Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Portugal.
Department of Archaeology, Durham University, South Road, Durham, DL8 5NP, Durham University, UK.
Int J Paleopathol. 2021 Mar;32:111-122. doi: 10.1016/j.ijpp.2020.12.005. Epub 2021 Jan 29.
Was cancer a rare disease in the past? Our objective is to consider the various terminological, theoretical, and methodological biases that may affect perceptions of the rarity of cancer in the past.
We discuss relevant malignant neoplastic biomedical and paleopathological literature and evaluate skeletal data. We selected 108 archaeological sites (n = 151 cancer cases) with published malignant neoplasms and that were amenable to calculating cancer crude prevalence. Furthermore, datasets from four medieval/postmedieval Portuguese and 12 postmedieval UK sites were used to compare age-adjusted rates for metastatic bone disease and tuberculosis.
In the literature review, mean cancer crude prevalence (1.2 %; 95 % CI = 0.96-1.4) exceeded the threshold for a rare disease (RD). Age-standardized rates of MBD and TB were not markedly different in the sites surveyed.
Methodological, theoretical and historical factors contribute to assumptions that cancers were rare diseases. The assumption that cancers are extremely rare in the paleopathological literature was not fully supported. Cancer is a heterogeneous concept, and it is important to view it as such. If a disease is considered rare, we may fail to recognize it or dismiss it as unimportant in the past.
We present a re-evaluation of the idea that cancer is a rare disease. We present a more nuanced way of comparing rates of pathological conditions in archaeological contexts.
Variation in the amount of useable information in published literature on malignant neoplasms.
More large-scale studies of cancer in the past alongside comparative studies of cancer prevalence with other assumed rare diseases.
过去癌症是一种罕见病吗？我们的目的是考虑各种可能影响人们对过去癌症罕见性看法的术语、理论和方法学偏见。
我们讨论了相关的恶性肿瘤生物医学和古病理学文献，并评估了骨骼数据。我们选择了 108 个有发表的恶性肿瘤且适合计算癌症粗患病率的考古遗址（n=151 例癌症病例）。此外，还使用了来自四个中世纪/后中世纪葡萄牙和 12 个后中世纪英国遗址的数据集，比较了转移性骨病和结核病的年龄调整发病率。
在文献综述中，癌症粗患病率的平均值（1.2%；95%CI=0.96-1.4）超过了罕见病的阈值。调查的遗址中，MBD 和 TB 的年龄标准化率没有明显差异。
方法学、理论和历史因素导致人们认为癌症是一种罕见病。在古病理学文献中，癌症是一种罕见病的假设并没有得到充分支持。癌症是一个异质的概念，重要的是要认识到这一点。如果一种疾病被认为是罕见的，我们可能无法认识到它，或者认为它在过去不重要。
我们对癌症是一种罕见病的观点进行了重新评估。我们提出了一种更细致入微的方法来比较考古背景下病理状况的发病率。
发表的恶性肿瘤文献中可用信息量的变化。
对过去的癌症进行更多的大规模研究，并与其他假设的罕见疾病进行癌症患病率的比较研究。
