Together with myc and ras, Bcl-2 is part of an oncogene trio, which controls each other; normal, finite cell growth requires their proper cooperation. It is a fallacy to consider genes as rigid programmers of predestination, including cancer. Some known and many more unknown external and internal factors (including stress) can alter their expression and their effect on physiological apoptosis is flexible. It is therefore not a paradox that Bcl-2 appears to have an ambivalent function and can be both a marker for malignancy and (relatively) better prognosis. Bcl-2 can be semi-quantitated in paraffin sections of tissues by immunohistochemical staining and is considered in general of limited diagnostic and prognostic value by itself. It was shown recently to be an independent prognosticator in a selected group: post-menopausal, node positive, estrogen-receptor positive breast cancer patients.
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