Absence of evidence or evidence of absence? A discussion on paleoepidemiology of neoplasms with contributions from two Portuguese human skeletal reference collections (19th–20th century)

Abstract

Biological, sociocultural, demographic and environmental factors are major contributors to the contemporary burden of oncological diseases. Although cancer's current epidemiological landscape is fairly well known, its past occurrence and history seem more obscure. In order to test the hypothesis that paleopathological diagnosis is an adequate measure of the prevalence of malignant neoplasms in human remains, 131 skeletons (78 females, 53 males, age-at-death range: 15-93 years) from Coimbra and Lisbon Identified Skeletal Collections, 19th/20th century (Portugal), were examined. The cause of death for all of the selected skeletons was a malignant neoplasm, as recorded in the collection's documental files. Through the application of standard paleopathological protocols, it was determined that 17.6% (n = 23) of the skeletons had unequivocal osseous signs of metastatic and/or neoplastic lesions. Forty-five percent (n = 59) had manifest osseous lesions, however the lesional patterns were not clearly pathognomonic. Although all of the analyzed individuals were documented as having succumbed to malignant neoplastic disease, a total of 37.4% (n = 49) of the individuals did not exhibit osseous abnormalities. Individuals with breast cancer often exhibited lesions. This study presents a quantitative estimate of the accuracy of paleopathological diagnosis; as well as a theoretical reflection on the burden of cancer in the past. We emphasize the need for a paradigm shift while thinking about the future of paleo-oncology.

Metastatic Cancer in the Middle Age: The Possible Case of a Female Skeleton from Bormio (Italy)

“…The limited diffusion of risk factors of malignant conditions in the ancient human remains supports the theory that multiple factors, such as shorter life expectancy, absence of environmental risk factors (pollution, smoke, drugs, chemical agents, heavy metals, etc. ), healthier lifestyle (physical activities and dietary habits) and higher mortality due to infectious diseases, could have influenced the incidence of cancer in the past (Assis & Codinha, ; David & Zimmerman, ; Marks & Hamilton, ; Marques et al ., ). Nevertheless, the absence of diagnosis of tumour on osteoarchaeological materials does not necessarily mean the absence of these conditions in ancient human populations (Kumar et al ., ).…”

“…The prevalence of cancer in the past population appears generally limited by the diagnostic difficulties to perform a diagnosis on dry bones. Primary and secondary malignant neoplasms can leave unspecific lesions on bones, particularly in early stage of disease, and the absence of any standardised diagnostic criteria further contributes to misleading a differential diagnosis (Marques et al ., ).…”

Metastatic Prostate Carcinoma from Imperial Rome (1st to 2nd Centuries AD)

“…The most ancient cases were recovered in a neolithic mass burial from Spain [3] dating back to the 32rd to 30th century BC, and in a Russian site dating back to the 27th to 26th century BC [7]. A review of the paleopathological literature on prostate cancer is presented in Table 1 [3,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. This is the first case to have been documented in Imperial Rome, when the city was a large metropolis of about 1 million inhabitants.…”

An osseous lesion in the maxillary sinus—Tumour or tumour‐like?

“…Due to a lower average life expectancy up to the 20th century, however, there was also a lower frequency of bone tumours in the population overall. Moreover, not all neoplastic diseases leave traces on or in the bone (Marques, Matos, Costa, Zink, & Cunha, ). Palaeopathological assessments of ossifications in archaeological skeletal remains that go beyond a mere tentative diagnosis, however, are not easily achieved and require both specialist knowledge and the use of imaging and histological procedures (Kirkpatrick et al, ; Ragsdale, Campbell, & Kirkpatrick, ).…”

“…Due to a lower average life expectancy up to the 20th century, however, there was also a lower frequency of bone tumours in the population overall. Moreover, not all neoplastic diseases leave traces on or in the bone (Marques, Matos, Costa, Zink, & Cunha, 2018).…”