Our understanding of cancer has greatly advanced since Nordling [Nordling CO (1953) Br J Cancer 7(1):68-72] and Armitage and Doll [Armitage P, Doll R (1954) Br J Cancer 8(1):1-12] put forth the multistage model of carcinogenesis. However, a number of observations remain poorly understood from the standpoint of this paradigm in its contemporary state. These observations include the similar age-dependent exponential rise in incidence of cancers originating from stem/progenitor pools differing drastically in size, age-dependent cell division profiles, and compartmentalization. This common incidence pattern is characteristic of cancers requiring different numbers of oncogenic mutations, and it scales to very divergent life spans of mammalian species. Also, bigger mammals with larger underlying stem cell pools are not proportionally more prone to cancer, an observation known as Peto's paradox. Here, we present a number of factors beyond the occurrence of oncogenic mutations that are unaccounted for in the current model of cancer development but should have significant impacts on cancer incidence. Furthermore, we propose a revision of the current understanding for how oncogenic and other functional somatic mutations affect cellular fitness. We present evidence, substantiated by evolutionary theory, demonstrating that fitness is a dynamic environment-dependent property of a phenotype and that oncogenic mutations should have vastly different fitness effects on somatic cells dependent on the tissue microenvironment in an age-dependent manner. Combined, this evidence provides a firm basis for understanding the age-dependent incidence of cancers as driven by age-altered systemic processes regulated above the cell level. somatic evolution | cancer | aging | oncogenic mutations | fitness C ancer is believed to develop as a multistage disease driven by oncogenic mutations (also called driver mutations) that occur in stem cells (SCs) or progenitor cells. Each such mutation is thought to confer to the recipient cell a certain fitness advantage over other cells in a competitive stem/progenitor pool, leading to proliferation of the cell's progeny (clone) in the pool. The successive clonal expansions driven by oncogenic mutations multiply the number of cells representing an oncogenic mutation-bearing clone, and thus increase the odds of the occurrence of the subsequent driver mutations in the premalignant genetic background. In this way, carcinogenesis is viewed as a Darwinian process of successive rounds of selection leading to the formation of a malignant cell phenotype produced by a certain number of driver mutations (1-7). SC fitness, being the ability of a SC of a particular genotype/epigenotype to be maintained, expand, or contract within the SC compartment, is thus a central phenomenon determining somatic evolution. Because cancer incidence increases exponentially with age, successive clonal expansions are thought to follow the occurrence of oncogenic mutations and increase the likelihood of subsequent drivers over time, su...