The terrible thing about these figures is their uniformity from year to year. With as great a degree of certainty as the farmer foretells the produce of his fields and the results of his seed-sowing, so the statistician can calculate the tribute that cancer will exact from the human race in future years. How many persons in England and Wales will die from some from of cancer during the year 1917? Unless some great catastrophe shall vastly lessen the total population, the number of victims destined to perish from malignant disease during that one year will hardly be less than 38,500, and in all probability will be more. And we have no reason to doubt that in the United States the mortality from cancer would be found equally uniform were it possible to know the facts.
Nor does uniformity pertain to numbers of either sex only. Each period of life has to furnish its special toll. If we look at the mortality among men or women for a period of years, we shall see this phenomenon very clearly. In the following table we see the deaths of men from cancer, in England, at each ten-year age-period.
DEATHS FROM CANCER AT DIFFERENT AGE-PERIODS (ENGLAND): AGE-PERIODS OF MALES
——————————————————————————————— |YEAR|Under|25-35.|35-45.|45-55.|55-65.|65-75.| Above |Total.| | | 25. | | | | | | 75. | | |——|——-|———|———|———|———|———|———-|———| |1906| 250 | 322 | 927 | 2,454| 4,087| 3,651| 1,566 |13,257| |1907| 305 | 277 | 921 | 2,392| 4,041| 3,675| 1,588 |13,199| |1908| 274 | 317 | 925 | 2,594| 4,147| 3,957| 1,687 |13,901| |1909| 262 | 296 | 921 | 2,581| 4,319| 4,174| 1,710 |14,263| |1910| 283 | 337 |1,001 | 2,778| 4,377| 4,315| 1,752 |14,843| |1911| 309 | 317 | 978 | 2,901| 4,627| 4,602| 1,855 |15,589| ———————————————————————————————
Precisely the same phenomenon is to be found in the cancer-mortality of women. Each ten-year period of life exacts its own proportion, with an increasing death-rate out of proportion to the increase of population.
Another fact, attainable only by the study of English statistics, is the singular regularity with which malignant disease selects different parts of the body year after year. If proclivity to this mysterious ailment were a matter of chance, or dependent upon the irregular action of certain forces, we should certainly fail to find such uniformity, or such approach to uniformity, as exists. One year, for instance, there would be, let us say, a preponderance of attacks upon the skin; another year the digestive organs would be the principal sufferers; a third year the joints and muscles would be chiefly involved. The actual experience proves that we are subject here to forces of incalculable stress, which nevertheless press steadily and uniformly upon humanity, where the habits and environment are the same. In the year 1901, for example, of the total number of fatal cases among men, the seat of the disease was the stomach in a little over 21 per cent. of the total number of cases. In 1910 the proportion was also 21 per cent. During the ten years 1901-1910, of the total mortality, the stomach was the organ involved in but a fraction over 21 PER CENT. OF THE TOTAL CASES.
Is cancer increasing? This is a question of vast importance to the human race. That in proportion to total population more die from the disease to-day than twenty or thrity years ago, is a fact about which there can be no doubt. Dr. Stevenson, in the Report of the Registrar- General for the year 1910, tells us that in "all countries from which returns have been received the mortality has shown a general tendency to increase in recent years." Speaking on the "Menace of Cancer," the statistician of the Prudential Insurance Company of America affirmed that "the cancer death-rate in the United States is increasing at the rate of 2.5 per cent. per annum, and a corresponding increase is taking place practically throughout the civilized world." The cancer- rate among men in the United States has increased, according to the same authority, 29 per cent. during the last decade. The steady increase of cancer year after year is strikingly shown by a curve diagram, based upon the English mortality for several years.
A significant illustration of the steady increase in the mortality from cancer is shown by its fatality among women in England between the ages of forty-five and sixty-five. In the year 1875, of all deaths of women at this period of life, one in ten (in round numbers) was due to some form of malignant disease. In 1890 the tribute exacted by the disease had become one in eight. Ten years later—in 1900—of all women dying in England during this period of middle life, the toll of cancer was one in seven; and in 1910 the corresponding proportion was one in five! At this rate of increase it will not be many years before a full third of all the deaths of women at this time of life will be due to malignant disease. There can be little doubt that the same phenomenon would be found to pertain to American experience, were it possible to disentangle the facts from the obscurity in which they are now permitted to lie. It is a curious fact that in England until the year 1900—and, so far as we know, for thousands of years—the death-rate from consumption among women was considerably higher than that of malignant disease; that in 1903, for the first time, the cancer-mortality of women exceeded that of phthisis; and that in 1910 it had so far surpassed it that they are not likely ever again to be equal, unless we shall discover the cause of the more fatal plague.
The theory has been put forth by certain writers that the increased death-rate from cancer is due, not to any increased frequency of the dissease, but rather to improved methods of detection. It is quite certain that fifty years ago, for instance, surgeons were less able and less willing to pronounce judgment regarding obscure cases of internal tumours. But if the better diagnosis of to-day accounts for some part of this increase since 1860, it does not seem probable that it can explain the rising death-rate of the last ten or fifteen years. The medical practitioner of 1900 was certainly as well qualified to pronounce upon the character of the disease as the surgeon or physician of to-day. Nevertheless, the cancer death-rate of England in 1910 had increased 16 per cent. above that of ten years before, and during the fifteen years 1895-1900 it had increased fully 28 per cent. Certainly in these last few years there has been no such increased ability to detect the disease as would account for all this. Yet another fact suggests doubt of this optimistic hypothesis. If the increased cancer death-rate were due merely to the increased ability of the physician or surgeon to recognize the ailment, we should certainly find that the increase of cancer would be seen only in those parts of the system, such as internal organs, where some degree of doubt might perhaps be entertained; while, on the other hand, there would be little or no increase discernible in the mortality of cancers affecting parts of the body where its nature could not be mistaken by any intelligent physician or surgeon. Now, for a number of years, perhaps with this hypothesis in view, the Registrar-General in England has tabulated all deaths from cancer of either sex, not only by different age-periods, but also by the part of the body affected by the fatal disease. A study of the facts thus made known is extremely suggestive. It is true that a marked increase in the death-rate has occurred in cancer affecting internal organs, as we should naturally suppose; but it is also true that malignant disease affecting parts of the body where little or no doubt of the character of the ailment could be entertained by the physician, exhibit in some instances as marked an increase in the death-rate as in some other cases, where doubt of malignancy might be justifiable. For example, cancer of the tongue among men showed a death-rate of 32 per million population in 1897; it went up to 47 per million in 1910— an increase of nearly 50 per cent. Cancer of the female breast showed a death-rate of about 142 per million population in 1897; it had arisen to a rate of 190 per million only thirteen years later; and here, assuredly, the nature of the disease in fatal cases cannot be mistaken.[1] Cancer of the stomach in its final stages does not present insuperable difficulties in way of diagnosis, but the death-rate increased for men about 40 per cent. in fifteen years; and although some of this increase may be due to more careful discrimination between cases of malignant disease affecting the liver, yet this explanation cannot account for the increase when both organs are considered together. The subject is worthy of careful and extended investigation, but even a cursory examination of the facts now available indicate a real increase in the death-rate from cancer in England, and probably in every other civilized country in the world.
[1] "During fourteen years … the mortality from mammary cancer has increased by about 29 per cent., NOTWITHSTANDING LIVES SAVED BY IMPROVED METHODS OF OPERATION."—Registrar-General's Report for 1910, p. 69.