What Percent of Cancer Mutations Are Random?

Peter Attia says about two-thirds of cancer mutations, 66-ish percent, are purely random. Recalling the math from a 2015 paper in Science, he puts about 5 percent of mutations down as hereditary and on the order of 30 percent down to environmental triggers or carcinogens.

The paper looked at cancers by tissue type. Hereditary mutations include BRCA1 and many others talked about less often. Smoking raises the risk of a mutation, and lots of UV light can cause one too. In 2017 the authors published another paper that revisited the result. The idea that stuck was that cancer is a bad luck disease: the healthiest person can do everything right and still get a random mutation, and Peter Attia says that pattern may explain up to two-thirds of the mutations seen. He says cardiovascular disease does not look like that in someone who has managed cholesterol and blood pressure.

The oncology community was divided on the 2015 paper. Peter Attia asks how to take the bad-luck observation and do something about it.