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This the other important diagram for biomarkers.

It begins with the exposure and ends with the disease.

There is the Internal dose:  is identified by a body tissue or fluid through a lab assay, and the amount of exogenous agent can be either unchanged or metabolically altered and absorbed by the human body. (e.g. urinary lead, cotinine in urine)

Biologically effective dose: the amount of absorbed agent that has interacted with a tissue in the body. (e.g. changes in DNA strands)

Biological response and alteration: biological or biochemical changes in target cells or tissues that result from the action of the chemical and are thought to be a step in the pathological process. (e.g. in lab animals)

Disease markers: is a measurable indicator of a biological or biochemical event that either represents a subclinical stage of disease or is a manifestation of the disease itself. (e.g. tumor specific antigens, SGOT)

The culture, biological, physical, and chemical factors represent what influence individual susceptibility. These are measurable indicators of the genetic or acquired factors, existing before and independent of exposure.

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