A study recently published in Science demonstrates a strong correlation between the total number of stem cell divisions and the lifetime risk of cancer in various organs. The tumors considered are divided into two classes, that is, D (Deterministic) and R (Replicative). Stochastic factors presumably attributable to errors deriving from DNA replication are proposed to be at the basis of R-tumor frequency, leading to the conclusion that ‘bad luck' is a primary determinant of certain types of cancer. The present Second Opinion highlights potential problems associated with the hypothesis of the study, as some of these also apply to kidney cancer. The aim is to point out that chance is not a major cause of cancer incidence because it is not substantiated by the data available through epidemiological evidence. In particular, we highlight that differences in tumor incidence associated with sex and geographic areas are not in line with the ‘bad luck' hypothesis. Further aspects of tumor biology that do not entirely fit with the idea that stochastic events related to DNA replication of normal stem cells are the heterogeneity of the cancer cell phenotype and the heterogeneity of intra-organ localization, often observed in tumors originating from the same tissue. From a public health perspective, the points discussed here as well as the absence of data on prevalent tumors, like breast and prostate cancer, do not support the oversimplified message conveyed by the media that the majority of cancer cases cannot be prevented.

Keywords:
Cancer, Tumor incidence, Kidney cancer, Stem cell, Replication
1.
Tomasetti C, Vogelstein B: Cancer etiology. Variation in cancer risk among tissues can be explained by the number of stem cell divisions. Science 2015;347:78-81.
2.
Couzin-Frankel J: Biomedicine. The bad luck of cancer. Science 2015;347:12.
3.
Couzin-Frankel J: Science communication. Backlash greets ‘bad luck' cancer study and coverage. Science 2015;347:224.
4.
Engel LS, Chow WH, Vaughan TL, Gammon MD, Risch HA, Stanford JL, Schoenberg JB, Mayne ST, Dubrow R, Rotterdam H, West AB, Blaser M, Blot WJ, Gail MH, Fraumeni JF Jr: Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst 2003;95:1404-1413.
5.
Lipworth L, Tarone RE, McLaughlin JK: The epidemiology of renal cell carcinoma. J Urol 2006;176:2353-2358.
6.
McLaughlin JK, Lipworth L, Tarone RE: Epidemiologic aspects of renal cell carcinoma. Semin Oncol 2006;33:527-533.
7.
Cheungpasitporn W, Thongprayoon C, O'Corragain OA, Edmonds PJ, Ungprasert P, Kittanamongkolchai W, Erickson SB: The risk of kidney cancer in patients with kidney stones: a systematic review and meta-analysis. QJM 2015;108:205-212.
8.
Benichou J, Chow WH, McLaughlin JK, Mandel JS, Fraumeni JF Jr: Population attributable risk of renal cell cancer in Minnesota. Am J Epidemiol 1998;148:424-430.
9.
Tavani A, Negri E, La Vecchia C: Re: ‘Population attributable risk of renal cell cancer in Minnesota'. Am J Epidemiol 1999;150:222.
10.
Polyak K: Heterogeneity in breast cancer. J Clin Invest 2011;121:3786-3788.
11.
Lee TT, Manzano GR: Third ventricular glioblastoma multiforme: case report. Neurosurg Rev 1997;20:291-294.
12.
Kleihues P, Cavenee WK (eds): Pathology and genetics of tumours of the nervous system, world health organization classification of tumours. Lyon, France, IARC Press, 2000.
13.
Dohrmann GJ, Farwell JR, Flannery JT: Glioblastoma multiforme in children. J Neurosurg 1976;44:442-448.
14.
Lowrance WT, Ordonez J, Udaltsova N, Russo P, Go AS: CKD and the risk of incident cancer. J Am Soc Nephrol 2014;25:2327-2334.
15.
Woldu SL, Weinberg AC, RoyChoudhury A, Chase H, Kalloo SD, McKiernan JM, DeCastro GJ: Renal insufficiency is associated with an increased risk of papillary renal cell carcinoma histology. Int Urol Nephrol 2014;46:2127-2132.
16.
Axelson H, Johansson ME: Renal stem cells and their implications for kidney cancer. Semin Cancer Biol 2013;23:56-61.
© 2015 S. Karger AG, Basel
2015
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