Objective

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.

Materials and methods

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.

Results

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.

Conclusions

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.

Significance

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.

Limitations

Variation in the amount of useable information in published literature on malignant neoplasms.

Suggestions for further research

More large-scale studies of cancer in the past alongside comparative studies of cancer prevalence with other assumed rare diseases.

中文翻译：

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癌症作为罕见疾病：术语、理论和方法偏差

客观的

癌症在过去是一种罕见的疾病吗？我们的目标是考虑可能影响过去对癌症罕见性的看法的各种术语、理论和方法偏差。

材料和方法

我们讨论相关的恶性肿瘤生物医学和古病理学文献并评估骨骼数据。我们选择了 108 个考古遗址（n = 151 例癌症病例），这些遗址有已发表的恶性肿瘤，并且可以计算癌症粗略患病率。此外，来自四个中世纪/后中世纪葡萄牙和 12 个后中世纪英国站点的数据集被用来比较转移性骨病和结核病的年龄调整率。

结果

在文献综述中，平均癌症粗略患病率（1.2 %；95 % CI = 0.96–1.4）超过了罕见病 (RD) 的阈值。MBD 和 TB 的年龄标准化率在调查的地点没有显着差异。

结论

方法、理论和历史因素促成了癌症是罕见疾病的假设。癌症在古病理学文献中极为罕见的假设并未得到充分支持。癌症是一个异质的概念，因此看待它很重要。如果一种疾病被认为是罕见的，我们可能无法识别它，或者在过去认为它不重要。

意义

我们重新评估了癌症是一种罕见疾病的观点。我们提出了一种更细致入微的方式来比较考古背景下的病理状况发生率。

限制

已发表的关于恶性肿瘤的文献中可用信息量的变化。

进一步研究的建议

过去更大规模的癌症研究以及癌症患病率与其他假设的罕见疾病的比较研究。