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. Author manuscript; available in PMC: 2012 Apr 10.
Published in final edited form as: Cell. 2012 Feb 17;148(4):633–635. doi: 10.1016/j.cell.2012.01.043

Figure 1. The Telomere Crisis Model of Cancer Evolution.

Figure 1

Cancers initially evolve slowly, gradually acquiring spontaneous mutations (yellow dots). With increasing numbers of cell divisions, however, telomeres erode, and this induces a rapid increase in both the number of mutations (red dots) and the subclonal heterogeneity in the organ. Out of these competing subclones, one emerges with more malignant potential. As Ding et al. (2012) show, it is to this clone’s selective advantage to re-establish genomic stability through re-expression of telomerase. A period of relative genomic stability may follow, but this equilibrium can be disrupted by inhibition of telomerase. Hu et al. (2012) find that, after initial therapeutic benefit, such inhibition induces a second telomere crisis, again with rapid acquisition of new mutations (green dots) and subclonal heterogeneity.