavy-smokers

With the generalized multiplicative model, the genderaveraged excess relative risk associated with smoking 20 cigarettes per day for 50 years for an unexposed individual born in 1915 was estimated to be 4.7

The practical interest arises in medical, occupational, and environmental exposure scenarios: namely, implications in risk/benefit analyses of lung cancer CT screening programs targeted at smokers, concern for the risk from the increasing use of CT scans and other radiological procedures, interpretation of the dose response found for lung cancer in a large population of nuclear industry workers with low-dose radiation exposure, and estimation of the proportion of lung cancers attributed to residential radon exposures

The results suggest that simple additive or multiplicative models may not adequately describe the complex interaction between smoking intensity and radiation and that a similar comprehensive analytical approach may be needed in risk estimation for smokers with medical or occupational radiation exposures

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