Currently, cancer, and the process from which it develops, carcinogenesis, is defined as a variety of somatic evolution, which compiles exactly with the most elementary and universal Darwinian laws. 13 Evolutionary dynamics in which deterministic and random forces intervene, imbricated in a complex ecological framework. Biological and evolutionary investigations of cancer have led to promising results; and contradictions. Two paradigms of carcinogenesis from an ecological-evolutionary perspective have been raised in the last decades: The theory of somatic mutation and the theory of adaptive oncogenesis. The first, predominant, proposes that a tumour develops as sequential and progressive accumulation of mutations that increase
high-risk group and none in the low risk group (p = 0.0005). Familial disease was more common in the low-risk (85%) than in the high-risk group (37%), but a higher proportion of genotyped individuals had positive findings in the high-risk (81%) than in the low-risk group (67%). MYH7 mutations were more common than MYBPC3 (29% versus 19%) in the high-risk group, whereas in the low-risk group MYBPC was predominant (33%). Additional genes affected in the highrisk group were ACTC, MYL, MYPN, LAMP2, RAF 1 and PTNP11. Conclusions: The simple inexpensive ECG risk score effectively pinpoints high-risk individuals who require urgent full risk assessment, and where the yield of genetic testing is particularly high.
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