“…Specific genetic and epigenetic alterations in the bronchoepithelium that have been shown to have predictive value for detection of early lung cancer include proteins that are differentially expressed in normal vs preneoplastic bronchoepithelium; mutation in genes involved in regulation of cell proliferation, differentiation, and apoptosis; and alterations in genetic and cellular elements that influence the transformation from normal to malignant tissue. Candidate biomarkers that show promise include methylation status in the promoter regions of the TSG gene p16 (354,355) and O 6 -methyl-guanine-DNA-methyltransferase (356), which is an enzyme involved in metabolism of carcinogens. Studies have shown that both genes were hypermethylated in 100% of squamous cell lung cancers up to 3 yr before diagnosis (301).…”