One of the earliest descriptions of someone with cancer comes from the fourth century BC. Satyrus, tyrant of the city of Heracleia on the Black Sea, developed a cancer between his groin and scrotum. As the cancer spread, Satyrus had ever greater pains. He was unable to sleep and had convulsions.

Advanced cancers in that part of the body were regarded as inoperable, and there were no drugs strong enough to alleviate the agony. So doctors could do nothing. Eventually, the cancer took Satyrus’ life at the age of 65.

Cancer was already well known in this period. A text written in the late fifth or early fourth century BC, called Diseases of Women, described how breast cancer develops:

hard growths form […] out of them hidden cancers develop […] pains shoot up from the patients’ breasts to their throats, and around their shoulder blades […] such patients become thin through their whole body […] breathing decreases, the sense of smell is lost […]

Other medical works of this period describe different sorts of cancers. A woman from the Greek city of Abdera died from a cancer of the chest; a man with throat cancer survived after his doctor burned away the tumour.

Where does the word ‘cancer’ come from?

The word cancer comes from the same era. In the late fifth and early fourth century BC, doctors were using the word karkinos – the ancient Greek word for crab – to describe malignant tumours. Later, when Latin-speaking doctors described the same disease, they used the Latin word for crab: cancer. So, the name stuck.

Even in ancient times, people wondered why doctors named the disease after an animal. One explanation was the crab is an aggressive animal, just as cancer can be an aggressive disease; another explanation was the crab can grip one part of a person’s body with its claws and be difficult to remove, just as cancer can be difficult to remove once it has developed. Others thought it was because of the appearance of the tumour.

The physician Galen (129-216 AD) described breast cancer in his work A Method of Medicine to Glaucon, and compared the form of the tumour to the form of a crab:

We have often seen in the breasts a tumour exactly like a crab. Just as that animal has feet on either side of its body, so too in this disease the veins of the unnatural swelling are stretched out on either side, creating a form similar to a crab.

Not everyone agreed what caused cancer

In the Greco-Roman period, there were different opinions about the cause of cancer.

According to a widespread ancient medical theory, the body has four humours: blood, yellow bile, phlegm and black bile. These four humours need to be kept in a state of balance, otherwise a person becomes sick. If a person suffered from an excess of black bile, it was thought this would eventually lead to cancer.

The physician Erasistratus, who lived from around 315 to 240 BC, disagreed. However, so far as we know, he did not offer an alternative explanation.

How was cancer treated?

Cancer was treated in a range of different ways. It was thought that cancers in their early stages could be cured using medications.

These included drugs derived from plants (such as cucumber, narcissus bulb, castor bean, bitter vetch, cabbage); animals (such as the ash of a crab); and metals (such as arsenic).

Galen claimed that by using this sort of medication, and repeatedly purging his patients with emetics or enemas, he was sometimes successful at making emerging cancers disappear. He said the same treatment sometimes prevented more advanced cancers from continuing to grow. However, he also said surgery is necessary if these medications do not work.

Surgery was usually avoided as patients tended to die from blood loss. The most successful operations were on cancers of the tip of the breast. Leonidas, a physician who lived in the second and third century AD, described his method, which involved cauterising (burning):

I usually operate in cases where the tumours do not extend into the chest […] When the patient has been placed on her back, I incise the healthy area of the breast above the tumour and then cauterize the incision until scabs form and the bleeding is stanched. Then I incise again, marking out the area as I cut deeply into the breast, and again I cauterize. I do this [incising and cauterizing] quite often […] This way the bleeding is not dangerous. After the excision is complete I again cauterize the entire area until it is dessicated.

Cancer was generally regarded as an incurable disease, and so it was feared. Some people with cancer, such as the poet Silius Italicus (26-102 AD), died by suicide to end the torment.

Patients would also pray to the gods for hope of a cure. An example of this is Innocentia, an aristocratic lady who lived in Carthage (in modern-day Tunisia) in the fifth century AD. She told her doctor divine intervention had cured her breast cancer, though her doctor did not believe her.

From the past into the future

We began with Satyrus, a tyrant in the fourth century BC. In the 2,400 years or so since then, much has changed in our knowledge of what causes cancer, how to prevent it and how to treat it. We also know there are more than 200 different types of cancer. Some people’s cancers are so successfully managed, they go on to live long lives.

But there is still no general “cure for cancer”, a disease that about one in five people develop in their lifetime. In 2022 alone, there were about 20 million new cancer cases and 9.7 million cancer deaths globally. We clearly have a long way to go.

Konstantine Panegyres, McKenzie Postdoctoral Fellow, Historical and Philosophical Studies, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A growing number of complaints against older doctors has prompted the Medical Board of Australia to announce today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table.

The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine.

The second would require only general health checks for doctors over 70.

A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their professional code of conduct, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo.

Haven’t we moved on from set retirement ages?

It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “still valid in a modern society”.

However, unlike judges, doctors are already required to renew their registration annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct performance assessments if and when they are needed.

What has prompted these proposals?

This latest proposal identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years.

Studies of medical competence in ageing doctors show variable results. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour.

The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors.

In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70.

In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015.

While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate.

It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients.

So what distinguishes the two new proposed options?

The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80.

Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions.

Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia.

The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia.

In practice, both of these proposals appear to allow doctors to manage their own general health confidentially.

The law tends to prioritise patient safety

All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. That provision basically says patient safety is paramount and trumps all other considerations.

As with legal regimes regulating childcare, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional.

Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “punished” for errors in practice.

All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care.

Could these proposals amount to age discrimination?

It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws.

For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals who are “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”.

In broader terms, a licence to practise medicine is often compared to a licence to drive or pilot an aircraft. Despite claims of discrimination, New South Wales law requires older drivers to undergo a medical assessment every year; and similar requirements affect older pilots and air traffic controllers.

Where to from here?

When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different.

How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, others have suggested this would only exacerbate shortages in the health-care workforce.

The proposals are open for public comment until October 4.

Christopher Rudge, Law lecturer, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.