43. the risk from hepatitis viruses: Heather M. Colvin and Abigail E. Mitchell, eds., Hepatitis and Liver Cancer (Washington, DC: The National Academies Press, 2010), 29–30. [http://www.nap.edu/catalog.php?record_id=12793]
44. exposure to aflatoxin: See, for example, P. E. Jackson and J. D. Groopman, “Aflatoxin and Liver Cancer,” Clinical Gastroenterology 13, no. 4 (December 1999): 545–55. [http://www.ncbi.nlm.nih.gov/pubmed/10654919]
45. Consuming two or three drinks a day: Wendy Y. Chen, Walter C. Willett, et al., “Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk,” JAMA: The Journal of the American Medical Association 306, no. 17 (November 2, 2011): 1884–90. [http://jama.ama-assn.org/content/306/17/1884]
46. a woman between the ages of forty and forty-nine: “Risk of Developing Breast Cancer,” Breastcancer.org website, last modified on March 14, 2012. [http://www.breastcancer.org/symptoms/understand_bc/risk/understanding.jsp]
47. Even tallness is a risk factor: Jane Green et al., “Height and Cancer Incidence in the Million Women Study,” Lancet Oncology 12, no. 8 (August 2011): 785–94. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70154-1/abstract]
48. Ecuadoran villagers with a kind of dwarfism: Jaime Guevara-Aguirre et al., “Growth Hormone Receptor Deficiency Is Associated with a Major Reduction in Pro-Aging Signaling, Cancer, and Diabetes in Humans,” Science Translational Medicine 3, no. 70 (February 16, 2011):70ra13 [http://stm.sciencemag.org/content/3/70/70ra13.abstract] and Mitch Leslie, “Growth Defect Blocks Cancer and Diabetes,” Science 331, no. 6019 (February 18, 2011): 837. [http://www.sciencemag.org/content/331/6019/837.summary]
49. measured not in small percentages: See, for example, the rankings in the Harvard Cancer Risk Index, described in G. A. Colditz et al., “Harvard Report on Cancer Prevention Volume 4: Harvard Cancer Risk Index,” Cancer Causes & Control 11, no. 6 (July 2000): 477–88. [http://www.ncbi.nlm.nih.gov/pubmed/10880030]
50. factors of ten to twenty: According to the “Lung Cancer Fact Sheet,” male smokers are twenty-three times more likely to develop lung cancer, and women thirteen times more likely, compared with people who never smoked (American Lung Association website, November 2010). [http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact- sheet.html]
51. the figure is more like 1 in 8: Rebecca Goldin, “Lung Cancer Rates: What’s Your Risk?” March 8, 2006, Research at Statistical Assessment Service (STATS) website, George Mason University. [http://stats.org/stories/2006/lung_cancer_rates_mar08_06.htm]
52. online Memorial Sloan-Kettering cancer prediction tool: See “Cancer Care/Prediction Tools” on the Sloan-Kettering website. [http://www.mskcc.org/cancer-care/adult/lung/prediction-tools]
53. one-tenth the risk: “Summary Report: Analysis of Exposure and Risks to the Public from Radionuclides and Chemicals Released by the Cerro Grande Fire at Los Alamos June 12, 2002,” New Mexico Environment Department, Risk Assessment Corporation, report no. 5-NMED-2002-FINAL, Risk Assessment Corporation website. [http://www.racteam.com/docs/Cerro_Grande_Fire_Summary_Report.pdf]
54. some evidence, weak and conflicting: “Vitamin D and Cancer Prevention: Strengths and Limits of the Evidence,” National Cancer Institute website, reviewed June 16, 2010, [http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D] and Cindy D. Davis, “Vitamin D and Cancer: Current Dilemmas and Future Research Needs,” American Journal of Clinical Nutrition 88, no. 2 (August 2008): 565S–69S. [http://www.ncbi.nlm.nih.gov/pubmed/18689403]
55. among male Finnish smokers: Rachael Z. Stolzenberg-Solomon et al., “A Prospective Nested Case-control Study of Vitamin D Status and Pancreatic Cancer Risk in Male Smokers,” Cancer Research 66, no. 20 (October 15, 2006): 10213–19. [http://www.ncbi.nlm.nih.gov/pubmed/17047087]
56. a distant second place: Office of Radiation and Indoor Air, EPA Assessment of Risks from Radon in Homes (Washington, DC: United States Environmental Protection Agency, June 2003), EPA website [http://www.epa.gov/radon/risk_assessment.html] , and “WHO Handbook on Indoor Radon: a Public Health Perspective” (Geneva: World Health Organization, September 2009), WHO website. [[http://www.who.int/ionizing_radiation/env/radon/en/index1.html]]
57. about 7 in 1,000: Office of Radiation and Indoor Air, EPA Assessment of Risks, appendix D, 82. The number they give is, more precisely, 73 out of 10,000.
58. constant exposure: With some digging one can find that the calculations assume 70 percent of one’s time is spent indoors. Office of Radiation and Indoor Air, EPA Assessment of Risks, 7, 44.
59. an artist living there had reported: Harry Otway and Jon Johnson, “A History of the Working Group to Address Los Alamos Community Health Concerns,” Los Alamos National Laboratory, January 2000, available on the website of the U.S. Department of Energy, Office of Scientific and Technical Information. [http://www.osti.gov/bridge/purl.cover.jsp?purl=/751963- rNM6nM/webviewable/751963.pdf]
60. State health officials investigated: William F. Athas and Charles R. Key, “Los Alamos Cancer Rate Study: Phase I,” New Mexico Department of Health and New Mexico Tumor Registry, University of New Mexico Cancer Center, March 1993 (published on the UNM Health Sciences Center website [http://hsc- sandia.health.unm.edu/som/nmtr/LAC%20Cancer%20Rate%20Study--Phase%201.pdf], and William F. Athas, “Investigation of Excess Thyroid Cancer Incidence in Los Alamos County,” Division of Epidemiology, Evaluation, and Planning, New Mexico Department of Health, April 1996. Available on the Department of Energy website. [http://www.doeal.gov/SWEIS/OtherDocuments/312%20athas1996- Investigation%20of%20excess%20thyroid.pdf]
61. Texas sharpshooter effect: The term was coined in the mid 1970s by the epidemiologist Seymour Grufferman while he was investigating a reported Hodgkin’s lymphoma cluster on Long Island, New York. E-mail to author, June 10, 2012. Also see S. Grufferman, “Clustering and Aggregation of Exposures in Hodgkin’s Disease,” Cancer 39 (1977): 1829–33; K. J. Rothman, “A Sobering Start for the Cluster Busters’ Conference,” American Journal of Epidemiology 132, no. 1 suppl. (July 1990): S6–13 [http://www.ncbi.nlm.nih.gov/pubmed/2356837] and Atul Gawande, “The Cancer-Cluster Myth,” New Yorker, February 8, 1999.
62. no harmful exposures from chemical or radioactive contamination: Agency for Toxic Substances and Disease Registry, “Public Health Assessment for Los Alamos National Laboratory,” September 8, 2006, available on the website of the U.S. Department of Health and Human Services, Agency for Toxic Substances and Disease Registry. [http://www.atsdr.cdc.gov/hac/pha//LosAlamosNationalLab/LosAlamosNationalLabPHA090806.pdf]
63. The Long Island cancer cluster: “Report to the U.S. Congress: The Long Island Breast Cancer Study Project” (Washington, DC: Department of Health and Human Services, November 2004). [http://www.cancer.gov/cancertopics/causes/breast/libcsp] The findings are summarized in Deborah M. Winn, “Science and Society: The Long Island Breast Cancer Study Project,” Nature Reviews Cancer 5, no. 12 (December 2005): 986–94 [http://www.ncbi.nlm.nih.gov/pubmed/16341086] and Renee Twombly, “Long Island Study Finds No Link Between Pollutants and Breast Cancer,” Journal of the National Cancer Institute 94, no. 18 (2002): 1348–51. [http://jnci.oxfordjournals.org/content/94/18/1348.short]
64. “a type of population control”: Patricia Braus, “Why Does Cancer Cluster?” American Demographics, March 1996. [http://connection.ebscohost.com/c/articles/9603061697/why-does-cancer-cluster]
65. the median age for diagnosis of breast cancer: “SEER Stat Fact Sheets: Breast,” National Cancer Institute, Surveillance, Epidemiology and End Results website. [http://seer.cancer.gov/statfacts/html/breast.html]
66. “there is an environmental connection”: Braus, “Why Does Cancer Cluster?”
67. reading about how this might have happened: My first stop was Robert A. Weinberg, “How Cancer Arises,” Scientific American 275, no. 3 (September 1996): 62–70.
CHAPTER 3 The Consolations of Anthropology
1. When Louis Leakey sat down to recount: He gave
at least three versions of the story: L. S. B. Leakey, The Stone Age Races of Kenya (London: Oxford University Press, 1935), 10–11; Leakey, By the Evidence (New York: Harcourt Brace Jovanovich, 1974), 20–22, 35–36; and Leakey, Adam’s Ancestors (London: Methuen & Co., 1934), 202–3. I also referred to Virginia Morell, Ancestral Passions: The Leakey Family and the Quest for Humankind’s Beginnings (New York: Simon & Schuster, 1995), 65–71, 80–93.
2. deposited … in Early Pleistocene time: Morell, Ancestral Passions, 85.
3. “not only the oldest known human fragment”: Leakey, Stone Age Races, 9.
4. Java man and Peking man: Piltdown man had not yet been exposed as a hoax.
5. One of his detractors thought: P. G. H. Boswell, “Human Remains from Kanam and Kanjera, Kenya Colony,” Nature 135, no. 3410 (March 9, 1935): 371. Morell describes the controversy, including some bungling of the evidence by Leakey, in Ancestral Passions, 69, 80–93. For an excoriating interpretation of the event see Martin Pickford, Louis S. B. Leakey: Beyond the Evidence (London: Janus Publishing Company, 1997). Pickford and the Leakey family have been bitter enemies (Declan Butler, “The Battle of Tugen Hills,” Nature 410, no. 6828 [March 29, 2001]: 508–9), [http://www.nature.com/nature/journal/v410/n6828/full/410508a0.html] and it can be difficult to separate the science from the politics. Pickford is also coauthor (with Eustace Gitonga) of a book about Louis Leakey’s son entitled Richard E. Leakey: Master of Deceit (Nairobi: White Elephant Publishers, 1995).
6. a more distant relative like Australopithecus: Kenneth P. Oakley, “The Kanam Jaw,” Nature 185, no. 4717 (March 26, 1960): 945–46. [http://www.nature.com/nature/journal/v185/n4717/abs/185945b0.html]
7. Neanderthal man: Phillip V. Tobias, “The Kanam Jaw,” Nature 185, no. 4717 (March 26, 1960): 946–47. [http://www.nature.com/nature/journal/v185/n4717/abs/185946a0.html]
8. or Homo habilis: That was the assessment of Harvard anthropologist David Pilbeam, who told Morell that the fossil may be as much as 2 or more million years old (Ancestral Passions, 9, note 11). He reconfirmed that in an e-mail to me, April 30, 2012.
9. others have come to believe: In “A Reconsideration of the Date of the Kanam Jaw,” Journal of Archaeological Science 2, no. 2 (June 1975): 151–52, Kenneth P. Oakley theorized that the fossil “may have been enclosed in a Middle Pleistocene surface limestone block which was down-faulted in a fissure penetrating the older Kanam Beds.” The Berkeley anthropologist Tim White concluded that the jaw is probably Late Pleistocene. See Eric Delson et al., eds., Encyclopedia of Human Evolution and Prehistory (New York: Garland, 2000), 739.
10. no more than about 700,000 years old: E-mail to author, May 7, 2012, from Richard Potts, director of the Human Origins Program at the Smithsonian Institution’s National Museum of Natural History in Washington.
11. carefully cleaning the specimen: Leakey, By the Evidence, 20–22.
12. diagnosed it as sarcoma of the bone: J. W. P. Lawrence, Esq., “A Note on the Pathology of the Kanam Mandible,” in Leakey, Stone Age Races of Kenya, appendix A, 139.
13. There was also a thin fracture: For a description of Kanam man’s anatomical details see Leakey, Stone Age Races, 19–23.
14. impossible to tell what Kanam man’s chin had been like: M. F. Ashley Montagu, “The Chin of the Kanam Mandible,” American Anthropologist 59, no. 2 (April 1, 1957): 335–38. [http://onlinelibrary.wiley.com/doi/10.1525/aa.1957.59.2.02a00140/abstract]
15. Another anthropologist disagreed: Tobias, “The Kanam Jaw.”
16. an entirely different cancer: G. Stathopoulos, “Letter: Kanam Mandible’s Tumour,” Lancet 305, no. 7899 (January 18, 1975): 165. [http://www.ncbi.nlm.nih.gov/pubmed/46076]
17. Others were not so certain: A. T. Sandison, “Kanam Mandible’s Tumour,” Lancet 305, no. 7901 (February 1, 1975): 279. [http://www.ncbi.nlm.nih.gov/pubmed/46423]
18. Brothwell concluded: Don Brothwell and A. T. Sandison, Diseases in Antiquity: A Survey of the Diseases, Injuries and Surgery of Early Populations (Springfield, IL: Charles C. Thomas, 1967), 330.
19. scanning the mandible with an electron microscope: J. Phelan, T. G. Bromage, et al., “Diagnosis of the Pathology of the Kanam Mandible,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 103, no. 4 (April 2007): e20. [http://www.journals.elsevierhealth.com/periodicals/ymoe/article/S1079-2104(07)00036-4]
20. “bone run amok”: Timothy Bromage, e-mail message to author, July 1, 2010.
21. “the giant sloth”: Details are from a sign at the museum. My visit there was in May 2011.
22. Leakey had sliced through the mass: He reported that “a section was cut through the mandible in the region of the first molar” (Stone Age Races, 2). He also mentions x-ray radiographs.
23. a small group of Greek and Egyptian oncologists: Spiro Retsas, ed., Palaeo-Oncology: The Antiquity of Cancer, 5th ed. (London: Farrand Press, 1986), 7–9.
24. “As a crab is furnished with claws”: Alexander Haddow, “Historical Notes on Cancer from the MSS. of Louis Westenra Sambon,” Proceedings of the Royal Society of Medicine 29, no. 9 (July 1936): 1015–28. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2076239]
25. “because it adheres with such obstinacy”: Haddow, “Historical Notes on Cancer,” 24.
26. “[I]t attaches itself to the body of a young crab”: Haddow, “Historical Notes on Cancer,” 25.
27. by placing a live crab on top of it: Haddow, “Historical Notes on Can- cer,” 28.
28. “With treatment they soon die”: Retsas, Palaeo-Oncology, 45.
29. a category of growth called “praeter naturam”: Erwin H. Ackerknecht, “Historical Notes on Cancer,” Medical History 2, no. 2 (April 1958): 114–19. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1034369]
30. “a tumor malignant and indurated”: Retsas, Palaeo-Oncology, 46.
31. “The early cancer we have cured”: Retsas, Palaeo-Oncology, 49.
32. “When a cancer has lasted long”: L. Weiss, “Metastasis of Cancer: A Conceptual History from Antiquity to the 1990s; Part 2: Early Concepts of Cancer,” Cancer Metastasis Reviews 19, nos. 3–4 (2000): i-xi, 205–17. [http://www.ncbi.nlm.nih.gov/pubmed/11394186]
33. diagnosed in people fifty-five or older: “Cancer Facts & Figures 2012,” American Cancer Society website. [http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012]
34. hovering around thirty or forty years: For a discussion of the difficulties of estimating past longevity, see J. R. Wilmoth, “Demography of Longevity: Past, Present, and Future Trends,” Experimental Gerontology 35, nos. 9–10 (December 2000): 1111–29. [http://www.sciencedirect.com/science/article/pii/S0531556500001947]
35. the Saxon skeleton whose tumorous femur: Brothwell and Sandison, Diseases in Antiquity, 331 and 339, figure 11b.
36. comb through the bones: One in 100,000 people gets osteosarcoma. See Lisa Mirabello, Rebecca J. Troisi, and Sharon A. Savage, “Osteosarcoma Incidence and Survival Rates from 1973 to 2004: Data from the Surveillance, Epidemiology, and End Results Program,” Cancer 115, no. 7 (April 1, 2009): 1531–43. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813207]
37. Iron Age man in Switzerland and a fifth-century Visigoth from Spain: Edward C. Halperin, “Paleo-oncology: The Role of Ancient Remains in the Study of Cancer,” Perspectives in Biology and Medicine 47, no. 1 (2004): 1–14 [http://www.ncbi.nlm.nih.gov/pubmed/15061165];; Brothwell and Sandison, Diseases in Antiquity, 331; and Arthur C. Aufderheide and Conrado Rodriguez-Martin, The Cambridge Encyclopedia of Human Paleopathology (Cambridge: Cambridge University Press, 1998), 379.
38. a medieval cemetery in the Black Forest Mountains: K. W. Alt et al., “Infant Osteosarcoma,” International Journal of Osteoarchaeology 12, no. 6 (December 24, 2002): 442–48. [http://onlinelibrary.wiley.com/doi/10.1002/oa.647/abstract]
39. “to die a painful death”: Alt et al., “Infant Osteosarcoma,” 447.
40. “The large size of the tumor”: Eugen Strouhal, “Anc
ient Egyptian Case of Carcinoma,” Bulletin of the New York Academy of Medicine 54, no. 3 (March 1978): 290–302. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1807435]
41. Traces were found in the skull: Kurt W. Alt and Claus-Peter Adler, “Multiple Myeloma in an Early Medieval Skeleton,” International Journal of Osteoarchaeology 2, no. 3 (May 23, 2005): 205–9 [http://onlinelibrary.wiley.com/doi/10.1002/oa.1390020304/abstract]; and C. Cattaneo et al., “Immunological Diagnosis of Multiple Myeloma in a Medieval Bone,” International Journal of Osteoarchaeology 4, no. 1 (May 27, 2005): 1–2. [http://onlinelibrary.wiley.com/doi/10.1002/oa.1390040102/abstract]
42. Most skeletal cancers by far come from metastases: Tony Waldron, “What Was the Prevalence of Malignant Disease in the Past?” International Journal of Osteoarchaeology 6, no. 5 (December 1, 1996): 463–70. [http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1099-1212(199612)6:5<463::AID-OA304>3.0.CO;2-Y/abstract]
43. discovered in Egyptian tombs: Eugen Strouhal, “Tumors in the Remains of Ancient Egyptians,” American Journal of Physical Anthropology 45, no. 3 (November 1, 1976): 613–20. [http://www.ncbi.nlm.nih.gov/pubmed/793419]
44. in a Portuguese necropolis: S. Assis and S. Codinha, “Metastatic Carcinoma in a 14th–19th Century Skeleton from Constância (Portugal),” International Journal of Osteoarchaeology 20, no. 5 (September 1, 2010): 603–20. [http://onlinelibrary.wiley.com/doi/10.1002/oa.1084/abstract]
45. in the Tennessee River valley: Maria Ostendorf Smith, “A Probable Case of Metastatic Carcinoma from the Late Prehistoric Eastern Tennessee River Valley,” International Journal of Osteoarchaeology 12, no. 4 (July 1, 2002): 235–47. [http://onlinelibrary.wiley.com/doi/10.1002/oa.618/abstract]
The Cancer Chronicles Page 24