The failure of cell cycle regulatory checkpoints is a common event in human cancer. Defects at the G(1)-S transition have been widely characterized, but only more recently has aberrant checkpoint signaling during mitotic progression been identified as playing a role in cancer. The metaphase to anaphase transition is regulated by multiple proteins that together comprise the mitotic checkpoint. Previously it has been shown that loss of one copy of MAD2, a mitotic checkpoint gene, results in aneuploidy and tumorigenesis arising from chromosome missegregation. More recently and quite surprisingly, MAD2 has been demonstrated to be an essential gene even in tumor cells such that near complete elimination of this protein from cancer cells results in p53 independent cell death. This is the first identification of a haploinsufficient tumor suppressor gene that is also required for tumor cell survival, and suggests that targeting this checkpoint in cancer might be a viable therapeutic strategy.