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Do stem cell divisions significantly contribute to cancer development?

Cancer is caused by uncontrolled cellular growth, yet some cancer cells may have greater roles in sustaining tumour proliferation and overcoming conventional cancer treatments. The origins of these cancer stem cells, as they are hypothesized, is widely contested. The current opinion points to extrinsic factors such as smoking, diet and sedentary lifestyle to be the primary inducer of cancer stem cells. This dogma was challenged in 2015 when Tomasetti and Vogelstein postulated that two-thirds of the variation in cancer risk could be explained by random mutations arising during DNA replication in healthy stem cells. Their "bad luck" hypothesis sparked fierce debate and controversy in the scientific community. In this point-counterpoint article, we discuss the random mutation cancer stem cell model and its implications for guiding public health through primary and secondary cancer prevention.