Characterizing Risk for Cumulative Risk Assessment. T. A. Burke, Johns Hopkins SPH, Baltimore, MD; and S. A. Ferenc, ILSI Risk Science Institute, Washington, DC
The fundamental purpose of a risk assessment is the evaluation of public health risk. However, cumulating both exposures and toxic responses in a cumulative risk assessment significantly increases the complexity of the assessment, and necessitates new considerations in risk characterization. These considerations focus on the choice of metrics for estimating risk, the consideration of uncertainty, and the description of public health implications. The challenge of providing guidance for characterization of cumulative risks can be well appreciated by risk assessment practitioners. It can be argued that our current knowledge is insufficient to enable us to accurately characterize cumulative risks. However, it is also to be recognized that there are practical needs of regulatory agencies, industry, and public health officials to develop refined approaches to understanding and managing cumulative risks. The goals of this presentation are to: present an overview of approaches to characterizing cumulative risks, identify key sources of uncertainty and data needs, and provide risk practitioners with a framework for organizing and presenting information about cumulative risks. The components of hazard identification, does-response assessment, and exposure analysis that should be addressed in risk characterization will be discussed, as well as the public health implications of cumulative risk. Various risk metrics will be placed in a public health context and the importance of risk "drivers" — those exposure or dose metrics that particularly influence a cumulative assessment — is recognized. A guide for presentation of CRA results will be outlined, and overarching issues and future directions are examined.
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