The Past, Present, and Future of Nutrition and Cancer: Part 1—Was A Nutritional Association Acknowledged a Century Ago?

ABSTRACT

Professional interest in the association of diet and nutrition with cancer first appeared in the early 1800s, if not before. Yet, progress in understanding this association over the past two centuries has been exceedingly slow and confusing. Without addressing this confusion, progress in using diet and nutrition information to prevent and even to treat cancer, will remain uncertain. To better understand this issue, the present paper is the first of two to explore the history of the diet and cancer relationship prior to a 1982 National Academy of Sciences (NAS) report on Diet, Nutrition and Cancer. This report was a milestone in the nutrition and cancer history because it was the first science-based, institutional report on this topic. But, based on the evidence cited in that report, it could be inferred that this topic was relatively new, perhaps beginning around 1940. While it attracted great public interest, it also generated great controversy, some of which was a natural response from affected industries. Exploring the history prior to 1940, therefore, might provide clues on the present-day confusion concerning the relationship between diet and cancer. This investigation asks three questions. First (the subject of this paper), was the relationship of nutrition to cancer even considered prior to 1940 and, if so, what was said? Second (the subject of the upcoming paper), assuming that nutrition was seriously considered, why then was it ignored or forgotten? Third, has the forgotten information contributed to the contemporary confusion surrounding the relationship to cancer? The answer to the first question, considered here, is that, yes, nutrition as a possible cause of cancer was not only hypothesized, it was a major topic for discussion in some quarters. But it also was a topic struggling to be heard among the authorities who had most of the power and influence in the professional cancer community. This paper documents that history and the corresponding struggle for this message to be heard. One figure, Frederick Hoffman, founder of the American Cancer Society and prodigious researcher, led much of that effort during the period of 1913-1943, but his contributions have remained almost totally unknown.

Acknowledgments

Dr. Joan Austoker at the Welcome Unit on the History of Medicine at the University of Oxford for sharing her superb knowledge of cancer research history, in reviewing drafts, retrieving papers, and arranging for library use; Dr. Thomas O'Connor, Senior Research Associate at Cornell University, for locating numerous old manuscripts of Frederick Hoffman and reviewing manuscript drafts; Sir Richard Peto for providing office space and an intellectual atmosphere where the author wrote while on sabbatical; Dr. Rory Collins for providing the hardware facilities for communicating with my Cornell office; to the entire National Academy of Science 1980–83 panel members on Diet, Nutrition and Cancer where the opportunity to practice the art of science and freely discuss this topic was unsurpassed; and to Carol Roertgen and Allison Telford for typing draft upon draft of this manuscript and, in more recent times, to Sarah Dwyer for transforming an old 1986 faxed copy of this draft manuscript and its manually typed references to this format with far more advanced typing technology.

Notes

¹ Action against myself (October 1984 and April 1986) and Sushma Palmer, Executive Director, NAS Food and Nutrition Board.

² Mider, Research Director of NCI in 1957, in summarizing the first 20 years of NCI-supported research (15), discussed a variety of projects concerned with the discovery of possible causes of cancer, ranging from chemical carcinogens to hormones, viruses, sunlight, radiation, and milk transmissible agents; no mention was made of diet or nutrition.

³ I am indebted to my associate, Dr. Thomas O'Connor, for bringing this review to my attention.

⁴ Hoffman first described the design and purpose of this massive case-control study in 1924 (20); it may be the first case-control study ever.

⁵ Eighty-one are listed in his 1933 report of the San Francisco survey (18).

⁶ Hereinafter, the ACS abbreviation will be used for both the present Society and for its predecessor; the name change was made in 1943 (28).

⁷ Hoffman had already been suffering from Parkinson's disease for about ten years (27) when he wrote his 1937 book.

⁸ In 1929 (31), he had discounted the possibility that influenza and pulmonary tuberculosis were responsible causes of the increasing prevalence of lung cancer and stated that, as of that time, there was, “…no definite evidence that smoking habits are a direct contributory cause toward malignant growth in the lungs”; instead, he suggested that the new road surfacing practices might be considered as a responsible cause.

⁹ This verbatim comment cited both by Williams (19) and by Hoffman (16) may have been a paraphrase of Lambe's very strong views against meat consumption, as I could not locate it either in Lambe's 1809 (35) or 1815 (36) books. It is, however, an accurate representation of his views published elsewhere by others.

¹⁰ In the history of the Society written by E.H. Rigney (28), Hoffman specifically said, “Since an erroneous diet is a probable causative factor in cancer occurrence, the nutrition of cancerous patients should be investigated in conformity with the strictly scientific and conclusive methods of Professors Atwater and Chittenden.”