In the textbooks, a driver mutation is the one steering the cancer, while a passenger is just along for the ride. But in my clinic, sequencing reports are like rare birds—we hear of them but seldom see one. So, the real difference for me is this: if a family has the same cancer in three generations, that mutation is driving their fear as much as the disease. I see it in their eyes when they ask, "Will my son get this too?" We look for patterns in family trees, not just DNA sequences, because sometimes the most important carrier is not a gene, but a grandmother's story. Doesn't the true burden often ride in the passenger seat of a shared worry?
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