A brief presentation is made of the theory underlying the multistage model of Armitage and Doll and its implications in assessing the effect of exposure to a carcinogen. The theory foresees different relationships between cancer risk and the dependent time variables (time from beginning of exposure, age at start of employment, duration of exposure and time since end of exposure) according to whether the carcinogen acts in the early or late stages of the process of cell transformation leading to tumour formation. The trend in risk of death from lung cancer was studied in a cohort of workers exposed to hexavalent chromium followed up between 1948 and 1985. The results, referred to the multistage model, indicate that hexavalent chromium probably acts in the later stages of the cell transformation process; the implications of this hypothesis for prevention and/or occupational safety strategies are discussed.
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