Cancer: A Disease of Civilization? (Part I)

Is cancer a disease of civilization? Is it related to other diseases that seem to increase with industrialization? If so, what are the implications for readers living in the 21st century?

Back in the 19th century, many of the diseases that now plague us were rare. Diabetes was twenty-seventh on the list of causes of death in the statistics of the Metropolitan Life Insurance Company in 1900. By 1950 it had become the third leading cause of death. The famous surgeon Alton Ochsner, MD, once related that, when he was in medical school in the early 20th century, one of his professors took his class to see the autopsy of a patient who had died of lung cancer. The disease was so rare at that time that his professor feared they might never see another such instance! Obesity was the subject of circus displays, not an everyday occurrence.

In fact, until the mid-1800s, cancer was relatively rare and was not considered statistically important. This was particularly true outside of the major cities. Then, in the mid-19th century, cancer began its stratospheric rise. Around the same time, well-trained medical personnel began to travel and even to live among indigenous peoples (the so-called "natives"). The news they brought back was startling. These diverse populations, many of whom lived a hand-to-mouth existence, were generally much healthier than their Western counterparts. True, they had a high infant mortality rate and easily succumbed to epidemics that originated in the West such as measles, smallpox and tuberculosis. But they had far less asthma, allergies, indigestion, and heart disease. The same disparity in health was seen between rural and urban populations in Europe. The French or English farmer was much less likely to develop cancer than the cosmopolite of Paris or London. And despite the stereotypical image of Eskimos and South Sea islanders as roly-poly, obesity was extremely rare among such people.

Most startling of all, cancer seemed nonexistent. In 1843, a French surgeon, Stanislas Tanchou, MD, formulated this observation into "Tanchou's Doctrine": the incidence of cancer increases in direct proportion to the "civilization" of a nation and its people. This doctrine was embraced by John Le Conte, MD (1818-1891), first president of the University of California, and his enthusiasm led medical missionaries, ship surgeons, anthropologists and others to undertake an avid search for cancer among the Alaskan Eskimo (Inuit), northern Athapaskans of Canada and the native peoples of Labrador. The result was always the same: For 75 years, not a single case of cancer was documented among the tens of thousands of such people studied by competent medical examiners. The Harvard-trained anthropologist, Vilhjalmur Stefannson, for instance, lived for 11 years among the Eskimo and never saw a case. In later life, he wrote a book on the topic, Cancer: A Disease of Civilization?

Unfortunately, whatever protection these native populations had against cancer was lost when they began to adopt Western ways in the 1920s. By the early 1930s, cases of cancer were being documented in Alaska and Canada. On July 27, 1933, an Eskimo named Jobe died of liver cancer at the Farthest North Hospital in Alaska. Similarly, in 1935, Michael Nochasak, an Eskimo, died of colon cancer in Labrador. After that, the rates of cancer among these native peoples underwent a steady rise, until they began to rival that of the white population.

Evidence from Africa and Asia

Similar stories are told about the indigenous peoples of Africa and Asia. Albert Schweitzer, MD, the famous Nobel laureate, testified as follows:

"On my arrival in Gabon, in 1913, I was astonished to encounter no case of cancer...I cannot, of course, say positively that there was no cancer at all, but, like other frontier doctors, I can only say that if any cases existed they must have been quite rare. The absence of cancer seemed to me due to the difference in nutrition of the natives as compared with the Europeans...

"In the course of the years, we have seen cases of cancer in growing numbers in our region. My observations incline me to attribute this to the fact that the natives were living more and more after the manner of the whites...I have naturally been interested in any research tracing the occurrence of cancer to some defect in our mode of nutrition."

The Hunza people, who live in a remote valley of the Himalayas, in the territory of Kashmir, provide further evidence of the rarity of cancer among indigenous populations. The Hunza were the subject of study from the 1910s onward by a number of diligent observers, including Sir Robert McCarrison, Major General in the Indian Health Service (1878-1960). McCarrison's seven years of careful scrutiny led him to conclude that there was little if any cancer among this population.

It might be objected that cancer is an "occult" disease, difficult to diagnose, and that for this reason it may have eluded early observers. I do not believe this to be the case. At least one-quarter of all cancers are external in nature. Basal and squamous cell carcinomas, tumors of the head and neck region, breast cancer and those of the external genitals, to name but a few, are all readily apparent and do not take great diagnostic skills to detect. Breast cancers in particular were well known and described even by ancient physicians. Other cancers also form noticeable lumps or break to the surface.

Besides, we are not talking about medieval medicine. By the late nineteenth and early twentieth centuries cancer pathology had taken great strides. Such works as James Ewing's Neoplastic Diseases, which was first published in 1920, demonstrate the sophistication of cancer science at that time. Frontier doctors were, by and large, competent, serious and well-trained. I don't think there is any doubt that if cancer had been widespread, they would have found it. I can only conclude that cancer is indeed a disease of industrial society.

To be completed next week...

--Ralph W. Moss, Ph.D.

References:

Stefannson V. Cancer: Disease of Civilization?. NY: Hill & Wang, 1960.

NOTE: If you would like to print this page, click here for a printer's view or right click any where on the window of this page and scroll to Print.