Cancer complexity and radiation protection

Management of radiological risks typically encountered in environmental and occupational settings is challenging because of uncertainties in the magnitude of the risks and the benefits of risk reduction. In practice, radiation dose instead of risk is measured. However, the relationship between dose and risk is not straightforward because cancer (the major health effect of concern at low doses) is a disease of complexity. Risks at small doses (defined as less than 100 mSv) can never be known exactly because of the inherent uncertainties in cancer as a complex disease. Tumors are complex because of the nonlinear interactions that occur among tumor cells and between the tumor and its local tissue environment. This commentary reviews evidence for cancer complexity and what complexity means for radiation protection. A complexity view of cancer does not mean we must abandon our current system of protection. What it does mean is that complexity requires new ways of thinking about control of cancer-the ideas that cancers can occur without cause, cancers behave unpredictably, and calculated cancer risks following small doses of radiation are highly uncertain.