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Cancer Care Chronicles
August 2015

The Implications of “Random Chance” in Cancer Genesis: Why Stochastic Can Be a Dirty Word

Author Affiliations
  • 1DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland
JAMA Oncol. 2015;1(5):575-576. doi:10.1001/jamaoncol.2015.0786

The recent publication in Science of calculations implying that oncogenesis is a “stochastic” (ie, random) process and that cancer results from “bad luck”1 was widely reported in the media.2 The poignant, often emotional comments that followed startled some3 but not those of us who care for cancer patients professionally. Years of patient interactions could have foretold that the “Why me?” question is an essential and sensitive subject for actual human beings living with cancer—and for loved ones left behind. The Science article reports no new experiments but rather extensive mathematical calculations with existing data from SEER (the Surveillance, Epidemiology, and End Results Program) regarding cancer incidence in different tissues and rates of stem cell division in those same tissues. Since DNA transcription errors are known to occur at similar rates in different tissues,1 the authors hypothesized that there should be a close correlation between stem cell division rates and cancer incidence rates if cancer is a result of random mutations to those stem cells. The authors found this precise correlation across cancers that vary in incidence by 5 orders of magnitude. They concluded that two-thirds of the difference in cancer incidence rates between types of tissue could be explained by random error during DNA transcription, or to use the authors’ own term, “bad luck.”