In the past few years, scientific interest has focused on We quantitatively assessed rates of cell replication and the process of apoptosis. Like cell replication, apoptosis is of apoptosis during the development and regression of controlled by the networks of positive and negative growth liver cancer. In rats, apoptotic activity gradually insignals. 3,[6][7][8][9][10][11] Currently prevailing views assume that maligcreased from normal liver to putative preneoplastic foci nant cells are incapable of apoptosis and/or are not responsive (PPF), to hepatocellular adenoma (HCA), and to hepatoto death signals, thereby allowing unrestrained growth of cellular carcinoma (HCC). At all stages, rates of cell replicancer. cation were higher than of apoptosis, allowing a prefer-We studied the role of apoptosis for carcinogenesis and ential net gain of (pre)neoplastic cells. As in rats, in tumor reversion in rat and human liver. Liver cancer is human HCC, birth and death rates were increased maniamong the eight leading causes of cancer death worldwide; fold, indicating a species-independent phenomenon. Imtherapeutic possibilities are very limited and prognosis is plications of the increasing cell turnover were studied usually poor. 12 Etiologic factors include genotoxic agents such in rats using the administration and withdrawal of naas certain mycotoxins or hepatitis B virus, and numerous fenopin (NAF), a liver mitogen and nongenotoxic carcinnongenotoxic exposures, e.g., ethanol, cytotoxic and inflamogen. Prolonged NAF treatment enhanced cell number matory events, steroid hormones, as well as overnutrition, in normal liver by 25%, while PPF and liver tumors were dietary constituents and some drugs, all of which may enamplified at least 100-fold. After stopping NAF treathance the growth rate of precancerous and cancerous lesions ment, cell replication ceased, while cell elimination by in the liver. 12,13 Experimental results on cancer prestages apoptosis was increased in normal and (pre)neoplastic (putative preneoplastic foci [PPF]) in this organ were not liver. HCA and HCC showed the most pronounced shifts consistent with the concept of failure of apoptosis during carfrom replication toward apoptosis. As a result, 5 weeks cinogenesis. Rather, PPF showed rates of apoptosis much after halting NAF, 20% of cells in normal liver, but about higher than normal liver; thus, the high rate of cell replica-85% of (pre)neoplastic lesions including HCC, were elimtion in PPF was largely counteracted and net growth was inated. The implications of these findings include that impeded. 11,14,15 Tumor promotion by liver mitogens or overnongenotoxic carcinogens can act as survival factors feeding inhibited apoptosis and enhanced survival of cells even for malignant cells. Furthermore, tumor cells not preferentially in PPF, thereby allowing their selective only exhibit excessive proliferation, but also undergo growth; conversely, withdrawal of these survival/growth facapoptosis at rates that far exceed those in normal tissue.tors enhanced apopt...