This leads to growth advantage for initiated cells.

In particular, there is a lack of experimental support for causal links, such as compensatory cellular proliferation or clonal expansion of initiated cells, between nephrotoxicity and kidney tumors induced by TCE.

Second stage tumor promoters like mezerein do not have the capacity to iniate tumors, but can create circumstances in which initiated cells are more susceptible to additional mutations or in which initiated cells have growth advantage.