A 4,000-year-old Egyptian skull, stored at the University of Cambridge, has been hiding almost imperceptible cut marks for decades.
Now a new study published in Frontiers in Medicine suggests these could be evidence of an ancient treatment for cancer.
The find shows that Egyptian medicine was both advanced and sophisticated, said author Edgard Camarós, a palaeopathologist from the University of Santiago de Compostela in Spain.
"This research has found a clear milestone in the history of medicine," Dr Camarós said.
"More than 4,000 years ago they were trying to medically manage what we nowadays call cancer."
However, questions remain over whether the tiny cuts show cancer treatment, or an ancient post-mortem investigation.
Did ancient people get cancer?
Despite our modern increase in life span, cancer is not exclusively a 20th and 21st century phenomenon.
The oldest known evidence of cancer was discovered in the toe bone of what researchers believe was a species of ancient human called Homo ergaster from 1.7 million years ago.
And a 2005 study found the incidence of cancer in ancient Egyptian and German populations was not much lower than we see today.
In that study, the researchers found evidence of five tumours in 905 ancient Egyptians buried in three separate necropolises between 3200 and 500 BC.
They then found 13 cases in 2,547 people buried in a Southern German ossuary between AD 1400 and 1800.
As seen in the graph below, scaled up to cases in 100,000 people, this is not far off the rate of new cancer diagnoses in Australia in 2023.
[Datawrapper cancer rates in Egypt]This may also be just the tip of the iceberg.
Cancer can occur in soft tissue or bone, but soft tissue decays unless a body is mummified, and while some ancient Egyptians underwent this process, it was reserved only for the rich and those deemed important.
This is why researchers generally only look for evidence of cancer in ancient humans in bone.
And this could skew what we see, said Ronika Power, a bioarchaeologist from Macquarie University, who was not involved in the new study.
"It has been upheld ... that the incidence of cancer is lower compared to modern rates, due to reduced human-made carcinogens in the environment, and the fact that life expectancy was generally shorter," Professor Power said.
"However, we are limited to observing diseases that were chronic or specific enough to affect bone."
Egyptian cancer investigations
The new study by Dr Camarós and colleagues, investigated two ancient skulls using high resolution 3D microscopy to reveal how cancer had eaten away sections of the bone.
The first was skull 236, dated to 2687–2345 BC, which belonged to a 30–35-year-old male and showed signs of small tumours and cut marks on the surface.
The second was skull E270. This belonged to a woman over 50, who lived between 664 and 343 BC, and had several healed fractures, as well as a large hole caused by a tumour.
"The authors have performed rigorous, non-invasive investigations of these two individuals, using state-of-the art microscopy and radiological methods," Professor Power said.
"Their findings ... are significant contributions to knowledge of the lived experiences of ancient Egyptians, as well as adding further data to observations of medical intervention in the past."
Skull E270 was included in the paper not just due to the tumour, but because it points to the level of care that would have been given for it's owner to survive.
The woman would have lived long enough after a severe skull trauma for the bones to heal over.
The researchers suggest the injury may have been from a sharp weapon, and the woman would have required both a "group and social response in terms of care."
Other researchers have found such support, including for people with disability, was common in the community.
"The general consensus is that people in ancient Egypt with disability — such as dwarfism or cerebral palsy — tend to be accepted," Hannah Vogel, an academic specialising in disability in ancient Egypt who was not involved with the study, said.
"We see people in very high, elite positions with these conditions living their lives."
While individual E270 lived approximately 1,500 years ago, individual 236 was from a much earlier period in Egyptian history, around 4,000 years ago — around the time the Great Pyramid of Giza was built.
The researchers suggest this time difference provides a type of timeline of medical care in the region.
[Flourish timeline]Interestingly, the cancer damage on skull 236 had been analysed back in the 1950s in Cambridge, but the small marks had been overlooked. It was only when the new researchers reanalysed the bone that the tiny cuts were found.
"Both skulls have been previously described when it comes to the pathological lesions, but the surgical intervention was never observed," Dr Camarós said.
"This is not just because of the advancement of new techniques, but also with the change in the perspective that medical care and treatment must have been older than previously thought."
According to Dr Camarós, it's unknown if the cuts occurred before death or just after it.
If the cuts were made before death, this would show ancient Egyptians were trying to cut out what we now understand as cancer from patients.
But if it was after, it would provide evidence of a type of post-mortem investigation.
"It is noteworthy that these cuts are so fine that they have only been detected and described under high-resolution microscopy after many decades under care and close study in the Duckworth Laboratory," Professor Ronika said.
"Perhaps this might infer that the ancient practitioners were being extremely cautious and sensitive about not causing the person undue pain while performing the procedure? This would not have been a concern if the individual was already dead."
Camilla Di Biase-Dyson, an Egyptologist specialising in ancient medical texts at Macquarie University, believes that a post-mortem investigation is exceptionally unlikely.
"If there were actually signs that after the death of this person, they are involved in an investigation ... that would be a complete frontier in science," Dr Di Biase-Dyson, who was not involved in the research, said.
"But from a cultural perspective, it's pretty unlikely, and it's certainly not documented in the textual record."
Papyrus Ebers
Research in ancient Egypt isn't just based on human remains. There are also plenty of texts which can be analysed to give more information about the ancient civilisation.
According to Dr Di Biase-Dyson, one of the most important of these was Papyrus Ebers, a medical manual with more than 900 recipes, spells and treatments.
"The final part of the papyrus ... about 20 recipes or treatments, which we call the 'tumour book' is a section of the papyrus that deals exclusively with growths of some kind," she said.
Checking the text for ABC Science, Dr Di Biase-Dyson found treatments for these growths ranging from a mix of herbs applied to the skin to surgery using a cauterising knife.
"They're quite explicit about the kinds of tools that they're using. Some involve cauterisation and others don't," she said.
According Dr Di Biase-Dyson's understanding of the ancient texts, cutting into the head in this way after death would have been improper.
"I'm not saying it's impossible, but if they did I don't think they would talk about it because they wouldn't think it's OK," she said.
"What the texts do say, is when the person is still alive, they certainly are cutting around what may be a tumour, and trying to heal it."
Dr Camarós and colleagues are now looking further abroad in the history of ancient cancer.
"Our next steps are trying to understand the relationship humans had with cancer in earlier periods of our evolution and history," he said.
"Our aim is to complete the biography of cancer from the very beginning of human history."
