The history of cancer: Part 1

(I was asked to make three short videos on the history of cancer, for the excellent liberal arts college, Gustavus Adolphus, where I spent a year. The theme of their annual Nobel Conference for 2020 was Cancer in the Age of Biotechnology. The videos are available here but if you prefer to read things, here is the script for the first one.)

Why do we want a disease to have a history?

There’s something about continuity and reassurance here, I think. Maybe it’s a bit like why we want a diagnosis when we go to see a medical practitioner? If you get a name for your condition, that’s sort of reassuring because it means you’re not the only one, and it means there’s likely to have been some research on it, and therefore likely that some treatment will have been developed and tested and used successfully?

But that’s about getting a name for the disease rather than a history of it. Names and history are connected, though. The name we get may be rather less impressive than it sounds when we hear it! You could go to your physician with an embarrassing sort of pain and be told you have proctalgia fugax – which is a mixture of ancient Greek and Latin, like so many disease names are – but in fact this ‘name’ is just a translation of the symptoms. It means ‘fleeting pain up the butt’. So ‘you’ve got proctalgia fugax’ isn’t telling you anything new, it’s just saying ‘this is something we know exists’.

So what about that name, ‘cancer’? It’s certainly an ancient word. The ancient Greeks had the word karkinos, as in carcinoma. Before that word was used in medicine, karkinos just meant ‘crab’. The use of the word in medicine goes back to the time when Hippocrates, the so-called father of medicine, lived: fifth century BCE. But in those days of course there was no knowledge of the body’s cells, and no diagnostic test, so we can’t be sure that an ancient medical text which says karkinos, or its Latin translation ‘cancer’, was anything of the kind. Finding the crab-words in medical texts is no guarantee of what they were writing about.

If you look into the history of cancer, you’ll find that cancer specialists really want to find cases of it in the past. They need a history. This is about more than just finding a word. They need a sense of a lineage of noble medical specialists helping patients. They also need a feeling of progress, in which even though some of their patients will die, nevertheless they are doing better than their predecessors. I think we as patients also need that sense of progress.

So, cancer gets a history. It’s worth doing a search for its history online. If you do this, you’ll find it linked not just to the name of Hippocrates, but to other ancient Greek and Roman writers too: Galen, Celsus. But keep in mind as you read these claims that we’ve no way of knowing what conditions are actually being included under those ‘crab’ labels. 

And then, is there just one thing called ‘cancer’? Today we’d probably emphasise the different types, the different causes, the different stages. 

So let’s take just one form, breast cancer, as an example. If you search online you’ll be told that it has a long history. You’ll find many, many sites which tell you that in ancient Egyptian medicine, there’s a description in something called the Edwin Smith papyrus of using cauterisation to remove a breast tumour. These general history-of-cancer sites, often run by medical groups, go along with that idea of a long history. If you look instead at experts on ancient Egyptian medicine, specialist historians, they see things rather differently. John Nunn was between the two worlds of medicine and history, as a retired anaesthesiologist, when he wrote his book Ancient Egyptian Medicine in 1996. He pointed out that we wouldn’t expect as much cancer in ancient Egypt, not just because of a lack of triggers in the environment, but more significantly because cancer is more common in older people whereas life expectancy then was low so you were less likely to live long enough to develop cancer! In the skeletal record, he said that cancer is very rare, although sometimes there’s evidence of bone cancer, sometimes evidence of damage to a bone from a tumour pressing on to it. But there’s another important factor here – he wrote in the 1990s, but until the early twenty-first century, we didn’t have sufficiently powerful imaging tools to detect very small tumours in human remains. There are more recent studies of ancient Egyptian burials which have found more evidence of cancer: one example is here, another here.

Specifically, what about that Edwin Smith papyrus? A quick online search will come up with the claim that its collection of 48 cases includes 8 cases of cancer. Is it that simple, though? You can find out for yourself, because the whole of the 1930 English translation of this papyrus is available online with lots of discussion of the various words used, and it’s a really interesting read.

There are certainly 8 cases of conditions affecting the chest area. One is case number 45. This says that if swellings over the breast area are cool, bulging, and spread over a large area, then ‘there is no treatment’. That’s not as doom-laden as it may sound – it’s something said about a lot of cases in this papyrus. Some English translations of the ancient Egyptian say ‘tumours’ here, rather than swellings. ‘Tumours’ immediately makes this sound more like cancer! Remember that every act of translation is also an interpretation!

The next one, case 46, is an abscess which has developed a clear ‘head’. This is what happens when there’s an infection and there’s so much pus in it that it’s under a lot of pressure and will be inflamed. But is this abscess cancer? Or is it simply a localised skin infection?

So, it’s probably not ‘8 cases of cancer’ and maybe none of these are cancer. Whatever these conditions are, it’s also worth noting that ALL 8 cases are in men. Not women! There are plenty of abscesses, swellings, ulcers and cysts in ancient Egyptian medicine, but there is no mention of the disease of breast cancer.

Maybe a better match for an ancient Egyptian cancer text is another papyrus, the Ebers papyrus, which mentions a condition called ‘eating of the uterus’. But we can’t know for sure.

In your online search for the history of cancer, you’ll find various images with titles like ‘The Evolution of Breast Cancer: 3500 BC to 2016’ which include an arrow pointing up. For both medical professionals trying to find cures, and patients wanting to feel they’re not suffering alone, knowing a disease has a history is comforting. We like that upwards trajectory in which knowledge and treatments gradually get better and better, even if they’re not perfect yet. We live in a world of changing theories – over history, breast cancer has been seen as being caused by black bile, by a sort of clot of the lymph, by not enough sex, by your genes, by your environment… Over history, we’ve had new tests – mammography, genetic tests – and new treatments – radical mastectomy or lumpectomy with radiotherapy, chemotherapy. Yet we still want ‘a history’. Part of developing a sense of progress is having something worse, to progress from. I’ll be returning to the early history in my next piece, which is on changing ideas and patient experiences!