“…In some cases, hot spot mutations in noncoding DNA promote carcinogenesis, as is the case for hot spot mutations in the promoter of the telomerase reverse transcriptase ( TERT ) gene (Horn et al, 2013; Huang et al, 2013; Chiba et al, 2017; Heidenreich & Kumar, 2017). However, recent studies have indicated that some hot spot mutations in noncoding DNA may not drive carcinogenesis, but instead function as neutral “passenger” mutations (Fredriksson et al, 2017; Buisson et al, 2019; Roberts et al, 2019). Such “passenger” hot spots are not under selection, but may instead arise from highly mutagenic processes, such as elevated UV damage formation, as occurs at the binding sites of ETS transcription factors (Elliott et al, 2018; Mao et al, 2018; Premi et al, 2019), or inhibition of repair (Poulos et al, 2016; Sabarinathan et al, 2016; Mao & Wyrick, 2019).…”