Cancer: Its Cause and Treatment, Volume 2 (of 2)

by Lucius Duncan Bulkley

Statistics from other countries, collected by Hoffman, show the same steady increase. I will not weary you with much more of statistical detail, but it is interesting to record a few of the more striking facts, illustrating the universal increase in the cancer death rate during these later years of cancer research and active surgery. The data are from 1896 to 1910, and the countries will be arranged according to proportionate increase in the death rate per 100,000 population. Thus, Ireland comes first, with an increase of 20.7, which is explained in part by the emigration of younger persons, leaving more of the cancer age; next comes Denmark, increased from 118.9 to 137.3, or 18.4 per 100,000 population; then the German Empire with an increase of 13.4; Hungary, 12.9; Italy, 12.7; Holland, 11.6; Norway, 10.9; Austria, 9.4; and France from 97.3 to 102.7, or only 5.4 per 100,000 population. During this same period the deaths from cancer in the United States have increased about 18 per 100,000, or almost as much as the highest of the countries mentioned.

In regard to the bearing of all these figures upon the alleged apparent and not real increase of cancer, I may quote from Hoffman: “The evidence is so convincing” as to the reality of the increase of cancer “that it may be safely maintained that no other statistical conclusion in medicine is so concisely and incontrovertibly established as this: in any event, no satisfactory evidence is available to successfully contradict this conclusion at the present time. If all this evidence, however, is inconclusive and worthless, then no alternative remains but to discredit the statistical returns of every country in the world with regard to any single disease or group of diseases, although the returns are accepted as approximately accurate in regard to every other important cause of death.”

In order that the real increase in the mortality from cancer may be readily understood, the accompanying chart (now hanging before you) has been copied from that given in the volume of the United States Mortality Statistics for 1914, and it will help to visualize what has just been stated. The data for 1915 have been added through the courtesy of Mr. Rogers, Director of the Census, in a personal communication.

The striking fact brought out in this chart is the comparison between the steadily diminishing death rate of tuberculosis, through careful medical supervision, and the steadily increasing death rate of cancer, under surgical care. While the mortality of tuberculosis has fallen from 201.9 persons in 1900 to 145.8 in 1915, or 56.1 less deaths in each 100,000 population, or over 27.7 per cent, the cancer death rate has risen in the same time from 63 to 81.1 per 100,000, or over 28.7 per cent. They have therefore approached each other by 56.4 per cent, and unless this rate of progression is changed in some way, the lines will have crossed one another in less than fifteen years more, even as that for organic heart disease has already crossed that of tuberculosis, it having risen almost 27 per cent.

Another interesting lesson to be drawn from this chart is that the death rate from organic heart disease, nephritis, and apoplexy have all risen coincidently with that of cancer, only that the rate of the latter has outstripped them all. If we accept the fact that the increasing death rate of these three diseases is largely the result of modern civilization, especially from erroneous eating and drinking, it would appear that cancer is due to the same cause.

Realizing, then, that the mortality of cancer is materially and steadily rising, in spite of most diligent research by innumerable honest and capable scientists, with the expenditure of vast sums of money and countless animal lives, and in spite of the work of ardent, earnest, and capable surgeons, who have failed to stay the terrible progress of the disease, let us briefly study some of the reported statistics in regard to the results of operative interference in cancer.

It may be first stated that this is a most difficult task, so different are the reports from different surgeons. There are many elements which affect the statistics relating to the surgery of cancer. First of these is, perhaps, the stage of the disease at which the operation is performed. Second, the results vary, of course, immensely with the knowledge and skill of the operator and the excellence of the technique. Third, the class of cases operated on has much to do with favorable or unfavorable results reported. Fourth, the length of observation after operation is always to be considered in connection with surgical statistics. Finally, the optimism of the reporter must be regarded in weighing the true value of reports as to ultimate results. We will briefly consider these points.

First, as to the stage of the disease at which the operation was performed. We have seen in this and previous lectures that the lesion which we call cancer is but a result of a deranged blood state, and is not a purely local process, a something simply to be removed surgically in order to have the patient get well and remain well. For one sees plenty of cases where there were recurrences even after the very earliest operations possible. But the claims put forth that favorable results are conditioned on very early operations are so strenuous and persistent that we must believe that a measure of the favorable results can be thus accounted for. We know, of course, that very late in the disease operations are out of the question. It is a little curious, however, that most of the pictures shown, statistics presented, and arguments adduced by these ardent advocates of early operation relate to cancer of the skin, especially about the face, which cause hardly 2 per cent of all the deaths from cancer in various countries; whereas those who see much of cutaneous epithelioma know that if properly handled it is generally a comparatively mild affair and relatively easily cured without surgical operation, as you have so constantly seen in this clinic in past years. But mortality statistics are greatly influenced by the class of cases which the operator takes, and so if epithelioma of the skin is included, the ratio of cures will be high. Selected cases also always give more favorable statistics.

Second, the knowledge and skill of the operator and the perfection of technique undoubtedly influence surgical statistics. The ordinary practitioner or surgeon cannot hope for as favorable results in many operations on cancer as can those who are past masters in this line, and these latter are the ones who furnish the favorable statistics.