Is your initiator really necessary?

There is little hard evidence for the involvement of specific genotoxic initiators in the pathogenesis of the common carcinoma. Recent findings suggest that sporadic carcinogenesis is a dynamic and probabilistic process which requires a critical mass of abnormal cells for its expression, and that this requirement may distinguish the evolution of carcinomas from that of paediatric or haematologic malignancies. The proposal that specific carcinogens are neither necessary nor sufficient for tumourigenesis is consistent with the growing realization that aberrant expression of specific oncogenes is neither necessary nor sufficient for cellular transformation. These new perspectives have major implications for basic research strategy and public health policy.