By Culturekiosque Staff
LONDON, 22 MARCH 2014 Cancer, one of the worlds leading
causes of death today, remains almost absent relative to other
pathological conditions in the archaeological record, giving rise to the
conclusion that the disease is mainly a product of modern living and
increased longevity. However, investigation of the skeleton of a young
adult male found in February 2013 at the archaeological site of Amara West
in northern Sudan has revealed evidence of metastatic carcinoma from a
malignant soft-tissue tumour on the collar bones, shoulder blades, upper
arms, vertebrae, ribs, pelvis and thigh bones. Buried in a tomb around
c.1200BC, this is the earliest complete example in the world of a human
who suffered metastatic cancer found to date. This find is of critical
importance as it allows us to explore possible underlying causes of cancer
in ancient populations, before the onset of modernity, and it could
provide important new insights into the evolution of cancer in the past.
The research was made possible through a grant from The Leverhulme
Trust, to investigate "Health and diet in ancient Nubia through political
and climate change", with further generous support from the Institute of
Bioarchaeology Amara West Field School. The Amara West fieldwork is
undertaken with the permission of the National Corporation of Antiquities
& Museums, Sudan.
The skeleton is of an adult male estimated to between 25 35 years old
at his death. The skeleton has been examined using radiography and a
scanning electron microscope (SEM). These techniques have resulted in
clear imaging of lytic (destructive holes)lesions on the bones and
following work undertaken by experts at Durham University, a diagnosis of
metastatic carcinoma secondary to an unknown soft tissue cancer was made.
The shape of the small lesions on the bones can only have been caused by a
soft tissue cancer even though the exact origin is impossible to determine
through the bones alone.
Lesions in the right scapula of a 3,200-year-old
the presence of cancer. Credit: Trustees of the
Lead author of the study, Michaela Binder from Durham University who
excavated and examined the skeleton said Insights gained from
archaeological human remains can contribute greatly to the understanding
of the evolution and history of many modern diseases, a knowledge that is
also very important for medical research today.
Previously there has been only one convincing, and two tentative,
examples of metastatic cancer predating the 1st millennium BC which have
been reported in human remains. However, because the remains derive from
early 20th century excavations, only the skulls were retained, thus making
a full re-analysis of each skeleton, to generate differential (possible)
diagnoses, impossible. Thus this skeleton from Amara West is the earliest
complete example in the world of a human with metastatic cancer.
Firm evidence for cancer in ancient human remains, prior to the
onset of modernity, is very rare. This dearth of evidence in the past has
led to the common perception that cancer is a disease of modern life.
Cancer is often blamed on lifestyle related factors and longer life
expectancy. The shorter life spans of our ancestors and a different living
environment was thought to explain the lack of evidence of cancer in
antiquity. Moreover, diagnosing cancer in skeletal human remains is very
difficult because the small cavities caused by metastases can easily be
mistaken for post-depositional damage or other diseases, or overlooked,
particularly during early stages of the disease. Very little is known
about the antiquity, epidemiology and evolution of cancer in past human
populations, though there are some textual references. The Edwin Smith
Papyrus (c.1600BC) contains the earliest known reference to a tumour-like
swelling in the breast and is widely believed to be the earliest known
description of cancer.
The skeleton of the adult male excavated from
Courtesy: Trustees of the British Museum
The site of Amara West is situated on the Nile, 750km downstream of the
countrys modern capital Khartoum. The settlement was founded around 1300
BC as a new administrative centre for the pharaonic (Egyptian) control of
(Kush). The research project led by the British Museum, with the
support of the National Corporation of Antiquities & Museums, Sudan,
has been investigating the experience of the people who lived there and
who were buried within the ancient town. Amara West was a largely
agricultural community with a subsistence based on grain cultivation and
livestock although integrated into the trading framework of Pharaonic
Egypt and beyond.
Neal Spencer, British Museum commented From footprints left on wet mud
floors, to the healed fractures of many ancient inhabitants, Amara West
offers a unique insight into what it was like to live and die in
Egyptian-ruled Upper Nubia 3200 years ago.
The skeleton was recovered in 2013 from a tomb located in the
north-eastern cemetery of Amara West. Based on tomb architecture and
aspects of funerary ritual, this burial ground appears to have been used
for commoners and high-status individuals from the town, but not the
ruling elite. The tombs architecture is evidence of a hybrid culture
blending Pharaonic elements (burial goods, painted coffins) with Nubian
culture (a low mound to mark the tomb). The skeleton was buried
extended on his back, within a badly deteriorated painted wooden coffin,
and provided with a faience scarab as a grave good. The well preserved
pottery recovered from the tomb provides a date within the 20th Dynasty
(1187-1064BC), a period when Egypt ruled Upper Nubia, endured conflicts
with Libya and while pharaohs such as Ramses III were being buried in the
Valley of the Kings.
The cause of the cancer itself can only be speculative but a large
number of environmental carcinogens also occur naturally and would have
affected our ancestors in the same way. The carcinogenic effects of smoke
from wood fires, particularly when indoors, are well known, and the houses
at Amara West typically feature hearths, but also bread ovens in small,
roofed spaces without windows where smoke dissipated slowly. In modern
Sudan the common usage of fires in poorly ventilated rooms is considered
one of the major causes of lung cancer.
Infectious diseases can also lead to cancer. Schistosomiasis has
plagued inhabitants of Egypt and Nubia since at least 1500BC and is now
recognized as a common cause of bladder cancer. In addition, it has been
associated with an increased risk of male breast cancer, and the male to
female breast cancer ratio in Egypt today is far greater than anywhere
else in the world. Genetic factors also need to be considered.
It seems plausible that an underlying schistosomiasis infection could
have led to cancer in this individual. From a modern clinical point of
view, the relative youth of the man from Amara West may seem unusual for
the onset of skeletal metastases (secondaries), but it remains unknown
whether the underlying causes of cancer affected people in the same way
and at the same speed as they do today.
This find is extremely important, both in terms of our knowledge of the
ancient world and in terms of the understanding of the epidemiology and
evolution of cancer. There is potentially a huge value in using this data
to contribute to our knowledge of disease today. Cancer specialists have
called for future research into the evolution of cancer to improve the
management of the disease. Ancient DNA analysis of skeletons and mummies
with evidence of cancer could also be used to detect mutations in specific
genes that are known to be associated with particular types of cancer. By
linking these to living environment and other contextual considerations it
may be possible to better understand why and in what ways cancer therapies
should or could be developed. Through taking an evolutionary approach to
cancer, information from ancient human remains may prove a crucial element
in finding ways to address one of the worlds major health problems.
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