HC12: How did cancer become the emperor of all maladies?

Overview

Cancer is the emperor of all maladies, the king of all terrors. The attention to and visibility of cancer is growing:

1. In Greek and Roman times, cancer was visible but not so prominent
2. More and more research of tissues is done
3. Around 1900, cancer became a new interest → a public health concern
4. The interest in occupational and environmental causes and complexity started growing

Cancer has become a more and more visible disease over the last two centuries. It has developed into the disease of modern times. The disease became a major object of medical, social, economic and political concern.

17^th century

In the 17^th century, breast cancer was seen as a female disease because only in women it was visible on the outside. Breast amputation was preformed, which had to be done very fast. Of course, men also had breast cancer, but they attributed the signs to something else than a tumor in the body. Breast cancer was connected with lust in sexuality because no breast cancer was found in nuns.

19^th century

In the 19^th century, a first turning point in cancer history occurred. It was stated that diseases weren’t located throughout the entire body, but could emerge from certain tissues and other parts. There was a localist approach focused on cells, tissues and organs. Doctors opened up a body and found tumors inside. Rudolf Virchow made an important statement: “all cells arise from other cells and malignant cells grow too fast”.

20^th century

Early 20^th century:

In 1900, the words cancer genetics and oncologist did not exist. Chemotherapy wasn’t present, but a cancer hospital was. Radiation therapy could already be preformed. In 1913, the Netherlands Cancer Institute (NKI) was established.

In the early 20^th century, cancer increasingly became a public health problem. This formed a second turning point. It statistically came more to the surface because the life expectancy started to rise. People started thinking more about prevention and control and saw it as “an enemy we have to fight”. Several patterns became visible, such as apprentice chimney sweepers getting scrotal cancer. Between the 1930s and 1960s, surgery underwent huge developments.

Late 20^th century:

After World War II, the complexity, risk and genetics of cancer became more and more visible. The erosion of cancer as a social taboo started.

Between the 1960s and 1980s, the relation between environment, behavior and cancer became increasingly visible. This formed a third turning point. For instance, smoking used to be very normal but caused many cases of cancers. Open minded doctors where needed, because the industry would put profit before health. They would create doubt about the relationship between smoking and lung cancer → “more doctors smoke Camels than any other cigarette”. Cancer was described as a single monolithic entity, which isn’t true.