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Medieval skeletons can hide a cancer rate that is far higher than expected

Cancer is not just a modern disorder. A new archaeological analysis suggests that malignant growths in medieval Britain were not as rare as we once thought.

Even before widespread smoking, the industrial revolution, and the modern rise in life expectancy, it seems that cancer was still a leading cause of disease.

Scanning and X-rays 143 medieval skeletons from six cemeteries in and around the city of Cambridge, archaeologists have predicted cancer cases between the 6th and 16th centuries were about a quarter of what they are today.

That is ten times higher than previous estimates, which had set the cancer rate at less than one percent.

“Until now, it was believed that the most significant causes of ill health in medieval people were infectious diseases such as dysentery and bubonic plague along with malnutrition and injuries due to accidents or warfare,”

; says archaeologist Jenna Dittmar of Cambridge University.

“We now have to add cancer as one of the biggest disease classes that affected medieval people.”

Previous analyzes of medieval skeletons in Britain have focused only on the exterior of the bone, but Dittmar and her colleagues also decided to seek evidence of bone metastases.

263379 webCT scan bone from a medieval skull with a white arrow showing metastasis. (Bram Mulder)

Scanning parts of the skeleton that are more likely to hold cancerous growth, such as the spine, pelvis and femur, the team found signs of malignancy in five people from the Middle Ages.

Most cases were confined to the pelvis, but there was a middle-aged man who had lesions spread through his skeleton, which is a sign of blood cancer.

263378 webExcavated medieval spine with white arrows showing cancer metastases. (Jenna Dittmar)

“Using CT scans, we were able to see cancerous lesions hidden inside a bone that looked completely normal from the outside,” says Dittmar.

This type of scan can detect bone metastases in patients about 75 percent of the time, and over a third of people who die of cancer today show signs of these growths in their bones.

Based on these statistics, the authors believe that the minimum incidence of all cancers in medieval Britain would have been somewhere between 9 and 14 percent.

In the centuries since, this speed has increased. In modern Britain, where people live far longer, inhale more pollutants and face more viruses, up to 50 percent of people have cancer when they die.

It is important to find out how much the cancer incidence has increased in recent years because it allows us to know where our biggest threats are coming from. At present, it is still not entirely clear how much tobacco smoking and pollutants have affected our disease rates as a whole because we do not have a baseline to work away from.

Historical texts are not very reliable and are difficult to compare with modern data, while archaeological remains are much more reliable, especially with the technology we have today.

The sample size for the current study was apparently small and focused only on one region. It is also a difficult business that diagnoses cancer so many centuries later.

But even with these reservations in mind, the results suggest that we have missed many cases of medieval cancer by not looking within the bone.

“We need further studies using CT scans of seemingly normal skeletons in different regions and time periods to see how common cancer was in important civilizations of the past,” says first author of the new research, archaeologist Piers Mitchell of Cambridge University.

The study was published in Cancer. The paper is unavailable at the time of publication, but evidence of the pre-press release can be reviewed at Academia.edu.

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