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Risk Assessment

Step 2 - Dose-Response Assessment

Step 2 - Dose-Response Assessment: To document the relationship between dose and toxic effect.

 This is a diagram of 4 -step Human Health Risk Assessment Process, highlighting the Dose-Response Assessment (step 2) which is to document the relationship between dose and toxic effect.

A dose-response relationship describes how the likelihood and severity of adverse health effects (the responses) are related to the amount and condition of exposure to an agent (the dose provided).  Although this webpage refers to the "dose-response” relationship, the same principles generally apply for studies where the exposure is to a concentration of the agent (e.g., airborne concentrations applied in inhalation exposure studies), and the resulting information is referred to as the "concentration-response" relationship.  The term "exposure-response" relationship may be used to describe either a dose-response or a concentration-response, or other specific exposure conditions.

Typically, as the dose increases, the measured response also increases. At low doses there may be no response. At some level of dose the responses begin to occur in a small fraction of the study population or at a low probability rate. Both the dose at which response begin to appear and the rate at which it increases given increasing dose can be variable between different pollutants, individuals, exposure routes, etc.

The shape of the dose-response relationship depends on the agent, the kind of response (tumor, incidence of disease, death, etc), and the experimental subject (human, animal) in question. For example, there may be one relationship for a response such as 'weight loss' and a different relationship for another response such as 'death'. Since it is impractical to study all possible relationships for all possible responses, toxicity research typically focuses on testing for a limited number of adverse effects.  Upon considering all available studies, the response (adverse effect), or a measure of response that leads to an adverse effect (known as a ‘precursor’ to the effect), that occurs at the lowest dose is selected as the critical effect for risk assessment.  The underlying assumption is that if the critical effect is prevented from occurring, then no other effects of concern will occur.

As with hazard identification, there is frequently a lack of dose-response data available for human subjects. When data are available, they often cover only a portion of the possible range of the dose-response relationship, in which case some extrapolation must be done in order to extrapolate to dose levels that are lower than the range of data obtained from scientific studies.  Also, as with hazard identification, animal studies are frequently done to augment the available data. Studies using animal subjects permit the use of study design to control the number and composition (age, gender, species) of test subjects, the levels of dose tested, and the measurement of specific responses. Use of a designed study typically leads to more meaningful statistical conclusions than does an uncontrolled observational study were additional confounding factors must also be considered for their impact on the conclusions. However, dose-response relationships observed from animal studies are often at much higher doses that would be anticipated for humans, so must be extrapolated to lower doses, and animal studies must also be extrapolated from that animal species to humans in order to predict the relationship for humans. These extrapolations, among others, introduce uncertainty into the dose-response analysis.

Dose-response assessment is a two-step process. The first step is an assessment of all data that are available or can be gathered through experiments, in order to document the dose-response relationship(s) over the range of observed doses (i.e, the doses that are reported in the data collected). However, frequently this range of observation may not include sufficient data to identify a dose where the adverse effect is not observed (i.e., the dose that is low enough to prevent the effect) in the human population. The second step consists of extrapolation to estimate the risk (probably of adverse effect) beyond the lower range of available observed data in order to make inferences about the critical region where the dose level begins to cause the adverse effect in the human population.

Basic Dose-Response Calculations & Concepts

As a component of the first step of the process discussed above, the scientific information is evaluated for a better biological understanding of how each type of toxicity or response (adverse effect) occurs; the understanding of how the toxicity is caused is called the "mode of action" (which is defined as a sequence of key events and processes, starting with interaction of an agent with a cell, proceeding through operational and anatomical changes, and resulting in the effect, for example, cancer formation). Based on this mode of action, the Agency determines the nature of the extrapolation used in the second step of the process discussed above, either through non-linear or linear dose-response assessment. 

Non-linear dose-response assessment

Non-linear dose response assessment has its origins in the threshold hypothesis, which holds that a range of exposures from zero to some finite value can be tolerated by the organism with essentially no chance of expression of the toxic effect, and the threshold of toxicity is where the effects (or their precursors) begin to occur. It is often prudent to focus on the most sensitive members of the population; therefore, regulatory efforts are generally made to keep exposures below the population threshold, which is defined as the lowest of the thresholds of the individuals within a population.  If the "mode of action" information (discussed above) suggests that the toxicity has a threshold, which is defined as the dose below which no deleterious effect is expected to occur, then type of assessment is referred to by the Agency as a "non-linear" dose-response assessment.  The term "nonlinear" is used here in a narrower sense than its usual meaning in the field of mathematics; a nonlinear assessment uses a dose-response relationship whose slope is zero (i.e., no response) at (and perhaps above) a dose of zero.

A No-Observed-Adverse-Effect Level (NOAEL) is the highest exposure level at which no statistically or biologically significant increases are seen in the frequency or severity of adverse effect between the exposed population and its appropriate control population. In an experiment with several NOAELs, the regulatory focus is normally on the highest one, leading to the common usage of the term NOAEL as the highest experimentally determined dose without a statistically or biologically significant adverse effect. In cases in which a NOAEL has not been demonstrated experimentally, the term "lowest-observed-adverse-effect level (LOAEL)" is used, which this is the lowest dose tested.

Mathematical modeling, which can incorporate more that one effect level (i.e., evaluates more data than a single NOAEL or LOAEL), is sometimes used to develop an alternative to a NOAEL known as a Benchmark Dose (BMD) or Benchmark Dose Lower-confidence Limit (BMDL).  In developing the BMDL, a predetermined change in the response rate of an adverse effect (called the benchmark response or BMR; generally in the range of 1 to 10% depending on the power of a toxicity study) is selected, and the BMDL is a statistical lower confidence limit on the dose that produces the selected response.  When the non-linear approach is applied, the LOAEL, NOAEL, or BMDL is used as the point of departure for extrapolation to lower doses.

The reference dose (RfD) is an oral or dermal dose derived from the NOAEL, LOAEL or BMDL by application of generally order-of-magnitude uncertainty factors (UFs).  These uncertainty factors take into account the variability and uncertainty that are reflected in possible differences between test animals and humans (generally 10-fold or 10x) and variability within the human population (generally another 10x); the UFs are multiplied together: 10 x 10 = 100x. If a LOAEL is used, another uncertainty factor, generally 10x, is also used. In the absence of key toxicity data (duration or key effects), an extra uncertainty factor(s) may also be employed.  Sometimes a partial UF is applied instead of the default value of 10x, and this value can be less than or greater than the default.  Often the partial value is ½ log unit (the square root of 10) or 3.16 (rounded to 3-fold in risk assessment).  Note, that when two UFs derived from ½ log units are multiplied together (3 x 3) the result is a 10 (equal to the full UF from which the two partial factors were derived).

Thus, the RfD is determined by use of the following equation:

RfD = NOAEL (or LOAEL or BMDL) / UFs

In general, the RfD is defined as an estimate (with uncertainty spanning perhaps an order of magnitude) of a daily oral exposure to the human population (including sensitive groups, such as asthmatics, or life stages, such as children or the elderly) that is likely to be without an appreciable risk of deleterious effects during a lifetime. The RfD is generally expressed in units of milligrams per kilogram of bodyweight per day: mg/kg/day.

A similar term, know as reference concentration (RfC), is used to assess inhalation risks, where concentration refers to levels in the air (generally expressed in the units of milligrams agent per cubic meter of air: mg/m3).  For more information, please see A Review of the Reference Dose and Reference Concentration Processes.

Linear dose-response assessment

If the "mode of action" information (discussed above) suggests that the toxicity does not have a threshold, then this type of assessment is referred to by the Agency as a "linear" dose-response assessment.  In the case of carcinogens, if "mode of action" information is insufficient, then linear extrapolation is typically used as the default approach for dose-response assessment (for more detailed information, please see EPA’s Guidelines for Carcinogen Risk Assessment).  In this type of assessment, there is theoretically no level of exposure for such a chemical that does not pose a small, but finite, probability of generating a carcinogenic response.  The extrapolation phase of this type of assessment does not use UFs; rather, a straight line is drawn from the point of departure for the observed data (typically the BMDL) to the origin (where there is zero dose and zero response).  The slope of this straight line, called the slope factor or cancer slope factor, is use to estimate risk at exposure levels that fall along the line.  When linear dose-response is used to assess cancer risk, EPA calculates excess lifetime cancer risk (i.e., probability that an individual will contract cancer over a lifetime) resulting from exposure to a contaminant by considering the degree to which individuals were exposed, as compared to the slope factor. Thus, 

Cancer Risk = Exposure x Slope Factor

Total cancer risk is calculated by adding the individual cancer risks for each pollutant in each pathway of concern (i.e., inhalation, ingestion, and dermal absorption), then summing the risk for all pathways.

A similar term, know as inhalation unit risk (IUR), is used to assess inhalation risks, where the exposure-response relationship refers to concentrations in the air.

Note: When there are alternative procedures having significant biological support, the Agency encourages assessments to be performed using these alternative procedures, if feasible, in order to shed light on the uncertainties in the assessment, recognizing that the Agency may decide to give greater weight to one set of procedures than another in a specific assessment or management decision.

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