More hits: Weinberg (MIT) demonstrated that except for congenital malignancies, it takes 3 separate hits to induce full malignant transformation. As such contact with a carcinogen may be the first and a viral hit the second. The 3rd hit takes more time. In addition once a cell is malignant it needs immortality by increasing telomerase activity. End effect in older patients.
Answered 9/29/2016
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