The effects of cancer predisposition and increased tumorigenic
radiosensitivity of the predisposed
genotypes on radiation cancer risks (in the general population and in sisters
and first cousins of
affected probands) are studied using an autosomal dominant model of cancer
predisposition and
radiosensitivity. The model assumes that the predisposing alleles, which
confer enhanced
tumorigenic radiosensitivity, are incompletely penetrant. In addition,
the model also allows for
sporadic cancers, unrelated to the predisposing locus. The predictions
of the model are illustrated
using current estimates of BRCA1 mutant gene frequencies; the estimates
of the strength of
predisposition and radiosensitivity differentials used are based on animal
and human studies. It is
shown that, unless both the strength of predisposition and radiosensitivity
differential are large
(say, >100-fold in comparison with normal homozygotes), (i) the effect
of risk heterogeneity on
cancer risk is marginal; (ii) dose-dependent radiation effect remains virtually
the same as in a
homogeneous irradiated population that has no predisposed subgroups; (iii)
for the same radiation
dose, relatives of affected probands show an enhancement of cancer risks;
and (iv) most extra
cancers in relatives can be attributed to radiosensitivity differentials.
This simple model can give an
upper bound of the effect of risk heterogeneity on radiation-induced breast
cancer risks even when
the cumulative breast cancer risk is age-dependent. Further, our model
predicts that the benefits of
mammography outweigh the risks.