LONDON.- Cancer, one of the world’s 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.

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 site of Amara West is situated on the Nile, 750km downstream of the country’s modern capital Khartoum. The settlement was founded around 1300 BC as a new administrative centre for the pharaonic (Egyptian) control of Upper Nubia (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 tomb’s 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 world’s major health problems.