scholarly journals Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study

2020 ◽  
pp. medethics-2020-106146
Author(s):  
Ineke Bolt ◽  
Eline M. Bunnik ◽  
Krista Tromp ◽  
Nora Pashayan ◽  
Martin Widschwendter ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Lifestyle Modification ◽  
Personal Responsibility ◽  
Research Programme ◽  
Practical Reasons ◽  
Predictive Test ◽  
Epigenetic Markers ◽  
Ethical Concerns ◽  
Predictive Tests ◽  
Risk Of Cancer

Epigenetic markers could potentially be used for risk assessment in risk-stratified population-based cancer screening programmes. Whereas current screening programmes generally aim to detect existing cancer, epigenetic markers could be used to provide risk estimates for not-yet-existing cancers. Epigenetic risk-predictive tests may thus allow for new opportunities for risk assessment for developing cancer in the future. Since epigenetic changes are presumed to be modifiable, preventive measures, such as lifestyle modification, could be used to reduce the risk of cancer. Moreover, epigenetic markers might be used to monitor the response to risk-reducing interventions. In this article, we address ethical concerns related to personal responsibility raised by epigenetic risk-predictive tests in cancer population screening. Will individuals increasingly be held responsible for their health, that is, will they be held accountable for bad health outcomes? Will they be blamed or subject to moral sanctions? We will illustrate these ethical concerns by means of a Europe-wide research programme that develops an epigenetic risk-predictive test for female cancers. Subsequently, we investigate when we can hold someone responsible for her actions. We argue that the standard conception of personal responsibility does not provide an appropriate framework to address these concerns. A different, prospective account of responsibility meets part of our concerns, that is, concerns about inequality of opportunities, but does not meet all our concerns about personal responsibility. We argue that even if someone is responsible on grounds of a negative and/or prospective account of responsibility, there may be moral and practical reasons to abstain from moral sanctions.

scholarly journals Health Risk Assessment for the Exposure of Workers to BTEX at the Gasoline Stations

2021 ◽  
Vol 25 (1) ◽  
pp. 71-77
Author(s):  
Nguyen Thanh Giao ◽  
Phan Kim Anh ◽  
Huynh Thi Hong Nhien
Keyword(s):  
Risk Assessment ◽  
Cancer Risk ◽  
Health Risk ◽  
Health Risk Assessment ◽  
Life Time ◽  
The United States ◽  
Gasoline Station ◽  
Toxic Gases ◽  
Benzene Toluene ◽  
Risk Of Cancer

The study was conducted to assess the health risks of workers due to exposure to toxic gases including benzene, toluene, ethylbenzene, m, p-xylene, o-xylene, formaldehyde and acetaldehyde at gasoline retail stations. In this study, data on the  concentrations of the toxic gases were collected from the previously published studies in the qualified scientific journals. The health risk assessment was followed by the process of the United States Environment Protection Agency (U.S. EPA). The results show that the concentrations of benzene, toluene, ethylbenzene, m, p-xylene, o-xylene, formaldehyde, and acetaldehyde were in the range of 12.40 - 357.5, 12.47 - 574.17, 2.05 - 156.5, 4.57 - 218, 2.36 - 77.04, 3.64 - 153.93 and 1.27- 27.83 µg/m3 , respectively. Life time cancer risk for gasoline station workers due to exposure to benzene, ethylbenzene, formaldehyde, and acetaldehyde was calculated in the ranges of 2.13x10-5 - 6.14x10-4 , 4.96x10-7 - 3.79x10-5 , 4.81x10-6 - 2.03x10-4 , and 7.99x10-7 - 1.75x10-5 , respectively. For non-carcinogenic  compounds, the hazard index due to benzene, toluene, m, p-xylene, o-xylene were respectively in the range of 0.13 - 3.81, 7.97x10-4 -  0.04, 0.01 - 0.70 and 0.01 - 0.25. The findings revealed that there is high risk of cancer and non-cancer for the workers working at the gasolines stations if they are not taking good preventive measures. The calculation showed that the limit levels of benzene, toluene, ethylbenzene, xylene, formaldehyde and acetaldehyde should be reduced to 5.82x10-4 , 15.64, 4.13x10- 3 , 0.31, 7.57x10-4 and 1.59x10-3 mg/m3 , respectively to meet the safety levels for the workers at the gasoline stations. Keywords: benzene, toluene, ethylbenzene, xylene, formaldehyde, acetaldehyde, life-time cancer risk, health

Letter to the Editor

PEDIATRICS ◽  
1994 ◽  
Vol 93 (1) ◽  
pp. 157-157
Author(s):  
Gerald B. Merenstein ◽  
William E. Hathaway ◽  
Robert W. Miller
Keyword(s):  
Vitamin K ◽  
Task Force ◽  
Vitamin K1 ◽  
Predictive Tests ◽  
Letter To The Editor ◽  
Risk Of Cancer

We thank Dr Israels for his thoughtful comments on the AAP Vitamin K Task Force statement. He raises two issues: the risk of cancer from currently recommended doses of intramuscular vitamin K1 and the need for the task force to reconsider the physiology of vitamin K. The ultimate measure of carcinogenicity in the human is an excess of cancer in the human—not predictive tests in vitro or in animals, useful though they may be to raise suspicions.

scholarly journals Cancer Risk Assessment and the Biostatistical Revolution of the 1970s—A Reflection

Dose-Response ◽  
2018 ◽  
Vol 16 (4) ◽  
pp. 155932581880640 ◽  
Author(s):  
Kenny Crump
Keyword(s):  
Risk Assessment ◽  
Cancer Risk ◽  
Environmental Protection Agency ◽  
Cancer Risk Assessment ◽  
Toxic Substances ◽  
Multistage Model ◽  
The Public ◽  
Cancer Data ◽  
Assessment Guidelines ◽  
Risk Of Cancer

Before around 1960, assessment of risk from exposure to toxic substances, including risk of cancer, was generally implemented using the NOAEL-safety factor approach that essentially assumed that an exposure threshold existed and exposures below the threshold carried no risk. In the 1970s there came a realization that cancer could develop from a mutation in a single cell and consequently it was unlikely that a threshold existed for substances that could cause such mutations, and that risk could increase linearly with exposure. During this time the Environmental Protection Agency (EPA) was formed and charged with protecting the public from a perceived high risk of environmental cancer. Faced with this difficult task, EPA decided to assess cancer risk by fitting a statistical model to dose-response cancer data and extrapolating to low dose using the fitted model. After some early experimentation EPA selected the Linearized Multistage Model for this fitting, which predicted risk increased linearly with exposure at low exposures. This approach led to an increased emphasis on statistical issues in risk assessment. Today, cancer risk assessment guidelines allow for different approaches depending upon the understanding of a substance's mode of action. However, a review of EPA's experience with current guidelines indicates that most cancer risk assessments still follow procedures similar to those initiated more than 40 years ago.

Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule.

1992 ◽  
Vol 10 (2) ◽  
pp. 316-322 ◽  
Author(s):  
J A Talcott ◽  
R D Siegel ◽  
R Finberg ◽  
L Goldman
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Cancer Patients ◽  
Group Iv ◽  
Assessment Model ◽  
Medical Complications ◽  
Stepwise Logistic Regression ◽  
Medical Risk ◽  
Group I ◽  
Risk Of Cancer

PURPOSE The study was undertaken to validate a clinical model for predicting the medical risk of cancer patients with fever and neutropenia. PATIENTS AND METHODS A consecutive sample of 444 cancer patients with fever and neutropenia (granulocyte count less than 500/microL) at two hospitals, a specialized cancer referral center and a university-affiliated general medical hospital, was studied to identify clinical characteristics in the first 24 hours that predict subsequent serious medical complications during the hospital stay. To control for bias, major risk factors and complications were subject to blinded review. RESULTS Serious medical complications occurred in 34% of patients with risk factors identified in a prior study, including prior inpatient status (group I), outpatients with a serious independent comorbidity (group II), or uncontrolled cancer (group III), compared with 5% of the remaining patients (group IV) (P less than .000001). Two of the complications in group IV patients were transient asymptomatic hypotension, and the remaining three complications occurred after at least 1 week of progressive medical deterioration. These risk groups were independently significant in stepwise logistic regression analysis. Multiple complications (17%) and death (10%) were common among patients in groups I through III but did not occur in group IV patients. CONCLUSIONS This risk assessment model accurately stratified the medical risk of these patients using only clinical information available on the first day of their course. Low-risk patients are an appropriate population in which to study less intensive treatment strategies.

scholarly journals Assessing variation in the potential susceptibility of fish to pharmaceuticals, considering evolutionary differences in their physiology and ecology

2014 ◽  
Vol 369 (1656) ◽  
pp. 20130576 ◽  
Author(s):  
A. R. Brown ◽  
L. Gunnarsson ◽  
E. Kristiansson ◽  
C. R. Tyler
Keyword(s):  
Risk Assessment ◽  
Life History ◽  
Fish Species ◽  
Drug Targets ◽  
Hormone Receptors ◽  
Receptor Activation ◽  
Steroid Hormone Receptors ◽  
Practical Reasons ◽  
Evolutionary Divergence ◽  
Wide Range

Fish represent the planet's most diverse group of vertebrates and they can be exposed to a wide range of pharmaceuticals. For practical reasons, extrapolation of pharmaceutical effects from ‘model’ species to other fish species is adopted in risk assessment. Here, we critically assess this approach. First, we show that between 65% and 86% of human drug targets are evolutionarily conserved in 12 diverse fish species. Focusing on nuclear steroid hormone receptors, we further show that the sequence of the ligand binding domain that plays a key role in drug potency is highly conserved, but there is variation between species. This variation for the oestrogen receptor, however, does not obviously account for observed differences in receptor activation. Taking the synthetic oestrogen ethinyloestradiol as a test case, and using life-table-response experiments, we demonstrate significant reductions in population growth in fathead minnow and medaka, but not zebrafish, for environmentally relevant exposures. This finding contrasts with zebrafish being ranked as more ecologically susceptible, according to two independent life-history analyses. We conclude that while most drug targets are conserved in fish, evolutionary divergence in drug-target activation, physiology, behaviour and ecological life history make it difficult to predict population-level effects. This justifies the conventional use of at least a 10× assessment factor in pharmaceutical risk assessment, to account for differences in species susceptibility.

Sign in / Sign up

Export Citation Format

Share Document