Apoptosis is a type of active cell death. It is involved in the homeostasis of cell number in tissues and is controlled by the growth regulatory network in the organism. It is also involved in the active removal of damaged cells. We have studied the role of apoptosis in cancer pre-stages and overt cancer in vivo, using rat liver as our main model system. Quantitative determination of apoptosis in histological specimens revealed that the rate of apoptosis tends to increase from normal to (pre)neoplastic to malignant cells. Thereby active cell death largely counterbalances the increasing replicative activity in developing malignancy. Tumor promoters shift the balance in favor of cell replication, whereas promoter withdrawal, fasting or TGF-beta 1 favor apoptosis (anti-promotion). Preneoplastic cells are more susceptible than normal liver cells to stimulation of both cell replication or cell death. Consequentially (pre)neoplastic tissue may preferentially grow or die during the appropriate treatment. Regimens that favor apoptosis and lower cell replication are shown to result in the elimination of preneoplastic cell clones from the liver (anti-initiation) and to reduce the cancer risk of the animal.