Ancient cancer

As I sat on my couch last night, laptop sitting in front of me, I awaited the Ken Burns adaptation of Siddartha Mukherjee’s excellent book The Emperor of All Maladies into a three part television documentary to air on PBS. I’m not sure whether I’ll blog the show or not, but if I do I’ll probably wait until all three episodes have aired. In the meantime, this seems as good a time as any to go back to a story that I saw a week ago but somehow, thanks to grants, traveling to Houston, and other distractions that I wanted to blog about more, never got around to. Since The Emperor of All Maladies, the book at least, is billed as “a biography of cancer,” I’d indulge my interest in ancient medicine, including ancient Egyptian medicine starting when I first wrote about the Edwin Smith papyrus, which I saw at the Metropolitan Museum of Art in New York nearly ten years ago.

If there’s one claim that irritates me that various proponents of alternative medicine like to make, it’s that cancer is a “modern” disease, that it was rare (or even didn’t exist) before the rise of modern societies, particularly the industrial revolution. This viewpoint bubbled up five years ago, when a commentary in Nature Reviews Cancer (yep, the same journal in which I published my opinion piece on integrative oncology a few months ago) that argued strongly that cancer was almost unknown (or at least very rare) in the ancient world based on the lack of finding it in mummies in Egypt and South America. They also looked at ancient texts and literature from Egypt and Greece, and say that there’s little sign that cancer was a common ailment. After all, cancer is mainly a disease of the elderly, with three-quarters of cases being diagnosed in people over 60 and more than a third of cases diagnosed in people 75 or older. Life expectancy was much shorter in ancient times; so relatively few people made it to cancer-prone ages. Most probably didn’t make it past age 40.

In any case, what caught my attention was a story reporting the finding of the oldest example of breast cancer:

Researchers working in Egypt say they have found the oldest example of breast cancer in the 4,200-year-old remains of an Egyptian woman — a discovery that casts further doubt on the common perception of cancer as a modern disease associated with today’s lifestyles.

Here’s the announcement from the Egyptian Ministry of Antiquities:

Ministry of AntiquitiesPress Office——————————–Evidenced in Egypt : the oldest breast cancer in…

Posted by Ministry of Antiquities on Tuesday, March 24, 2015

See:

Antiquities Minister, Dr. Mamdouh el-Damaty announces the discovery of the oldest evidence of breast cancer in the world. This discovery was made along the seventh archaeological season carried out by University of Jaen (Spain) in the necropolis of Qubbet el-Hawa (West Asuan). Dr. Miguel Botella (University of Granada) and his team of anthropologists have identified on the bones of an adult woman an extraordinary deterioration in all her skeleton. The study of her remains shows the typical destructive damages provoked by the extension of a breast cancer as a metastasis in the bones.

The team from University of Jaen has confirmed that the woman lived at the end of the 6th Dynasty (2200 BCE) and was part of the élite of the southernmost town of Egypt, Elephantine. The virulence of the disease impeded her to carry out any kind of labor, but she was treated and taken care during a long period until her death.

It turns out that the apparently low incidence of cancer in mummies, skeletons, and other ancient remains might be an illusion. For example, investigators from the United Kingdom reported a year ago on the case of 3,000 year old skeleton found in Sudan of a man who appeared to have had metastatic prostate cancer, which they published in PLoS One by Michaela Binder and colleagues. It was the oldest complete example of a skeleton of an ancient human with cancer. The authors wrote:

The apparent absence of cancer in archaeological remains may also partly be an illusion created by issues of bone preservation, and due to the fact that methods of analysis are inadequate to detect initial changes within bone. Due to financial, time and logistical reasons, human remains are usually not systematically radiographed, and bone metastases originating in cancellous tissue only penetrate the bone surface in their advanced stages. If the immune system was already compromised by other negative influences in a person’s life, people may not have survived long enough to develop full skeletal metastases. Thus, evidence for a large proportion of tumours could be missed when skeletal remains are analysed [72]. Another challenge in detecting cancer in ancient human remains is the poor preservation of bone which often prevents the clear identification of lytic lesions and precludes the diagnosis of incomplete remains [27]. With increasing numbers of skeletal collections and more detailed analysis, as well as more readily available standard radiographic equipment, the evidence for cancer in antiquity could increase significantly.

In other words, for the most part, archaeologists haven’t been looking carefully for evidence of cancer in ancient remains, and if you don’t look for something you aren’t very likely to find it. Moreover, it’s not at all straightforward to find and confirm evidence of cancer in remains that are usually just skeletons and usually just fragments of skeletons at that. Comparatively speaking, there aren’t that many mummies and not that many remains with soft tissue that can be examined for evidence of cancer. In this case, the Binder et al studied the skeleton of a man aged 25-35 years recovered in 2013 from Amara West. It was found in a tomb with characteristics that suggest what the authors referred to as a “sub-elite” buried according to Egyptian customs.

The authors examined the bones and found lytic lesions (lesions that eat away bone tissue) affecting the ribs, vertebrae, clavicle, scapulae, pelvis, sternum, humeral and femoral heads of skeleton. Such lesions are very characteristic of some sorts of cancer metastases to bone. Radiographic, scanning electron microscope (SEM) images, and microscopic images were taken of the lesions, and a differential diagnosis constructed. The lesions were most consistent with bony metastases, but the authors had to rule out other potential causes of lytic lesions. These include metastatic carcinoma, multiple myeloma (a cancer of the plasma cells of the bone marrow that can produce lesions very similar to metastatic carcinoma), fungal infections, and taphonomic damage. Taphonomy is the study of what happens to an organism after its death and until its discovery as a fossil, including decomposition, post-mortem transport, burial, compaction, and other chemical, biologic, or physical activity which affects the remains of the organism. About this last possibility, the authors noted that “mall round holes similar to metastatic lesions can be caused by a variety of factors including roots, water, and termites [68] or dermatid beetles [69].” SEM examination, however, found characteristics more consistent with metastatic carcinoma than with any of the other things that can cause taphonomic damage.

The authors also reiterate:

The lack of evidence for cancer in antiquity may to a large extent, be the result of reduced life expectancy, and thus less time to develop skeletal lesions if the immune system is already compromised by an inadequate supply of nutrients and diseases. This represents one of the major problems in inferring the absence or presence of disease in the past in general [87]. The archaeological and historical record certainly provides plenty of evidence for possible causes of developing cancer. Despite recent advances, the genetic background for cancer predisposition is still far from being understood today [88], [89]. Even though it may perhaps remain unknown, there is no reason to assume that predisposing genetic factors were not present in the past. The man from Amara West does indicate that it was indeed possible to develop skeletal lesions of cancer, provides a glimpse into one individual’s life experience, and cautions against claims for the absence, or presence, of any disease based on skeletal evidence alone.

Besides, there’s also evidence that cancer has been with us since prehistoric times. For instance, there was Kanam Man, whose fossilized jawbone was found by Louis Leakey back in 1932, who called it, “Not only the oldest known human fragment from Africa, but the most ancient fragment of true Homo yet discovered anywhere in the world.” Kanam Man was controversial at the time, specifically whether it was what Leakey proclaimed it, but it also had an unusual feature:

At the time of the discovery, it had seemed like a bother, detracting from Leakey’s find. He was working in his rooms at St. John’s College at the University of Cambridge, carefully cleaning the specimen, when he felt a lump. He thought it was a rock. But as he kept picking, he could see that the lump was part of the fossilized jaw. He sent it to a specialist on mandibular abnormalities at the Royal College of Surgeons of England, who diagnosed it as osteosarcoma — a cancer of the bone.

Others have not been as certain. As recently as 2007, scientists scanning the mandible with an electron microscope concluded that this was indeed a case of “bone run amok” while remaining neutral on the nature of the pathology.

Of course, from a science-based perspective, none of this should be surprising. We might argue over how large a contribution of random chance there is to the development of cancer, but there’s little doubt that there is a large random component to it, a component of what can be called, for lack of a better term, “bad luck.” And, although cancer is primarily a disease of the elderly, young people can and do get it. As for cancer caused by the environment, there were also a lot of things that ancient humans encountered that could cause cancer: Sunlight leading to melanoma, infections that can cause cancer, radon, naturally occurring chemicals. The ancient world was hardly as pristine as it’s envisioned.

It’s not just cancer, either. Advocates of “paleo” diets, which, accurately or not, are designed to mimic what our paleolithic ancestors ate, frequently claim that heart disease would be virtually nonexistent if we all ate that way. Of course, as I’ve described on more than one occasion, ancient humans were prone to atherosclerotic heart disease as well. In fact, the evidence we have suggests that, for example, ancient Egyptians were prone to all manner of illnesses.

When it comes to cancer, in 1600 BC the Egyptian physician who wrote the Edwin Smith papyrus recommended cauterization of breast cancer with a tool called the “fire drill.” He also wrote about the disease, “There is no treatment.” If there’s one big difference between humans now and humans thousands of years ago, it was not biology or the factors that cause us to develop cancer. It was that there was no treatment. Now there is. What I’ve seen of The Emperor of All Maladies thus far demonstrates this.

Comments

  1. #1 herr doktor bimler
    March 31, 2015

    My smarter elder sister was blogging the other day about atherosclerosis in mummies, but she linked to the Egyptian and Sudan ancient-cancer reports. This was in the context of a bizarre 2010 argument from Manchester researchers, that “cancer was so rare in Egyptian mummies that it had to be a modern disease”.
    Double face-palm.

  2. #2 novalox
    March 31, 2015

    I tend to run into this argument with some alties who say that cancer is a modern disease, caused by the modern lifestyle, modern medicine, etc.etc.

    I usually respond by saying that we in society are living longer d/t advances in science and modern medicine, we’re not dying d/t diseases that would have killed or maimed large swaths of the population a long time ago. Eventually, something will cause us to die, and cancer (correct me if I’m wrong) is more a disease that you tend to get as you get older. Since more of the population are living longer lives, we’re more likely to get cancer and to die from it.

    It usually ends up going over their heads, and they revert to the same old tired tropes and misguided information.

  3. #3 herr doktor bimler
    March 31, 2015

    The Manchester group’s riposte to that was that childhood cancer “has risen massively since the Industrial Revolution […] proving that the rise is not simply due to people living longer.”

    It did not occur to them that the commonest childhood cancers — leukemia and lymphoma — weren’t even recognised until 1845 and 1832, and until then kids were just dying of marasmus or because God took them home.

    Would they be detectable in mummies?

    • #4 Orac
      March 31, 2015

      I don’t see how they could be, since the blood and marrow don’t survive.

  4. #5 JJ Jacobs
    March 31, 2015

    I do agree that cancer is more of a general disease in older generations.
    The younger generations however seem to be increasingly developing specific types of cancer due to unhealthy lifestyles. A modern example could be the shocking age that children start to smoke, inevitably leading to a premature diagnosis of lung cancer due to chronic smoking.

  5. #6 herr doktor bimler
    March 31, 2015

    Imagine my disappointment to discover that I had been lied to, and “Apop-Tosis” was not the name of a particularly short-lived Pharaoh.

  6. #7 Stephanie
    March 31, 2015

    It can be argued that the modern world today exposes humans to more carcinogens than in ancient times. But in those times exposure could also have occurred. People were working in the fields all day being exposed to the sun. They made fires in their homes exposing the community to smoke. Perhaps the people who suffered from cancer were the poor as they were more exposed to carcinogens, these people might not have been able to afford to be preserved that well after death. This makes it very difficult to research the history of cancer, there are just so many unseen factors that have to be taken into account.

  7. #8 Helianthus
    March 31, 2015

    @Stephanie

    these people might not have been able to afford to be preserved that well after death.

    Precisely.
    It’s the part which blew my mind when reading about the article about the absence of cancer in mummies.
    If the tissues which show tell-tale signs of a disease disappear after death, as most soft tissues will, how could we accurately state that such illness was not present? There is a huge sample bias right there.
    Now, if you look at collateral damage on bones, I guess the case may rest on firmer ground.

    Re: toxic environment in ancient time, my favorite example is the existence of a fine layer of lead dust in the south pole ices, dating from the time of the Roman Empire, when they were using lead a bit like we are using plastic today.

  8. #9 Daniel Corcos
    https://www.researchgate.net/profile/Daniel_Corcos2
    March 31, 2015

    The major bias of these studies is that, at best, they can only inform on the percentage of cancer in dead people, whereas what is important is the rate of cancer occurrence in living people.

  9. #10 Michael Finfer, MD
    Edison, NJ
    March 31, 2015

    “In other words, for the most part, archaeologists haven’t been looking carefully for evidence of cancer in ancient remains…”

    WNL is a commonly used medical abbreviation. It stands for “within normal limits”. It also means “we never looked.”

  10. #11 Krebiozen
    March 31, 2015

    Helianthus,

    Re: toxic environment in ancient time

    Tangentially related, I just read an article that claims 50 million people died in the Americas after Europeans arrived with their various diseases. The resulting increase in forestation, particularly in the Amazon, may have led to a marked decrease in carbon dioxide levels, causing a little Ice Age. It seems we have been altering the climate for longer than I realized.

  11. #12 Krebiozen
    March 31, 2015

    Daniel Corcos,

    The major bias of these studies is that, at best, they can only inform on the percentage of cancer in dead people, whereas what is important is the rate of cancer occurrence in living people.

    If we did find that ancient people didn’t get cancer it would give us some useful information on the causes of cancer in living people. The fact that they did suggests that at least some causes were around thousands of years ago.

  12. #13 Daniel Corcos
    https://www.researchgate.net/profile/Daniel_Corcos2
    March 31, 2015

    Krebiozen
    I agree, but the question is about frequency. Most cancer “causes” are increasing the incidence of cancer. Not having relevant information about numbers is a major problem.

  13. #14 Krebiozen
    March 31, 2015

    Daniel Corcos,

    I agree, but the question is about frequency. Most cancer “causes” are increasing the incidence of cancer. Not having relevant information about numbers is a major problem.

    The claim commonly made is that cancer is a modern disease and that it didn’t occur in ancient times. A single well-documented case of ancient cancer is enough to refute that claim. Even dinosaurs got cancer, by the way.

    As for the incidence of cancer increasing (if that’s what you meant), if you correct for age, it seems to be going down, if anything, supporting the idea that an aging population is responsible for an increase in absolute numbers of cancer cases.

  14. #15 Eric Lund
    March 31, 2015

    There is also the question of misdiagnosis. For instance, it used to be common to die of “consumption”. Today that’s usually understood to be tuberculosis, but how do we know that some of those cases weren’t some kind of cancer? Eighteenth-century medicine probably would not have been able to distinguish tuberculosis from, e.g., lung cancer, as one of the major symptoms in both cases is severe coughing.

  15. #16 K. Moore
    nj
    March 31, 2015

    I really enjoyed the book, however, I was struck at how little Mukherjee said about anyone besides doctors and cancer. I was disappointed that he said almost nothing about oncology nursing in particular. People with cancer may have better options for treatment now, but they also have better nursing care and that really is a big part of the picture. Nursing advances continue to be obscured and discounted. I still feel 2yrs after reading his book that Mukherjee missed the boat on this issue. Doctors very rarely work by themselves in managing diseases like cancer in the Western World at least. I wish they would acknowledge this more often.

  16. #17 BBBlue
    March 31, 2015

    Some folks argue that life expectancy of ancient Egyptians is not all that different from today and that it’s infant mortality rates that skew that statistic for ancient groups. I thought this was an interesting discussion of that point: http://bit.ly/17IGxff

  17. #18 MarkN
    March 31, 2015

    Speaking of books, Weinberg’s is fantastic on discussing the evidence-based biological/bio-chem pathways (for those lurking and wanted to get more of an education than Google U).

  18. #19 Cherise Swanepoel
    South Africa
    March 31, 2015

    I think this theory could only be proven if there could be a bigger sample of ancient ancestors tested. These mummies represent the ‘elite’ society of ancient times, not the working class that faced carcinogens every day. I do not believe that this is a modern disease, but simply that there was a lack of diagnostics in ancient times.

  19. #20 Daniel Corcosd
    https://www.researchgate.net/profile/Daniel_Corcos2
    March 31, 2015

    Krebiozen
    “The claim commonly made is that cancer is a modern disease and that it didn’t occur in ancient times.” This claim is completely wrong for the reason I mentioned:
    “The major bias of these studies is that, at best, they can only inform on the percentage of cancer in dead people, whereas what is important is the rate of cancer occurrence in living people.”
    “A single well-documented case of ancient cancer is enough to refute that claim. ” Only if you consider a deteministic view of cancer. If you consider that cancer “causes” only change frequency, then the issue of whether there are much more or much less cancers in modern times simply cannot be answered.

  20. #21 TBruce
    March 31, 2015

    Couple of additional points:

    Not all deaths from cancer involve bone metastasis. Malignant brain tumours don’t go to bone. Colorectal and cervical cancers don’t cause bone mets in most cases. These would be more difficult to detect in skeletal remains.

    Further to Eric Lund’s comment, advanced Tb clinically can easily be confused with metastatic cancer even today. As a pathologist, I always have to keep aware of the possibility of Tb when I get a biopsy from suspected cancer, and it does occasionally appear. Tb, of course, was far more common back in the “good old days” and I suspect that some deaths attributed to “consumption” were in fact due to metastatic cancer.

    Also, didn’t Egyptian mummies have the internal organs removed before mummification? That, too, would interfere with identification of cancer in mummies.

  21. #22 janerella
    March 31, 2015

    @TBruce #18 IanGawlerMiracleCancerCure

  22. #23 Calli Arcale
    http://fractalwonder.wordpress.com
    March 31, 2015

    TBruce — not all of the organs were removed before mummification. For instance, it was considered absolutely vital that the heart remain in place as they believed that to be the seat of consciousness. The actual seat of consciousness, however, was simply discarded as the brain has lots of fat, which is great for promoting decay, and they thought its only real function was to regulate blood temperature. So the brain was deemed expendable. Other organs which could contribute to decay but which were deemed important were preserved separately from the body in the set of four canopic jars, each presided over by one of Horus’ four sons. These contained the lungs, liver, stomach, and intestines. The idea was that the resurrected person could retrieve their bits from the jars and put everything back together again. Later, once they figured out how to preserve the body with these organs still present, they started leaving them in the body along with the heart. (The brain they still chucked, though.)

    In theory, you could study the preserved viscera in the canopic jars for signs of cancer, presuming of course that the preservation process didn’t ruin the tissue too much.

  23. #24 Krebiozen
    March 31, 2015

    Calli Arcale,

    In theory, you could study the preserved viscera in the canopic jars for signs of cancer, presuming of course that the preservation process didn’t ruin the tissue too much.

    From what I have seen of mummified soft tissues (I have held a mummified human head in my hand and had a good look), they are carbonized beyond recognition, so I’m surprised that anything histologically recognizable remains, but apparently it does.

  24. #25 Fergus
    Glasgow
    March 31, 2015

    The antivaxxers have also scored a victory as no sign of autism has been found on any of the fossils either. No vaccines back then you see.

  25. #26 Sigivald
    March 31, 2015

    As for cancer caused by the environment, there were also a lot of things that ancient humans encountered that could cause cancer: Sunlight leading to melanoma, infections that can cause cancer, radon, naturally occurring chemicals.

    That and people forget that before the Industrial Revolution and the invention of coal gas … people did their cooking with wood, more than anything else. (And raw coal, too.)

    Wood smoke is full of stuff that’s carcinogenic, especially when you concentrate it by cooking (and heating) indoors with often-shoddy ventilation.

    Do that for decades on end, see some cancers in a population, no surprises.

    (Unlike paranoid hippies, of course, this doesn’t make me scared of a wood fire on a summer evening, or doing firepit cooking while camping.

    Dose makes the poison and all that.)

  26. #27 Andreas Johansson
    March 31, 2015

    Calli Arcale wrote:

    For instance, it was considered absolutely vital that the heart remain in place as they believed that to be the seat of consciousness. The actual seat of consciousness, however, was simply discarded as the brain has lots of fat, which is great for promoting decay, and they thought its only real function was to regulate blood temperature.

    Since I can remember, it’s seemed obvious to me, especially when I’ve got a headache, that the seat of my consciousness is inside the skull. I guess this must be a culturally conditioned perception, but I nevertheless find it hard to imagine how anyone could perceive differently.

  27. #28 JP
    March 31, 2015

    I actually find that my “consciousness” is more or less diffuse throughout my body. Right now I’m conscious of the feeling of my fingers typing and the general sensation of being in a body as much as I am of the words I’m typing, for instance.

    When I’m reading difficult poetry or philosophy, I often feel like there’s some sort of effort involved in the general “heart” area, but I’m pretty weird.

  28. #29 JP
    March 31, 2015

    and the general sensation of being in a body

    FTFM.

  29. #30 Ren
    March 31, 2015

    Someone did once say that there wasn’t anything new under the Tuscan sun… Or something like that.

  30. #31 Johnny
    March 31, 2015

    Well we all know old people die of cancer. The modern trend however is that more young people are getting it and that certainly isn’t showing up in old mummies is it?

  31. #32 Andreas Johansson
    March 31, 2015

    @Johnny: Did you bother to read the post? It mentions cancer in a mummy of a man 25-35yo when he died.

  32. #33 Roadstergal
    March 31, 2015

    As for the incidence of cancer increasing (if that’s what you meant), if you correct for age, it seems to be going down, if anything, supporting the idea that an aging population is responsible for an increase in absolute numbers of cancer cases.

    Thanks for the link – that’s a good graphic.

    If you pull out small-cell lung cancer, I wonder if the trend would be even stronger. I’ve read that the incidence has probably peaked in males, but not in females, looking at smoking stats?

  33. #34 Emma Crew
    March 31, 2015

    @Daniel C. # 20
    The point is, there are plenty of folks who claim cancer NEVER happened in ancient times. I realize that’s not the factor you consider important in this research, but there is a definite subset of the population who needs to understand “any is more than none.”

  34. #35 Roadstergal
    March 31, 2015

    Oh duh, I can actually do what I mentioned above. If you look at only lung cancer, it’s been dropping since the ’90s in males and maybe just barely starting to drop in females.

  35. #36 Daniel Corcos
    https://www.researchgate.net/profile/Daniel_Corcos2/?ev=hdr_xprf
    March 31, 2015

    Emma Crew
    The issue here is: to argue against people that are completely outside of rationality, should we abandon our own rationality? I think there is more to lose than to gain.

  36. #37 Krebiozen
    March 31, 2015

    Roadstergal,
    There are hours of fun to be had with SEER faststats 😉

  37. #38 Narad
    March 31, 2015

    Tangentially related, I just read an article that claims 50 million people died in the Americas after Europeans arrived with their various diseases.

    Well, if disease in the New World and taphonomy are going to appear together, it’s as good a time as any to mention syphilis.

  38. #39 Jane
    Washington,DC
    March 31, 2015

    Let’s not forget that many children in the past didn’t live too long and therefore didn’t get cancer.Small pox got there first!

  39. #40 Lawrence
    March 31, 2015

    Or Diptheria, Typhus, TB, Measles, or any of the other host of diseases that used to kill at least 50% of these children before they reached the age of 5.

  40. #41 Kay Mooney
    March 31, 2015

    I think it is fair to say that with all that was said we are able to question the validity of many scientific claims, of which these are two (the fact that cancer is a modern disease and that it is found mostly in older people). How do we ever make a conclusion when there will always be something later on to falsify it. This perplexes me as it is just so true that we will never be completely certain. My opinion on the matter anyhow is that it is not a modern disease as there has not been enough evidence to completely show that cancer only developed recently. There might not be the advanced experimental equipment to test and conclude that there is no cancer found in people from thousands of years ago. I do however think that cancer is definitely not mostly found in older people as there are countless cases today of child cancers. It is however fascinating to think about! This topic has always been an interesting one to me.

  41. #42 Narad
    March 31, 2015

    I think it is fair to say that with all that was said we are able to question….

    Formerly “Kay Mooney 15022219.”

    Looks like the botherd has finally figured out to delete the serial numbers.

  42. #43 herr doktor bimler
    March 31, 2015

    to question the validity of many scientific claims, of which these are two (the fact that cancer is a modern disease and that it is found mostly in older people)

    But they weren’t “scientific claims”. Anyone with an agenda or an obsession can pump out a press release and call it a “scientific claim”, and the Daily Mail will reprint it with 144-pt headlines; there is no Central Science Press Agency to stop them.

  43. #44 TBruce
    March 31, 2015

    I do however think that cancer is definitely not mostly found in older people as there are countless cases today of child cancers.

    Nope. Childhood cancer is still pretty uncommon compared with the incidence over age 65. This is certainly my experience seeing biopsies and blood films from people of all ages in my practice. I have also seen numbers as to incidence, which I will attempt to track down.

  44. #45 herr doktor bimler
    March 31, 2015

    “Botherd” is too harsh. If a class of kids in Pretoria have been tasked with the assignment of voicing opinions on science blogs, their opinions are no sillier than mine.

  45. #46 Jenora Feuer
    March 31, 2015

    I do however think that cancer is definitely not mostly found in older people as there are countless cases today of child cancers.

    In both reliability and mortality studies, there is a concept known as the ‘bathtub curve’. Basically, the times at which you get the most failures/deaths are right at the beginning (manufacturing defects, many genetic disorders) and much much later on (wearing out, most cancers). The period in between tends to have a much lower background level.

    The fact that children are having cancer doesn’t mean that cancer isn’t still mostly a disease of the elderly. There have always been children having cancer, they just didn’t usually survive long and it wasn’t until recently that we could treat it. (Heck, I knew one person in elementary school who was being treated for leukemia. Thirty five years ago.)

    Cancer tends to be a case of what happens once you eliminate most of the other things that might kill people first.

  46. #47 TBruce
    March 31, 2015

    I just looked up some figures at the Canadian Cancer Society:

    Incidence of childhood cancer in Canada (ages 0-14) is about 150 per million per year. This is very close to the rates in the UK and USA.

    Incidence of cancer per million per year in Canada between age 60 and 70 is 16,000-18,000 in men and 10,000-12,000 in women.
    Between age 70 – 80+ is 30,000-38,000 in men and 25,000 – 30,000 in women.

  47. #48 The Ridger
    March 31, 2015

    People used to die of other things before the cancer got them.

    I remember telling a coworker that Sappho’s husband died of cancer. He couldn’t tell which he was more surprised at: cancer back then or Sappho having a husband…

  48. #49 alison
    March 31, 2015

    Thank you for the H/T, herr doktor 🙂 I’ve added a link on my piece to Orac’s great take on the story.

  49. #50 JP
    March 31, 2015

    He couldn’t tell which he was more surprised at: cancer back then or Sappho having a husband…

    The only source claiming that Sappho had a husband dates from the 10th century, a bit after the fact. I guess it made the Byzantines feel less freaked out about her or something.

    That bit about her killing herself over Phaon is also totally made up, although there is a certain Ukrainian soft-core porn movie that manages to work it it.

  50. #51 dbistola
    USA
    March 31, 2015

    Hatshepsut, an Ancient Egyptian queen and later Pharaoh, is a mummy that shows cancer metastases on her pelvic bones.

  51. #52 Emma Crew
    March 31, 2015

    Daniel Corcos
    No, but there is some value in having truthful information out there for people who might be swayed by the pitches of the irrational.

    Also, it’s a pretty amazing story to be able to identify diseases in people who died thousands of years ago, even if it doesn’t give us much data in terms of overall cancer rates. As a starting point I find it quite impressive.

  52. #53 Narad
    March 31, 2015

    If a class of kids in Pretoria have been tasked with the assignment of voicing opinions on science blogs….

    If a group of people has been tasked with hit-and-run comment flooding,* I’d be inclined to apply the SPEWS approach.

    * Bonus: This one includes Phildo.

  53. #54 Krebiozen
    March 31, 2015

    Here’s a graph or relative incidence of cancer for different age groups from SEER. It’s essentially the same data as TBruce provided but in graphic form.

  54. #55 Krebiozen
    March 31, 2015

    ^ Note the terrifying tsunami of cancer in young people. /sarcasm

  55. #56 Old Rockin' Dave
    The last place you'd ever look...
    March 31, 2015

    Sharks date back to about four hundred million years ago. Sharks get cancer (Forget all that shark liver oil snake oil.).
    Probably due to teh vaccines.

  56. #57 Robert L Bell
    April 1, 2015

    @herr doktor bimler

    Anyone with an agenda or an obsession can pump out a press release and call it a “scientific claim”,

    A fact that chaps my hide to no end. When the “GMO food will kill us all in our beds” crowd got fed up with being clubbed by peer reviewed articles in the hands of evil scientists, they did the natural and went out to get their own peer reviewed articles. The fact that these articles are shoddy and biased and rotten with ideology – in fact, the very embodiment of what they think the evil scientists are – bothers them not one whit. To the fanatics and true believers it’s all about winning the propaganda war by the most expedient means available, facts and evidence and reason and logic be damned.

  57. #58 Daniel Corcos
    https://www.researchgate.net/profile/Daniel_Corcos2
    April 1, 2015

    @ Robert L Bell
    You are right. Indeed, it is better to criticize the way science is currently done and to define it better, rather than to argue with fanatics.
    A theoretical paper by Einstein is science, a clinical trial of homeopathy showing data with a p<0.05 is not.

  58. #59 Kdog
    Durham,NH
    April 1, 2015

    I’m going to make taphonomy my word of the day. (I always learn new things here.) It might be difficult to work into a conversation though.

  59. #60 Fergus
    Glasgow
    April 1, 2015

    Krebiozen @34

    Neat site. Thanks.
    Any thoughts on the upward blip at about 1992?

  60. #61 Jsteel
    April 1, 2015

    As there are so many tangents …. The Sumerians thought that the place of the mind was in the stomach. Strange lot. Having said that, I’m well fed while they were well fed some times …

    As to cancer, there was some study (I cannot find it, so probably it was a printed version, and now only my memory … Which counts as an anecdote) on 10th century Cemetries in Hungary, which suggested incidences of metastatic bone cancer).

  61. #62 NoPanShabuShabu
    April 1, 2015

    @Narad #53
    “If a group of people has been tasked with hit-and-run comment flooding,* I’d be inclined to apply the SPEWS approach.”

    It’s seems a strange thing for the botmaster to be using their herd to write short on-topic comments that are generally in agreement with the writer and don’t contain links to sites selling knockoff Nike footwear.

    The software is also so strange that it uses different styles to add it’s ID number: sometimes in the user name, sometimes at the end of the comment, vary it’s format (123456789, u0123456789, #123456789, etc), and even as a correction the the previous message where it forgot to do either.

    271994121

  62. #63 MI Dawn
    April 1, 2015

    The ancients were often quite aware of cancer – especially the leukemias though they didn’t relate them to cancer specifically. The “White Sickness” – so called because the children/adults who got it became very pale from anemia – was greatly feared and known to be a killer.

    A lot of cancers – unless they were fulminating – just weren’t known. Patient spitting blood? Could be TB, Cancer, a broken blood vessel. Our ability to differentiate diseases has changed how many things are diagnosed.

  63. #64 MrrKAT, Finland
    https://www.youtube.com/user/MrrKAT
    April 1, 2015

    3 yrs ago I was among audience in thesis defense about VHF detection by hands (practically: dowsing) . In dissertation there was hint or claim that all leukemia are due to radio masts. It was hinting that leukemia didn’t exist until at the end of 19th century.

    Btw. The dissertation session was scandalous (3 professors protesting, I was too) and it was rejected. Funny too: Formal (russian) opponent started to defense doctoral candidate during session when those 3 profs opposed among us audience.. 😀

  64. #65 magnocrat
    England
    April 2, 2015

    This harking back to the good old days is a common misconception. However our environment is changing fast and bringing apon us new health dangers such as obesity and lack of immunity. Perhaps we can no longer rely on medicine to increase longlevity.

  65. #66 Chris
    April 2, 2015

    magnocrat: “Perhaps we can no longer rely on medicine to increase longlevity.”

    So what do you propose? Not allowing those with type 1 diabetes access to insulin, outlawing vaccines, and stopping all cancer screening tests plus refusal to treat cancer?

  66. #67 Richard Smith
    April 2, 2015

    @magnocrat (#65):

    Perhaps we can no longer rely on medicine to increase longlevity.

    Well, I know that they say laughter is the best medicine, but have we ever really relied on medicine for a laugh, regardless of duration?

  67. #68 JGC
    April 2, 2015

    What environmental changes have been shown to cause “lack of immunity”, magnocrat?

  68. #69 Krebiozen
    April 2, 2015

    Fergus #60,

    Any thoughts on the upward blip at about 1992?

    I suspect increased surveillance of prostate cancer with routine PSA;

    Age-adjusted rates of prostate cancer incidence rose 69 percent in U.S. men from 1989 to 1992, compared with 20 percent from 1985 to 1988, and 3 percent from 1981 to 1984.
    For white men, the incidence rate peaked in 1992 at 185.8 new cases per 100,000 men before dropping 27 percent to 135.3 new cases per 100,000 in 1994. Incidence in African American men peaked in 1993 at 264.7 cases per 100,000 before declining 11 percent to 234.4 cases per 100,000 in 1994.
    There is broad agreement that increased use of the prostate specific antigen (PSA) screening test after 1989 created an artificial rise in incidence rates.

  69. #70 Colleen
    April 2, 2015

    I use to think that cancer was a disease commonly found in the older generation, however there seems to be an increase in the development of specific types of cancer in the younger generation of today. This could be due to unhealthy lifestyles such as children starting to smoke at a very young age, conclusively leading to a early diagnosis of cancer- in this case lung cancer. I believe that anyone can be diagnosed with cancer at any stage in their life, no matter their age.
    15031642

  70. #71 Chris
    April 2, 2015

    Colleen: ” however there seems to be an increase in the development of specific types of cancer in the younger generation of today.”

    Citation needed.

    “This could be due to unhealthy lifestyles such as children starting to smoke at a very young age,”

    Your country needs to work on that. Selling tobacco to minors in this country is prohibited by law.

  71. #72 shay
    April 2, 2015

    Well, I know that they say laughter is the best medicine, but have we ever really relied on medicine for a laugh, regardless of duration?

    I dunno — I see stuff here at the health department that cracks me up all the time.

  72. #73 Narad
    April 2, 2015

    “If a group of people has been tasked with hit-and-run comment flooding,* I’d be inclined to apply the SPEWS approach.”

    It’s seems a strange thing for the botmaster to be using their herd to write short on-topic comments that are generally in agreement with the writer and don’t contain links to sites selling knockoff Nike footwear.

    Leaving aside the fact that not all efforts to autogenerate text are necessarily attempts to spam (and some of these names actually can be tracked down), I can only guess that you didn’t get the SPEWS reference.

    The comments are, in fact, hit and run – even when they contain direct questions, there is no acknowledgment of the answers that I’ve seen during this most recent infestation. If a bunch of kids is earning class credit just for the sake of posting mostly empty comments, I’d block the IPs and then the ranges if necessary, and let them find someplace else to do their homework for Graffiti 101.

  73. #74 Payal Upadhyay
    South Africa
    April 2, 2015

    It is true that humans in the ancient times were not exposed to as many carcinogens as humans are exposed to today but we cannot ignore the fact that they were also exposed to carcinogens for example they had to create a fire to keep warm and they had to work under the scorching sun.Therefore it would not be correct to assume that cancer did not exist in ancient times and that it is a modern disease.

  74. #75 herr doktor bimler
    April 2, 2015

    a bunch of kids is earning class credit just for the sake of posting mostly empty comments

    There was a similar wave of vapidity this time last year.

    increase longlevity.
    Absolute Levity is of course the antidote to Specific Gravity.
    http://1.bp.blogspot.com/_Os6aUImRi8I/S7E_JHfFfII/AAAAAAAAAtc/K0SiV7CMjG8/s1600/hogarth3.jpg

  75. #76 Chris
    April 2, 2015

    “a bunch of kids is earning class credit just for the sake of posting mostly empty comments”

    I remember a time on UseNet when the class assignment was to post on disability newsgroups. Unfortunately I don’t remember much, but it was annoying.

  76. #77 JustaTech
    April 2, 2015

    What’s odd about the posts from South Africa (beyond being post-and-go) is that they tend to be pretty blog-specific. They’re usually on Aetiology, The Pump Handle and now here. But I don’t remember seeing them on PZ’s blog.

    I sure hope they are first-years or in high school, because sometimes the comments they leave are ignorant or naive in the extreme.

  77. #78 JP
    April 2, 2015

    I believe Narad linked to an infestation on the ScienceBlogs version of Pharyngula, actually.

  78. #79 Old Rockin' Dave
    Hiding in my tax shelter under the streets of Manhattan...
    April 2, 2015

    Lest we forget, Sir Percival Pott identified scrotal carcinoma among the boy chimney sweeps who climbed naked into the chimneys of London in the 18th Century. It was a squamous cell carcinoma caused by the soot lodging in the skin folds. Sounds like the good old days of no cancer to me.
    Oh, and don’t we all remember that commercial sales of tobacco started in the 17th Century.
    And let’s not forget that we call it “cancer” today because Hippocrates called it “karkinos”. If he felt compelled to name it, it’s a good bet that he saw a fair number of cases. That was a mere 2400 years ago, no doubt any eyeblink to the quackerati.

  79. #80 Old Rockin' Dave
    The dark side of the Sun (Why should the Moon have all the cool names?)
    April 2, 2015

    I thought everyone would get a smile out of this:
    Last night, at a political meeting, there was a woman who had once been a chiropractor, but is now an MD.
    I said. “You came on over from the Dark Side.”
    She answered, “I love Western medicine!”

  80. #81 herr doktor bimler
    April 2, 2015

    The dark side of the Sun
    I shall assume that to be a Terry Pratchett shout-out, whether intended as such or not.

  81. #82 Old Rockin' Dave
    The Ringworld, which is much cooler than a discworld...
    April 2, 2015

    Mein Güt Freund, der Herr Doktor,
    I have never read Terry Pratchett (a failing I will some day remedy), so no, I’m afraid it’s not. Nor is it to be taken as some kind of Pink Floyd tribute, at least until the rest of the band beat the snot out of him and throw him off the stage. It’s just wordplay, which is the next best kind of play to foreplay. Or afterplay. Or duringplay.

  82. #83 Old Rockin' Dave
    April 3, 2015

    “Nor is it to be taken as some kind of Pink Floyd tribute, at least until the rest of the band beat the snot out of him and throw him off the stage.” Him=Roger Waters.

  83. #84 herr doktor bimler
    April 3, 2015

    The Ringworld, which is much cooler than a discworld…
    Terry Pratchett shared your reverence for the classics; a version of Discworld first appeared in his third novel, Strata, which is essentially Ringworld fanfic.

  84. #85 Old Rockin' Dave
    The Big Bang Burger Bar, ordering a McMegadonkey...
    April 5, 2015

    Not to the topic, but I have wondered why Niven portrays the Ringworld as having only alcohol as a source of hydrocarbon fuel. After so much time and biologic activity, why no methane, and also why no methane cookers? Are there no fats, waxes, or oils among its varied animal and plant life? If the spill mountains are so many hundreds of miles high, couldn’t their weight compress organic material into substances on the order of coal or petroleum? No peat bogs?
    Larry Niven is a very smart man (even if he has collaborated with Jerry Pournelle), but like Asimov, when he fails, he fails big.

  85. #86 Vicki
    April 5, 2015

    The physics of the Ringworld and the Discworld are both problematic. The difference is that Pratchett knew he was writing fantasy; Niven claimed to be writing hard science fiction.

  86. #87 A Coz
    Cape Town
    April 6, 2015

    As well as the loner lifespan, surely the increased size of the population has affected the number of cancer cases? As there is a greater population size nowadays than in the past, there are more people that can get cancer, and so the number of cancer cases would be greater than in the past where the population wasn’t as big.

    Also, cancer awareness has increased drastically which leads to more people being aware of such symptoms, resulting in more people going to doctors and such to check it out. This leads to an increase in the number of known cases of cancer. This also goes hand in hand with the improvement of medical technology over the years and thus the ability to diagnose a disease such as cancer.

    Of course these points do not determine whether cancer is a modern disease or not. Cancer has been around as long as humans have. It is just more noticeable now due to the previously mentioned factors.

  87. #88 Bill Price
    April 6, 2015

    A Coz: It’s not just the better diagnosis. Way back when, a known cancwer patient had a very shoprtlifespan, the time betweennbecoming a ‘known cancer patient’ and death was much shorter. Now, it’s years, not weeks. This means that the cancer patient is counted for five years or more, depending on the definition the statistician is using. Thus, the Pt is counted five times (in annual cancer stats), rather than just once.

  88. #89 Seb Long
    April 7, 2015

    Bill Price: Had cancer been defined as cancer back then? Surely those people in the past had just treated the symptoms of cancer, not the actual cause? As they did not have the medical technology to identify the root cause of the illness?

  89. #90 Bill Price
    April 7, 2015

    Bill Price: Had cancer been defined as cancer back then?

    I’m talking about people I’ve known in my lifetime. Granted, I’m an old coot, but “back then” seems a little presumptive. Yes, cancer was well known in the 1950’s. Here’s examples (yes, anecdotes—for illustration only) of people in my life. (‘Undisclosed’ means I don’t know.)

    ● 1953, favourite aunt; brain, of undisclosed type; died 6-8 weeks after Dx.

    ● 1966, coworker; Undisclosed (or maybe I’ve forgotten) abdominal; exploratory surgery found extensive metastases; died 6 weeks post surgery.

    ● 1998, father, undisclosed brain; inoperable; died 7 weeks post Dx.

    ● 2000 Dx, coworker, prostate; still hanging around post treatment.

    ● 2002 Dx, coworker, breast; still alive post treatment (lumpectomy?).

    ● 2006 died, boss’ wife, undisclosed brain; lotsa treatment, died ~11 years post Dx.

    ● 2007 Dx, wife, terminal ileum; Dx by colonoscopy, verified by remote imaging (swallowed a miniature TV station), surgically removed. She just walked by, so she’s still alive…

    ● 2009 Dx, wife’s cousin, prostate; undisclosed treatment. Still alive as of last week.

    ● Dx 2012, Daughter-in-law; glioblastoma multiform; radiation and chemo; died 2 years post Dx.

    Surely those people in the past had just treated the symptoms of cancer, not the actual cause?

    It’s not clear what you mean by “just…the symptoms of cancer.” When possible, they were treated for cancer by removal and/or destruction of the cancer tissue, the actual cause of the symptoms. My aunt and my father could not be treated this way, so palliative care (symptom relief) was the only treatment option.

    As they did not have the medical technology to identify the root cause of the illness?

    you
    The root cause of a cancer is an insult to a cell with damage to or destruction of its internal ‘quality control’ during division. The practical oncologist doesn’t waste the patient’s time in determining the root cause—which cell got what insult, and when (unless it helps indicate the best treatment for that patient). The research oncologist is concerned with identifying (and helping prevent) kinds of cancer-causing insults—and may be interested in classes of potential root causes for future patients.

  90. #91 Bill Price
    April 7, 2015

    The stray ‘you’ just before the last paragraph above goes somewhere else–maybe a different comment.

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