Table 1.

Challenges for developing mitigators for radiation-induced cancer.

● Biomarkers for cancer

○ Radiation—biomarker for dose

○ Radiation risk—biomarker for radiation damage

○ Cancer biomarker—is there one to assess person’s risk of cancer in general or of a specific cancer and efficacy of an intervention?

● Individuals at risk

○ Based on underlying genetic susceptibility

○ Family history (no known genetic marker)

○ Individual exposure history to genotoxic injury including lifestyle choices (e.g., smoking)

○ Children? Pregnant women?

○ Threshold dose at which to consider mitigation

● Operative molecular and biological mechanisms during latency

○ Are any subject to ‘chemo-modification’?

○ What mechanisms can be affected by an individual’s effort and what are beyond intervention?

● Drug development

○ Develop a drug for this purpose?

○ Utilise an existing drug—repurposing?

○ Assess safety

○ Assess efficacy of common dietary foods or nutraceuticals

● Cost versus benefit

○ At what excess lifetime risk is intervention appropriate?

○ Toxicity, expense, time and excess stress from an intervention