Giulio Genovese has published a follow-up article to his initial discovery of a common precancerous condition. In 2014, we described a common pre-cancerous state, involving the clonal amplification of blood cells with somatic mutations, that is readily detected by DNA sequencing, is increasingly common as people age, and is associated with increased risk of blood cancer later in life. Now, we describe the inherited and acquired mutations that drive this precancerous condition. For more information, please check out: An HMS News article; A New York Times article on heart disease; A feature in Science; A Boston Globe article