Good Calories, Bad Calories

The two most comprehensive attempts to deal with the question of cancer in isolated populations were in The Natural History of Cancer, with Special Reference to Its Causation and Prevention, published in 1908 by W. Roger Williams, a fellow of the British Royal College of Surgeons, and The Mortality from Cancer Throughout the World, published in 1915 by the American statistician Fredrick Hoffman. In The Natural History of Cancer, Williams marched from continent to continent, region to region. In Fiji, for instance, in 1900, among 120,000 aborigines, Melanesians, Polynesians, and “Indian coolies,” there were only two recorded deaths from malignant tumors. In Borneo, a Dr. Pagel wrote that he had been in practice for ten years and had never seen a case. Williams also documented the rising mortality from cancer that Tanchou had reported in the developed nations. In the United States, the proportional number of cancer deaths rose dramatically in the latter part of the nineteenth century: in New York, from thirty-two per thousand deaths in 1864 to sixty-seven in 1900; in Philadelphia, from thirty-one in 1861 to seventy in 1904.

Hoffman dedicated the better part of his career to making sense of these observations. He began his cancer studies as chief statistician of the Prudential Insurance Company and continued them as part of an investigation of the Committee on Statistics of the American Society for the Control of Cancer (a predecessor of the American Cancer Society, of which Hoffman was a founder). In The Mortality from Cancer Throughout the World and then again in Cancer and Diet, his 1937, seven-hundred-plus-page update of the evidence, Hoffman concluded that cancer mortality was increasing “at a more or less alarming rate throughout the entire world,” and this could only partially be explained by new diagnostic practices and the aging of the population.

Hoffman could not explain away the observations that physicians like Schweitzer and Hutton had made around the world and that both he and Williams had documented so comprehensively. In 1914, Hoffman himself had surveyed physicians working for the Bureau of Indian Affairs. “Among some 63,000 Indians of all tribes,” he reported, “there occurred only 2 deaths from cancer as medically observed during the year 1914.”

“There are no known reasons why cancer should not occasionally occur among any race or people, even though it be of the lowest degree of savagery or barbarism,” Hoffman wrote.

Granting the practical difficulties of determining with accuracy the causes of death among non-civilized races, it is nevertheless a safe assumption that the large number of medical missionaries and other trained medical observers, living for years among native races throughout the world, would long ago have provided a more substantial basis of fact regarding the frequency of occurrence of malignant disease among the so-called “uncivilized” races, if cancer were met with among them to anything like the degree common to practically all civilized countries. Quite to the contrary, the negative evidence is convincing that in the opinion of qualified medical observers cancer is exceptionally rare among primitive peoples.

Through the 1930s, this evidence continued to accumulate, virtually without counterargument. By the 1950s, malignancies among the Inuit were still considered sufficiently uncommon that local physicians, as in Africa earlier in the century, would publish single-case reports when they did appear. One 1952 article, written by three physicians from Queen’s University in Ontario, begins with the comment “It is commonly stated that cancer does not occur in the Eskimos, and to our knowledge no case has so far been reported.” In 1975, a team of Canadian physicians published an analysis of a quarter-century of cancer incidence among Inuit in the western and central Arctic. Though lung and cervical cancer had “dramatically increased” since 1949, they reported, the incidence of breast cancer was still “surprisingly low.” They could not find a single case in an Inuit patient before 1966; they could find only two cases between 1967 and 1974.