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Epidemiology

Age distribution and a multi-stage theory of carcinogenesis: 70 years on

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Abstract

The Armitage Doll model demonstrates that the impact of age-dependent exposure to carcinogenic factors depends on whether the induced change occurs early, at the midpoint or late in carcinogenesis. 70 years on, updated modelling shows that their epidemiological observations still provide insight into clinical observations and their underlying molecular mechanisms.

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Fig. 1: Change in incidence and mortality for a selection of cancers between Armitage and Doll publication and the modern era.

Data availability

The UK cancer registration statistics used in the commentary are publically available at the websites as referenced.

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Acknowledgements

This study represents independent research supported by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. AW acknowledges funding from the RMH/ICR Cancer Research UK RadNet Centre.

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AW, RC and RE planned the commentary. AW and RC drafted the original manuscript and RE reviewed and edited the manuscript. All authors agreed to submission of the final version.

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Correspondence to Anna Wilkins.

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The authors declare no competing interests.

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All analysis in this manuscript is on UK publically-available data as referenced.

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Wilkins, A., Corbett, R. & Eeles, R. Age distribution and a multi-stage theory of carcinogenesis: 70 years on. Br J Cancer 128, 404–406 (2023). https://doi.org/10.1038/s41416-022-02009-9

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