Summation and Synthesis: From the Immunology Point of View
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As Eric has said from the cancer point of view, cancer is a series of genetic changes, which from my, the immunology, point of view, only become meaningful under particular environmental conditions, and that is the environment of the host. I would certainly agree that the order in which the molecular genetic events appear to occur is probably a part of that. But, I do not know if the order is not an important part of that. I think that they can occur in any order, but what cannot be overlooked is that the recognized changes are found in lesions. The reasons that molecular genetic studies can be done is because the lesions are there; so that even though the order in which the particular molecular events occurred is somewhat irrelevant in the overall process, it may be highly relevant from the clinical point of view. In a sense this is a hierarchy of events that we are witnessing. And the reason that you have a lesion at any particular time is that some event has occurred. So, I think that it is important to do the map and try to see if there is a sequence of events that is being imposed on the whole process because I think, in fact, that might tell us something about what the rate-limiting processes are from the clinical point of view. Changes can occur in any order, but when you have a lesion, that is simple. And if those changes actually manifest themselves at some point along the line, then a clinically detectable entity can be teased out from among the others. They are then the rate-limiting changes. They are the ones that will really matter from the point of view of ultimate prevention. I think this is important, practically.