A metabolic perspective of Peto's paradox and cancer

The frequency of cancer is postulated to be proportional to the number of cells an animal possesses, as each cell is similarly exposed to mutagens with every cell division. Larger animals result from more cell divisions with more mutagenic exposure, and hence are expected to have higher frequencies of cancer. Yet, as stipulated by Peto's paradox, larger animals do not have the higher rates of cancers seen in smaller animals despite the significant differences in cell numbers and a longer lifetime that would expose larger animals to more mutagens. The rates of cancer appear to be inversely proportional to animal body size, which scales inversely with specific metabolic rates of mammals. Studies over the past 20 years have linked oncogenes and tumour suppressors to alterations in cancer metabolism, and conversely, mutations in metabolic genes have been documented to trigger tumorigenesis. The by-products and intermediates of metabolism, such as reactive oxygen species, oxoglutarate, citrate and acetate, all have the potential to mutate and alter the genome or epigenome. On the basis of these general observations, it is proposed that metabolic rates correlate with mutagenic rates, which are higher in small animals and give the mechanistic basis for Peto's paradox. The observations discussed in this overview collectively indicate that specific metabolic rate varies inversely with body size, which seems to support the hypothesis that metabolism drives tumorigenesis and accounts for Peto's paradox.