Cancer as a Disease of Civilization

by Ralph Moss, Ph.D

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 a heart attack. 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.

Similarly, 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.

Rates of Cancer Vary Widely

Even today, we find huge disparities in the incidence of cancer worldwide, with increased rates seemingly tied to the adoption of a refined diet and other harmful habits. Hungary: for instance, has a cancer death rate of 272.2 per 100,000 (men) and 138.4 per 100,000 (women). Contrast this with Mexico, where the death rate among men is 85.0 and among women 78.9 per 100,000.

Evidence points to drastic changes in diet as the most likely explanation for the increase in cancer. Indigenous people of regions across the globe seem protected so long as they eat the diet that their ancestors ate for millennia. But once they adopt Western dietary habits, cancer appears and then begins its inexorable climb towards the same astronomical heights as are seen in the societies they emulate.

Some scholars who studied vegetarian cultures have concluded that it was the high fruit and vegetable content that kept these native peoples from getting cancer. Conversely, some researchers who focused on northern populations in which meat was prominent have advocated a meat-based diet for cancer protection. Others have ascribed the healthfulness, longevity and lack of cancer in indigenous populations to the intake of specific nutrients (such as the "laetrile" found in such abundance in apricot kernels, a staple of the Hunza diet).

But no single, simplistic answer will fit these tremendously varied cultures. In my opinion, what these diverse populations ate is much less important than what they did not eat (at least until recently): "white" foods, specifically white sugar, white flour, and salt. The addition of these foods to their diet was disastrous to their health, as it has been to ours. White sugar and white flour are especially harmful, because these "high glycemic" foods are quickly absorbed into the bloodstream, where they wreak havoc with the regulation of insulin and blood sugar levels. This is a major factor in increasing rates of type 2 diabetes and obesity.

Unfortunately, white sugar, white flour, and refined sweeteners are ubiquitous in the Western diet. They are found in sodas and other sweet drinks, breads and snack foods, beer and ice cream, you name it. But even "natural" forms of carbohydrates may not be as innocent as once thought. Whole wheat flour, potatoes, and other seemingly healthy foods also have a high glycemic index and may not be safe to consume in anything except small quantities.

The list of diseases linked to obesity is a lengthy one. According to the American Cancer Society, obesity contributes to hypertension, lipid disorders, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems. And as body mass index goes up, rates of cancer also increase, by as much as 80% in women.

Thoughts in a Country Churchyard

Some people believe that the increase in cancer incidence is an illusion. The reason that there is more cancer today than in former times, they say, is that present-day people live much longer. Since cancer is primarily a disease of middle and old age, these writers claim, there simply weren't enough people in former ages who lived long enough to develop this disease.

"For all of history the average life span was about 35-40 years," wrote one of these commentators. "In the last hundred years life spans in industrialized countries have increased to 70 years." Therefore, what appears to be a fault of civilization (an increase in cancer) is actually another one of its blessings.

How true is this claim? There are reasons to doubt it. The Biblical "Book of Psalms" states: "The days of our years are three-score years and ten, / Or even by reason of strength fourscore years" (90:10). A score is twenty years. Thus, the Biblical author believed that the normal life span was 70 years or, for those who had a particularly vigorous immune system, around 80. How does this gibe with the notion that until the advent of modern medicine people only lived to around 35?

During my morning walk, I pass an old churchyard, dating from the time of the American Revolution. Spurred by these questions about the average span of human existence, I studied the gravestones. I observed that in 19th century New England, at least, deaths tended to cluster in one of four categories:

1) Many children died either during childbirth or from epidemic diseases.

2) All too frequently women died young, generally in childbirth, and were sometimes buried next to their equally unfortunate babies.

3) Some men also died in their early decades of accidents and wars.

4) Once you eliminate these obvious checks on human longevity, people in previous centuries seemed to live about the same number of years as they do today. Most of those who managed to attain adulthood lived into their seventies and eighties.

Many of our Founding Fathers lived to ripe old ages. True, Washington died at 67. (He was probably bled to death by overzealous doctors). But John Adams was 90, Thomas Jefferson 83, James Madison 85, James Monroe 73, John Quincy Adams 81, Andrew Jackson 78, and Martin Van Buren 80. If we average these we get 80, which is exactly what the Bible predicts for such healthy human specimens.

Longevity in Antiquity

The same holds true for antiquity. If you look at the famous writers of China, Greece and Rome you find that they generally lived about the same as adults today. I averaged the first 20 writers whose dates are given in Bartlett's Familiar Quotations. None lived less than 60 years. The average was 74 years, right in the middle of the Biblical range. Some lived into their 90s. During lifetimes of such a generous span, cancer would have shown itself. The average age at which cancer strikes is around 62 years and, as we know, it strikes many before this. Yet there are relatively few references to cancer in antiquity.

Could it be that cancer was just as rampant in olden times as it is today, with the only difference being that it went undiagnosed? Some readers have proposed this idea. My view is this: the disease was definitely known, and it was just as definitely rare in most periods in human history. About one-quarter of tumors manifest externally. Pre-modern medical writers were fascinated by cancer and were on the lookout for malignancies. They had the ability to identify many types of cancer. However, they seldom had the opportunity to do so, due to the paucity of cases. Reports of cancer, and interest in the disease, began to increase, like an incessant drumbeat, throughout the 19th and into the 20th centuries.

Even as late as the 1920s, cancer was still not a major factor in medicine. The Practice of Medicine, by A.A. Stevens, MD of the University of Pennsylvania, is a comprehensive work on the full scope of medicine dating from 1922. Yet in the course of over 1,000 pages, the book contains only two dozen references to solid tumors of all types. The description of lung cancer takes up one paragraph and states that the disease is "comparatively rare." Breast cancer is not even mentioned, nor are most of the other types of malignancy that fill the cancer textbooks today. Simply not there. In fact, the first comprehensive English textbook on cancer treatment was not published until 1940!

My conclusion is that although cancer is indeed a very old disease it was not very common in antiquity or until the late 19th or early 20th century. The reason was not that people did not live long enough to develop the disease. Many did indeed live into their sixties, seventies and beyond. No, the reason is that cancer only took on epidemic proportions in the last 100 years or so. We therefore have to look to peculiarly modern conditions for the cause of this epidemic. And of these, the overall impact of sugar needs to be considered. I suggest that readers limit their intake of refined carbohydrates. Evidence suggests that it will decrease your chances of developing a host of diseases, probably including some kinds of cancer.