Presentism in paleopathology, through the lens of male breast cancer

To highlight possible presentist biases within paleopathological differential diagnosis by calling into question the diagnostic value of the concept of clinical rarity in modern populations, with reference to male breast cancer as a case study.

Published paleopathological case reports of human skeletal remains estimated to be biologically male or possibly male with lesions attributed to metastatic carcinoma and multiple myeloma. Case reports from 1909 to 2017 were sourced from the Cancer Research in Ancient Bodies (CRAB) Database (n = 275), as well as a supplemental literature search for publications from 2018 to 2023.

Exclusion criteria were established to filter and identify paleopathological case reports published before 2024. All identified cases were assessed whether, when presented with metastatic lesions in the skeleton of a male, breast cancer was considered in the differential diagnosis or rejected, and the reasoning.

Eighty-five case reports were identified that included skeletal remains estimated as male with metastatic lesions. Of these, 13 case reports considered male breast cancer in the differential diagnosis. This diagnosis was reasoned against by all but one, with most citing modern clinical rarity with little to no further consideration of this disease.

Presentism bias and the concept of clinical rarity may be hindering paleo-oncological research, as potential diagnoses are not often fully considered.

Paleopathological researchers are called on to re-examine their theoretical methodology and reflect on possible presentist biases in their investigation of diseases in the past.

Further interrogation and consideration of male breast cancer in paleopathological differential diagnosis.