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ABSTRACTThe general approach to risk assessment of genotoxic carcinogens has been to advise reduction of exposure to "as low as reasonably achievable/practicable" (ALARA/P). However, whilst this remains the preferred risk management option, it does not provide guidance on the urgency or extent of risk management actions necessary. To address this, the "Margin of Exposure" (MOE) approach has been proposed. The MOE is the ratio between the point of departure for carcinogenesis and estimated human exposure. However, interpretation of the MOE requires implicit or explicit consideration of the shape of the dose-response curve at human relevant exposures. In a structured elicitation exercise, we captured expert opinion on available scientific evidence for low dose-response relationships for genotoxic carcinogens. This allowed assessment of: available evidence for the nature of dose-response relationships at low levels of exposure; the generality of judgments about such dose-response relationships; uncertainties affecting judgments on the nature of such dose-response relationships; and whether this last should differ for different classes of genotoxic carcinogens. Elicitation results reflected the variability in experts' views on the form of the dose-response curve for low dose exposure and major sources of uncertainty and most importantly, query the rigour of the assumption of a linear relationship.Highlights Experts are reluctant to express views on the dose-response curve for genotoxic carcinogens
*Manuscript for revision (track changes hidden) Click here to view linked ReferencesPage 2 of 48 The POD can be extrapolated first from high to low dose in animals and then to humans, or vice versa Expert judgement was that the dose-response curve is highly non-linear at human relevant exposures Stochastic events and the distribution of susceptibilities will contribute, to an unknown extent Interpretation of the MOE requires consideration of MOA, species differences and human variability Keywords Dose-response function; expert judgment; genotoxic carcinogens; low dose extrapolation; margins of exposure; risk assessment