11. Cancer Is Reported From The Canadian Eastern Arctic

Among Eskimos, Europeanization has been longest delayed in the Canadian eastern Arctic, that great region which begins on the mainland about 500 miles east of the Mackenzie at Dolphin and Union Strait and extends to Hudson Bay. There, in Coronation Gulf and Victoria Island, our second expedition, the one of 1908-12, found more than 500 of what are now called Copper Eskimos, most of whom had never seen a white man. A decade later, in the 1920's, the Danish explorer Knud Rasmussen found on the eastern edge of the Copper Eskimo district about twenty who had missed seeing us, and who told him he was the first white man they had ever seen.

The Copper Eskimos, so named because many of their weapons and tools were of native copper, had never dealt with any traders before 1910. They did not even know tea, used no salt, and lived exclusively on flesh foods, eating roots and such only in time of famine. In 1910, they for the first time tasted sugar, given them by the first trader to reach Coronation Gulf, Joseph Bernard. They disliked it. Ten years later they were beginning to use material amounts of European foods, including both sugar and salt. Farther east, in the same section of arctic Canada, are people who first met whites long ago; but, even including them, the Eskimos of this section still are, with respect to food, the least Europeanized of all North Americans.

A health survey made in 1935, with cancer as one of its focal points is described in an article by the senior investigator of the survey, Dr. I. N. Rabinowitch of Montreal, appearing in the May 1935 issue of The Canadian Medical Association Journal (Toronto).

“Two different interests prompted this investigation. The purpose of the Canadian Government was to determine the general health of the Eskimos; whether contact with civilization is causing their deterioration; and, if so, the causes. Quite frankly, this was not the writer's interest ... His interest was primarily in the alleged absence of diabetes, cancer, and arteriosclerosis, and the possible relationship between such absence and the peculiar dietary habits of the people.”

Dr. Rabinowitch found in 1935 that the Eskimos of the northern coastal section of the Canadian eastern Arctic were still living substantially on their native foods, although they were in some places eating enough carbohydrates to materially affect their previously good teeth. Of diabetes and arteriosclerosis he found only slight indication. Of cancer he says on page 493:

“In the western Arctic [from Alaska to Coronation Gulf] Dr. Urquhart has not yet met with a single case of cancer in the seven years of his practice. Cancer must be very rare in the eastern Arctic also. I saw one suspicious case ...” [Dr. Rabinowitch thought it was probably not cancer.]

Chronologically speaking, the next report on cancer for this region is credited to me, on page 171 of Dr. Frederick L. Hoffman's Cancer and Diet (Baltimore, 1937) :

“... food surveys of the Arctic region, particularly by Stefansson [in northern Alaska and the Canadian western Arctic] seem to show, regardless of a practically exclusive meat diet, that Eskimos suffer very little from malignant disease ...”

Some thirteen years after the above-mentioned Canadian government expedition a similar medical research expedition was sent into the Canadian eastern Arctic by Queens University of Kingston, Ontario. Their report, as pertains to cancer, is by Drs. Brown, Cronk, and Boag and refers to Dr. Rabinowitch and his “one suspicious case.” I quote from Cancer, Journal of the American Cancer Society, Vol. V (1952):

“It is commonly stated that cancer does not occur in the Eskimos, and to our knowledge no case has so far been reported. Rabinowitch (1936) mentions the absence of reports of its occurrence and gives details of a suspicious case ... In August, 1949, the opportunity came to the Queens University Arctic Expedition to carry out an autopsy on an elderly Eskimo man who had died of a wasting illness. Histological study of a mass in the neck has shown carcinomatous tissue. The patient was a pure blooded Ivilik of about 70 years.”

This being a positively identified case, although questioned by a pathologist, and as such the first in the region, it is unfortunate that the authors do not say anything about the way of life of the “pure blooded Ivilik of about 70 years” who is our first known local native malignancy victim. However, the usual diet and way of life of the Iviliks are well known, The Indians of Canada (1932) by Dr. Diamond Jenness being the frequently revised authority. In 1949, the discovery date of this first certified malignancy, Dr. Jenness was the chief Eskimo specialist of the Canadian government. Discussing our region, he says, on pages 421-22 of his 1932 edition:

“The Eskimos of eastern Canada ... have been in contact with Europe for more than two hundred years ... partly from a misguided imitation of Europeans, many Eskimos now wear woolen clothing and even the complete European costume, although their earlier garments of loosely fitting caribou were more picturesque and hygienic, and offered greater protection against the cold.

“Very few Eskimos now hunt intensively during the winter months; instead they trap foxes which are useless to them for either food or clothing. In order to maintain their families during the season they buy European food from the fur traders, largely flour, sugar and tea.”

These paragraphs written around 1930, give an approximate picture of how the first known cancer victim of this district must have been living for some decades prior to his death in 1949.

That the cancer incidence has continued low in the Canadian eastern Arctic — east of Anderson River and west of Labrador — is to be inferred from an article in The Canadian Medical Association Journal of Toronto for 1956 (LXXV, 486-88) signed by Drs. Lawson, Saunders, and Cowen, which says:

“For the past 10 years we have been aware of the relative freedom of Eskimos [of the Canadian eastern Arctic] from breast cancer and cystic disease. In spite of strenuous efforts, we have so far been unable to discover one authenticated case of Eskimo breast malignancy.”

Since this statement is restricted to one localized form of malignancy, breast cancer, I arranged through mutual friends to meet, on my next visit to Montreal, Dr. Ray N. Lawson of 4459 Sherbrooke Street West, Montreal 6. He said in conversation, and has more recently said in writing, that he believes most or all other types of malignancy to be as rare as breast cancer, among those Eskimos of the Canadian Arctic who still depend for the main part of their food on fat and lean seal's meat, cooked moderately or eaten raw. Those whom he investigated, up to the end of 1957, were typically seal hunters, not much dependent on fur trapping, very little dependent on European foods or on European-style cooking.

At first Dr. Lawson's inability to find cancer led him to think that there might be some special immunizing agent in seal's fat, particularly if rancid. However, my understanding later (as of middle 1958) was that while he remains a believer in the general merit of high-fat, low-carbohydrate, little-cooked diets, he is no longer so strongly inclined to believe that seal's fat, fresh or rancid, has any marked anticarcinogenic effect, beyond whatever merit there is in the Stone Age Eskimo way of life as a whole. He feels that “there is something in primitive [Eskimo] diet that protects from malignant disease.”

Obviously, from the testimony presented so far, the frontier doctors of Alaska and northern Canada would have expected that statistics, if and when published, would confirm their view that the most civilized parts of northern territories would show the highest cancer incidence.

The chance to test this theory against the facts of statistically adequate population, and for a large and culturally differentiated area, did not come until the U.S. Treasury's Public Health Reports for March 2, 1934, carried “Mortality in the Native Races of the Territory of Alaska, with Special Reference to Tuberculosis," by F. S. Fellows, Passed Assistant Surgeon, United States Public Health Service, and Director, Alaska Medical Service.

The discussion by Dr. Fellows does have “special reference to tuberculosis.” But “malignancy" receives a column in the statistical tables, from which we can readily derive the information we need. The time covered is the five years 1926-30; the population, by the 1930 census, was around 60,000, about evenly divided between natives and whites, thus about 30,000 of each. As to causes of death, Dr. Fellows compares natives with whites and each of the four judicial divisions of Alaska with the other three. For my analysis of his cancer results I shall arrange the divisions in descending order of Europeanization. With an eye on the map (p. 91) and bearing history in mind, we may characterize the judicial divisions as follows:

Most intensively and longest civilized is the First Judicial Division, the Panhandle that stretches southeasterly along British Columbia. Its first European contacts were probably with Spain through Mexico in the 1500's. After Bering's voyage in 1741 the capital of Russian America was established at Sitka, where it remained even for some decades after the over-all name was changed to Alaska through purchase by the United States in 1867. Both before and after 1776 Yankee influence was considerable, as was British. After the purchase the influence of San Francisco was at first dominant, until Seattle and Vancouver took over.

Since the forest Indians of the Panhandle have been civilized the longest and most intensively of native Alaskans, the First Judicial Division ought to show the heaviest cancer incidence, according to the views of the frontier doctors whom we have quoted. That is the theory. Let us turn to statistics and seek the facts.

Table 2 of the Fellows paper is entitled “Actual and relative mortality from important causes among the native Indians and Eskimos and among the white population of Alaska during the five years 1926-30.” In the first third of this table, under “Average annual death rate per 100,000,” we find in the column marked “Malignancy” that in the First Judicial Division the white deaths from cancer are 92, the native 70. In the middle third of the table, under “Percent of all deaths due to indicated cause,” we learn that the white percentage from cancer was 7.8, the native 2.8. In the lowest third of the table, under “Number of deaths,” we learn that the whites who died of cancer were 59, the natives 21.

judicial divisions of Alaska
Map showing judicial divisions of Alaska

Historically the Third Judicial Division of Alaska ranks second among the divisions in Europeanization. It consists of the Aleutian island chain and of the southwestern corner of the mainland. Russian influence in the islands dates as far back as in the Panhandle, but the mainland part of the division was never intensively Europeanized. By the Tanchou-Le Conte principle, the native cancer rate should be fairly high but not as high as that of the Panhandle. According to Fellows' Table 2, the cancer figure per 100,000 is 75 for whites and 22 for natives; in percentages the whites rate 6.0 and the natives 1.4; in actual cancer deaths the whites have 33 and the natives 8.

The Second Judicial Division, from its history, should be in native cancer deaths the next to the lowest of the judicial districts, by the frontier theory. According to the tables of Dr. Fellows the per hundred thousand rate is white 126 to native 14; in percentages it is white 10.8 to native 0.8; in actual deaths the white are 9 to the native 6.

The Fourth Judicial Division should be lowest of the four in native cancer deaths. Here the population consists mainly of Athapaskan forest Indians who, except in becoming Christian, have resisted Europeanization much more successfully than either Eskimos or Aleuts, and far more successfully than the natives of the Panhandle.

According to Dr. Fellows the per hundred thousand rate is white 98, native 3; in percentage it is white 8.4, native 0.1; in actual number of cancer deaths the Fourth Judicial has white 27 and native 1.

 

The medical missionary theorists, those who favor the Tanchou-Le Conte principle, will think that the percentage table (the middle division of Dr. Fellows' Table 2) confirms their belief in most satisfactory fashion. In percentages of all deaths during the five years 1926-30, the cancer rate drops from the highest to the lowest of the districts on the scale as 7.8 to 2.8; 6.0 to 1.4; 10.8 to 0.8; and 8.4 to 0.1.



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