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All cancers arise as a result of somatically acquired changes in the DNA of cancer cells. That does not mean, however, that all the somatic abnormalities present in a cancer genome have been involved in development of the cancer. Indeed, it is likely that some have made no contribution at all. To embody this concept, the terms 'driver' and 'passenger' mutation have been coined.

A driver mutation is causally implicated in oncogenesis. It has conferred growth advantage on the cancer cell and has been positively selected in the microenvironment of the tissue in which the cancer arises. A driver mutation need not be required for maintenance of the final cancer (although it often is) but it must have been selected at some point along the lineage of cancer development shown in Fig. 1.

A passenger mutation has not been selected, has not conferred clonal growth advantage and has therefore not contributed to cancer development. Passenger mutations are found within cancer genomes because somatic mutations without functional consequences often occur during cell division. Thus, a cell that acquires a driver mutation will already have biologically inert somatic mutations within its genome. These will be carried along in the clonal expansion that follows and therefore will be present in all cells of the final cancer.