Summary: Desmoplasia-the presence of a rich stroma around a tumor-has long been associated with a poor clinical outcome in patients with cancer. It is considered to be a response to the presence of invasive tumor cells. There is now evidence that desmoplasia is the result of coordinated changes in several stromal cells under the control of a single gene product, CD36, whose repression leads to a decrease in fat accumulation and an increase in matrix deposition. The presence of these changes in tumor-free human breast tissue strongly suggests that desmoplasia may precede and not always follow the presence of malignant cells. This concept has an important clinical implication for women at high risk of developing breast carcinoma, considering that the presence of desmoplasia in normal breast tissue detected in the form of mammographic density is one of the strongest risk factors. Cancer Discov; 2(9); 772-4. ©2012 AACR.Commentary on DeFilippis et al., p. 826 (7).The term desmoplasia (from the Greek word desmos, to fetter or restrain ; and plasis, formation ), has been used by pathologists for more than a century in reference to the formation of excessive connective tissue around invasive carcinoma, primarily but not exclusively of the breast ( 1 ). Desmoplastic tissues are characterized by alterations of the tumor stroma that can range from an abundance of cellular elements such as fi broblasts, vascular cells, and immune cells with little extracellular matrix (ECM) to the presence of an abundant collagen-rich ECM with a minimum of cells, mainly fi broblasts and myofi broblasts. Initially considered to represent a condensation of preexisting collagen fi bers, desmoplasia in fact is the result of an increased synthesis of ECM proteins and collagen by stromal cells such as myofi broblasts ( 2 ). The presence of desmoplasia in aggressive tumors was counterintuitive, in view of the fact that a dense ECM represents a barrier against cancer invasion and metastasis. It was therefore considered to be a reaction and response of the host tissue against invasive cancer cells, and accordingly designated "desmoplastic response or reaction."This idea, however, was challenged in the late 1980s, when the presence of desmoplastic tissue in normal breast became noticeable on mammography studies carried out on women screened for risk of breast cancer. Desmoplastic tissues were radiographically detected as areas denser than the fat and designated mammographic densities ( 3-5 ). High mammographic density is one of the strongest risk factors for breast cancer development and is associated with common breast cancer susceptibility variants ( 6 ).The discovery that desmoplastic lesions can be present in the absence of tumor cells suggests that desmoplasia may not be-as initially thought-a reaction to invasive malignant cells, but a preexisting condition favoring the development of a malignancy. However, there has not been any solid explanation in support of this possibility.In this issue of Cancer Discovery , DeFilippis and colleagues ( 7 )...