Casey L Kirkpatrick | Max Planck Institute for Evolutionary Anthropology (original) (raw)

Papers by Casey L Kirkpatrick

The Lancet Neurology, 2020

In, K. Muhlestein, K.V.L. Pierce, B. Jensen (eds.), Excavations at the Seila Pyramid and Fag el-Gamous Cemetery. Boston: Brill, pp. 249-284., 2020

This chapter presents a preliminary analysis of the osteological collection within the Fag el-Gam... more This chapter presents a preliminary analysis of the osteological collection within the Fag el-Gamous storage magazine to determine the potential for further bioarchaeological analysis and academic contribution to knowledge. A small sample of the cranial collection was observed and documented using more comprehensive methods than those that were possible under the time constraints of previous seasons. Following a brief discussion of the site, cranial collection, and materials and methods used within this study, the resulting raw paleopathological data is revealed in this chapter, followed by a summary of the findings. Although in most cases the archived osteological records were not available for comparison, with the knowledge of what characteristics had been documented in previous seasons, this study reveals the vast potential for further bioarchaeological studies at Fag el-Gamous and brings to light some previously unknown information about the individuals examined.

ΑΚΑΔΗΜΙΑ ΑΘΗΝΩΝ (Special Issue on Palaeo-oncology: Proceedings of the 2nd International Symposium of the European Society of Oncology History), pp. 49-66, 2020

Paleo-oncological evidence can now be interpreted through the use of macroscopic osteological dia... more Paleo-oncological evidence can now be interpreted through the use of macroscopic osteological diagnostic criteria, medical imaging techniques, histological analyses, and biomolecular methods, such as aDNA and proteomic studies. This paper begins with a brief review of these variable use of these methods and their limitations with the goal of evaluating the reliability of paleo-oncological diagnoses. The challenge of paleo-oncological diagnosis is also demonstrated through the existence of conflicting diagnoses in the Cancer Research in Ancient Bodies (CRAB) database, and possible reasons for these diagnostic differences are discussed.
Additionally, this paper discusses a macroscopic and radiographic diagnostic workshop was hosted by the author, Dr. Bruce Ragsdale, and Dr. Roselyn Campbell at the Paleopathology Association’s 2018 meeting in Austin, Texas. This workshop reviewed the visual and radiographic diagnostic indicators for neoplastic disease that were included in the paleo-oncological article recently published by Ragsdale et al. (2018). Following this interactive instruction, participants were asked to visit workstations in small groups to diagnose neoplastic diseases, or conditions resembling neoplastic disease, as observed in bones, radiographs, or histological slides with known pathologies. These diagnoses were recorded on a team worksheet. During the exercise, the importance of consensus-based diagnosis was emphasized, as well as the value of multidisciplinary collaboration in the differential diagnosis of neoplastic disease. Following the exercise, the correct diagnoses were discussed to ensure that participants understood and recognized the diagnostic indicators for neoplastic diseases. The worksheets were also collected to assess diagnostic accuracy. This paper discusses the preliminary results of this workshop. In an effort to encourage paleo-oncological training on a larger scale, all resources used to host the aforementioned workshop, including images of the lab specimens, were made available at bit.ly/paleo-onc. A list of medical specialists interested in collaborating on paleo-oncological studies (available upon request by paleopathologists) was also introduced at the first “Antiquity of Cancer” colloquium hosted by ESHO. Interested individuals are still encouraged to submit their information at https://www.cancerantiquity.org/collaborate and the Paleo-oncology Research Organization continues to encourage collaboration and consultation with medical professionals. Lastly, the potential for improvements in diagnostic accuracy is viewed in light of a list of “7 S-es” recommended for continued progress in the field of paleo-oncology (Kirkpatrick et al. 2018).

Head and Neck Pathology, 2020

Here we describe a potential case of metastatic carcinoma associated with lymphoadenopathy and ac... more Here we describe a potential case of metastatic carcinoma
associated with lymphoadenopathy and acquired
Horner Syndrome’s portrayed in a third century CE male
bust housed in the collection of Count Franz I Erbach-
Erbach (1754–1823) at Erbach Castle (Erbach, Hesse, Germany)
(see Fig. 1a–d). The bust depicts an unknown bearded
adult man known as “Single-eyed man”.

International Journal of Osteoarchaeology, 2018

This study describes a probable proportionate dwarf from a Third Intermediate Period cemetery at ... more This study describes a probable proportionate dwarf from a Third Intermediate Period cemetery at Ain Tirghi in the Dakhleh Oasis, Egypt. The skeleton (Burial 22 or B22) is an adult woman estimated to be in her mid-to-late thirties. Most medical literature defines an adult stature of 2 standard deviations below the population mean as an indicator for clinically short stature, with some bioarchaeologists and clinicians identifying severe short stature at 3 standard deviations below the population mean. B22 satisfies either criteria when compared with the Ain Tirghi adult female population mean for measurements of the radii and femora, as well as the summed measurements of the femora and tibiae. Her limb proportions were normal, and this, with a lack of morphological abnormalities, eliminated several possible causes of small stature (e.g. achondroplasia). The differential diagnosis for an individual with short stature and normal proportions indicates that she represents a probable case of pituitary dwarfism or hypopituitarism. B22 was buried in the same fashion as adjacent burials in a family group burial and showed no differential indication of physiological stress or illness.

International Journal of Paleopathology, 2018

This study summarizes data from 154 paleopathological studies documenting 272 archaeologically re... more This study summarizes data from 154 paleopathological studies documenting 272 archaeologically recovered individuals exhibiting skeletal or soft tissue evidence of cancer (malignant neoplastic disease) between 1.8 million years ago and 1900 CE. The paper reviews and summarizes the temporal, spatial and demographic distribution of the evidence and the methods used to provide the cancer diagnoses. Metastasis to bone is the most widely reported evidence (n = 161), followed by multiple myeloma (n = 55). In the dataset, males were represented more than females (M = 127, F = 94), and middle-adults (35-49) and old-adults (50+) were represented most among age groups (MA = 77, OA = 66). The majority of the evidence comes from Northern Europe (n = 51) and Northern Africa (n = 46). The data are summarized in the Cancer Research in Ancient Bodies (CRAB) Database, a growing online resource for future paleo-oncological research. This systematic review contributes to broader studies of malignant neoplastic disease in antiquity; it provides an overview of paleo-oncological data, discusses the many practical and methodological challenges of paleo-oncological research, and dispels presumptions about cancer's rarity in the past.

International Journal of Paleopathology, 2019

Objective: To document sacral spina bifida occulta (SSB0) prevalence in a population sample from ... more Objective: To document sacral spina bifida occulta (SSB0) prevalence in a population sample from the Dakhleh Oasis, Egypt, and address methodological issues in recording and quantifying SSBO variations.
Materials: 442 adult sacra from two temporally disjunct samples from the same deme traversing the 3rd intermediate (TIP) and the Roman Periods.
Methods: Sacra were scored for SSBO, excluding the sacral hiatus. Risk of SSBO was calculated with the common odds ratio and statistical significance by X 2. Data were compared to other archaeological SSBO data.
Results: SSBO was present in 15.6% of the sample with a slight, but not significant, temporal increase (TIP to Roman Period) in males, and a significant age-correlated increase in both sexes. Most open sacra occurred in young adults.
Conclusions: Data support that SSBO can be considered as a morphogenetic variant. Dakhleh data fall within the prevalence range for most populations, however inter-population comparisons are complicated by methodolo-gical inconsistencies.
Significance: SSBO can be used in paleogenetic research.
Limitations: Methodological differences in scoring SSBO prevent effective comparative study.
Suggested future research: Future studies require more rigorous and standardized scoring methods. aDNA may be used to corroborate the morphogenetic value of SSBO and determine its clinical significance.

International Journal of Paleopathology, Special Issue "Paleo-oncology: Taking Stock and Moving Forward", 2018

The Paleo-oncology Research Organization (PRO) was founded following bioarchaeologist Kathryn Hun... more The Paleo-oncology Research Organization (PRO) was founded following bioarchaeologist Kathryn Hunt's battle with ovarian cancer. As she recovered from chemotherapy and continued her studies, she contemplated how ancient people might have dealt with cancer and began her journey exploring the fascinating field of paleo-oncology. At the 2012 annual Paleopathology Association meeting soon thereafter, she discussed the lack of synthesized paleo-oncological data with her friends and fellow colleagues in bioarchaeology: Casey L. Kirkpatrick, Roselyn A. Campbell, and Jennifer L. Willoughby. Together, the idea for an organization devoted to the study of cancer in the ancient world developed, and an impromptu first meeting was held over lunch, where an outline of the organization's mission was drafted on a napkin, and the Paleo-oncology Research Organization (PRO) was born.

International Journal of Paleopathology, Special Issue "Paleo-oncology: Taking Stock and Moving Forward", 2018

This article serves as an introduction to the International Journal of Paleopathology's special i... more This article serves as an introduction to the International Journal of Paleopathology's special issue, Paleo-oncology: Taking Stock and Moving Forward. Reflecting the goals of the special issue, this paper has been designed to provide an overview of the current state of paleo-oncology, to introduce new and innovative paleo-oncological research and ideas, and to serve as a catalyst for future discussions and progress. This paper begins with an overview of the paleo-oncological evidence that can be found in ancient remains, followed by a summary of significant paleo-oncological findings and methodological advances to date. Thereafter, challenges in estimating past prevalence of cancer are highlighted and recommendations are made for future advancements in paleo-oncological research. The groundbreaking studies included in the special issue and referenced throughout this introduction embody the many ways in which progress can be made in the field of paleo-oncology.

International Journal of Paleopathology, Special Issue "Paleo-oncology: Taking Stock and Moving Forward", 2018

Unlike modern diagnosticians, a paleopathologist will likely have only skeletonized human remains... more Unlike modern diagnosticians, a paleopathologist will likely have only skeletonized human remains without medical records, radiologic studies over time, microbiologic culture results, etc. Macroscopic and radiologic analyses are usually the most accessible diagnostic methods for the study of ancient skeletal remains. This paper recommends an organized approach to the study of dry bone specimens with reference to specimen radiographs. For circumscribed lesions, the distribution (solitary vs. multifocal), character of margins, details of periosteal reactions, and remnants of mineralized matrix should point to the mechanism(s) producing the bony changes. In turn, this allows selecting a likely category of disease (e.g. neoplastic) within which a differential diagnosis can be elaborated and from which a favored specific diagnosis can be chosen.

http://ir.lib.uwo.ca/totem/vol15/iss1/4/

Conference Presentations/Posters by Casey L Kirkpatrick

University of Basel Research Showcase "Studying Graeco-Roman Egypt: New Approaches in a New Generation" , 2017

The Fag El-Gamous cemetery is a 125 hectare Roman/Byzantine Period necropolis on the eastern edge... more The Fag El-Gamous cemetery is a 125 hectare Roman/Byzantine Period necropolis on the eastern edge of the Fayum Depression near the modern Egyptian village, Seila. It makes up a significant part of the Brigham Young University (BYU) concession, which also includes a
Fourth Dynasty step pyramid (known as the Seila Pyramid), some Middle Kingdom tombs, and the Greco-Roman town of Philadelphia[1].
The first documented survey of the Fag El-Gamous cemetery was conducted by Bernard Grenfell and Arthur Hunt in the early twentieth century, at which time the researchers collected several Fayum mummy portraits from an undocumented location on the site[2]. In the 1970s, interest in the site grew as the Fayum sites were declared endangered by
agricultural expansion and high ground waters. As a result, Dr. Leonard H. Lesko (Project Director and Field Director) and Dr. C. Wilfred Griggs (Field Director) successfully applied for the aforementioned concession with the joint sponsorship of the University of California, Berkeley and Brigham Young University. In 1981, survey and excavation of the concession commenced with Lesko directing the Seila Pyramid investigations and Griggs directing the necropolis efforts. Following some progress in both areas, Lesko accepted a position at
Brown University and the concession fell solely to BYU, and thus the ability to focus on more than one area of the concession at a time subsided. As a result, excavations at the Fag El-Gamous necropolis were subsequently prioritized due to the risks of plundering and encroachment[3].
Griggs continued to direct excavations at Fag El-Gamous most years between 1984 and his retirement in 2011[4]. During this time, it was discovered that the cemetery is densely packed with generally well-preserved human remains in many areas, and that there is a change in
burial orientation over time from head east burials to head west burials[5]. Most of the better preserved skeletal remains were found wrapped in linens without evidence of evisceration; the textiles were removed and examined by textile specialists following excavation. Due to time constraints and the sheer number of human remains excavated at Fag El-Gamous, prior osteological studies focused on preservation, burial treatment, burial context, basic demographic information (age, sex, and stature estimation), and any obvious anomalies or pathologies[6]. During this time, over 1000 individuals were exhumed from the cemetery, analysed under tight time restrictions, and reburied, apart from some of the skulls, which were collected in the site’s storage magazine[7]. Despite the enormous amount of information being gleaned from this site, only a small handful of bioarchaeological publications were released under the directorship of Dr. Griggs.
Following Dr. Griggs’ retirement, Brigham Young University awarded the directorship of the concession to Dr. Kerry Muhlestein, who has made significant efforts to bring the site’s bioarchaeological methods up to date while encouraging transparency in scholarship and publication of the data collected from the site. This presentation is a preliminary analysis of the osteological collection within the Fag El Gamous storage magazine and an assessment of its potential for further analysis and academic contribution to knowledge, which will be published in an upcoming edited volume.
Through this preliminary analysis of the Fag El-Gamous cranial collection, it was determined that this collection, and the further excavation of the Fag El Gamous cemetery, have incredible potential for significant contribution to the fields of bioarchaeology, Egyptology
and the history of occupation in the Fayum. This conclusion was based on the excellent state of preservation, the large number of burials and the large time span during which this cemetery was in use (c. 30-641 CE)[8]. Given the sizable cranial collection, there is also ample opportunity for in-depth bioarchaeological analysis. Unfortunately, the reburial of the
infracranial remains precludes any possibility for their re-examination in association with their crania and known archaeological contexts. Nevertheless, if given the opportunity to expand our bioarchaeological study to use advanced technology in the analysis of the Fag El
Gamous cemetery population, this large site could give unprecedented access to information about changes in the illnesses, diets and lifestyles of the Fayum inhabitants spanning a long period of time, including a period of religious transition.
The twenty-two skeletons that were analysed during the abbreviated 2014 field season, and will be described during this presentation, have already produced information through dental and skeletal indicators of nutrition and illness. However, a large scale paleo-epidemiological
study would further add to our collective understanding of the lives of those interred at Fag El-Gamous and the environmental and cultural factors that contributed to pathology in the individuals interred at this site. Studies of genetically linked non-discrete cranial and dental
traits also have the potential to provide significant information about the genetic composition of the population interred at Fag El Gamous and may contribute to our understanding of how the cemetery was established, through the possible identification of family groups and the
ancestry of the people interred in this cemetery. With the potential for future studies outlined, it is hoped that this preliminary analysis will be the beginning of a new era in bioarchaeological scholarship at the Fag El-Gamous cemetery.

[1] Evans, R. Paul, David M. Whitchurch, and Kerry Muhlestein, “Rethinking burial dates at a Graeco-Roman
Cemetery: Fag el-Gamous, Fayoum, Egypt,” Journal of Archaeological Science: Reports 2 (2015): 209–214.
[2] Grenfell, B. P., and A. S. Hunt, “Excavations in the Fayum,” Egypt Exploration Society Archaeological
Report 10 (1900):4-7; Grenfell, B.P., and A. S. Hunt, “Excavations in the Fayum and at El Hibeh,” Egypt
Exploration Society Archaeological Report 11(1901): 2-5.
[3] Leonard Lesko, “Seila 1981.” Journal of the American Research Center in Egypt 25(1988):215-235; C.
Wilfred Griggs, “Introduction,” in Excavations at Seila, Egypt, ed. C. Wilfred Griggs, (Provo, Utah: Religious
Studies Center, Brigham Young University, 1988), xi–xiii.
[4] Kristin Hacken South, "Roman and Early Byzantine Burials at Fag el-Gamus, Egypt: A Reassessment of the
Case for Religious Affiliation," BYU Scholars Archive: All Theses and Dissertations, Paper 3534(2012),
https://scholarsarchive.byu.edu/etd/3534/.
[5] C. Wilfred Griggs, “Excavating a Christian Cemetery Near Selia, in the Fayum Region of Egypt,” in
Excavations at Seila, Egypt, ed. C. Wilfred Griggs, (Provo, Utah: Religious Studies Center, Brigham Young
University, 1988), 74–84.
[6] Vincent A. Wood, “Paleopathological Observations and Applications at Seila,” in Excavations at Seila,
Egypt, ed. C. Wilfred Griggs (Provo, Utah: Religious Studies Center, Brigham Young University, 1988), 31–44;
R. Paul Evans, personal communication, 2014.
[7] Kristin Hacken South, "Roman and Early Byzantine Burials at Fag el-Gamus, Egypt: A Reassessment of the
Case for Religious Affiliation," BYU Scholars Archive: All Theses and Dissertations, Paper 3534(2012),
https://scholarsarchive.byu.edu/etd/3534/."; Evans, R. Paul, David M. Whitchurch, and Kerry Muhlestein,
“Rethinking burial dates at a Graeco-Roman Cemetery: Fag el-Gamous, Fayoum, Egypt,” Journal of
Archaeological Science: Reports 2 (2015): 209–214.
[8] Evans, R. Paul, David M. Whitchurch, and Kerry Muhlestein, “Rethinking burial dates at a Graeco-Roman
Cemetery: Fag el-Gamous, Fayoum, Egypt,” Journal of Archaeological Science: Reports 2 (2015): 209–214.

83rd Annual Meeting of the American Association of Physical Anthropologists, 2014

This study presents the description and differential diagnosis of a probable pituitary dwarf from... more This study presents the description and differential diagnosis of a probable pituitary dwarf from a Third Intermediate Period cemetery at Ain Tirghi in the Dakhleh Oasis, Egypt. The skeleton is an adult female estimated to be in the third decade of life. Most medical literature defines a variation of 2 standard deviations below the population mean as an indicator for clinically short stature, with some identifying severe short stature at 3 standard deviations from the population mean. Some bioarchaeologists have chosen not to make this distinction, and prefer to use only the more cautious level of 3 standard deviations to designate shortness. In any case, the individual at Ain Tirghi presents a difference satisfying either criteria when compared with the adult female population mean for measurements of the radii and femora, as well as the summed measurements of the femora and tibiae. Further calculations, however, revealed that her limb proportions fell within the normal range. Normal proportions and a lack of morphological abnormality were also observed during macroanalysis of the skeletal remains. Consequently, conditions leading to disproportionate short stature could be ruled out. A differential diagnosis for an individual with short stature, normal proportions and a lack of osteoporosis indicates this individual represents a probable case of pituitary dwarfism, or hypopituitarism, in the Egyptian archaeological record.

The Antiquity of Cancer – A colloquium hosted by the European Society for the History of Oncology, 2018

Most scientific knowledge of cancer is based upon very recent evidence, with most information com... more Most scientific knowledge of cancer is based upon very recent evidence, with most information coming from studies over the last 200 years. With increased understanding of the manifestation and presentation of cancers throughout thousands, if not millions, of years, researchers can work together to answer the complex questions surrounding cancers today and tomorrow. The rapidly expanding field of palaeo-oncology, the study of the global history of cancers and other neoplastic diseases, contributes to this expansion of data and our collective understanding of neoplastic diseases and their evolution. This paper delves into the development of techniques, technologies and theoretical models used in the detection and interpretation of palaeo-oncological evidence in skeletonized and mummified remains.
When palaeopathology was first introduced as a scientific endeavour, visual analysis of the bodily remains was the only available method and studies required the unwrapping and defleshing of mummified remains. These early methods were terribly destructive, and many soft tissue and bone pathologies were overlooked. Thankfully, the fields of palaeopathology and palaeo-oncology have a history of quickly adapting to incorporate state-of-the-art diagnostic tools and methods, resulting in a drastic reduction of destructive studies. For example, the first palaeo-radiological image of an ancient neoplasm was taken only two years after the discovery of x-rays, and one year after the first x-ray of bone cancer. Palaeo-oncological research has similarly incorporated more complex medical imaging techniques and histological analysis following their introduction to the world. Most recently, biomolecular methods of analysis, such as aDNA and proteomic analyses, have begun to make an impact on palaeo-oncological research with promising results. This paper begins with a historical review of the development of the palaeo-oncological toolbox enabling the minimally invasive analysis of physical remains and the limitations of these methods.
Following this history of palaeo-oncological methodology, attention is turned to the quantification of the use of these methods in palaeo-oncological studies to date. This information is gleaned from the CRAB (Cancer Research in Ancient Bodies) Database (http://www.cancerantiquity.org/crabdatabase); a global summary of the published evidence of ancient cancer in humans and early hominins as well as the methods used in these studies. This database was created by Kathryn Hunt for her Masters degree at Durham University, then verified, further refined and published online with the assistance of the Palaeo-oncology Research Organization’s executive team, including the current speaker. Results of an associated article (Hunt et al., 2018), co-authored by the current speaker, are also briefly discussed with regard to the state of the art of palaeo-oncology to date, its limitations, and the need for more multidisciplinary collaboration.
In addition to methodological progress, the role of recent theoretical breakthroughs in the advancement of palaeo-oncology are also discussed in relation to the potential for further discovery in this field. Looking to the future, the unfulfilled potential of palaeo-oncological research is noted, along with its ability to contribute to our collective scholarly understanding of cancer and neoplastic disease in manners not possible through clinical studies.

Most paleopathological case studies of cancer have been based on the description and analysis of ... more Most paleopathological case studies of cancer have been based on the description and analysis of neoplastic disease in skeletal remains, which limits diagnosis to cancers that affect the skeleton. Mummified human remains, however, have the potential to preserve soft tissue tumors, in addition to skeletal evidence of neoplastic disease, thus presenting a broader and more detailed picture of neoplastic disease in the past. Non-invasive imaging analysis is preferred for the study of mummies, with CT analysis representing the most detailed and informative method. Unfortunately, the effects of natural and anthropogenic mummification on soft tissue tumours are unknown and could affect the visibility of tumours in mummies examined through CT analysis. To this end, an experimental archaeology project was undertaken to test the effects of natural and anthropogenic mummification on tumorous tissues and their appearance through CT imaging analysis. Mice from a cancer research center that contained human tumors were mummified in various conditions, including: anthropogenic mummification in the ancient Egyptian style, natural desiccation using a controlled heat source, frozen, and naturally preserved in an anaerobic bog environment. The mice were documented before mummification using a microCT scanner, and then again at intervals after mummification. Tumour size and shape were recorded and changes in the different tissues were observed over time. Preliminary results will be presented as this long-term project is ongoing. This research demonstrates the value of experimental archaeology for paleopathological research, as well as for our understanding of the presentation of cancer in mummified remains.

Cancers and neoplastic diseases are highly present in our world today, and according to an increa... more Cancers and neoplastic diseases are highly present in our world today, and according to an increasing volume of bioarchaeological and historical research, it is probable that cancer also affected many people in the past. Most published case studies of ancient cancer record tumors or neoplastic disease in skeletal remains. However, mummified human remains have the potential to preserve soft tissue tumors, thus providing a more complete picture of the presence of cancer in the ancient world. Non-invasive methods such as CT imaging provide information on the internal structures of mummies, but identifying cancer in mummified human remains can be difficult for several reasons, one of them being that cancerous tissues likely undergo changes during and long after the mummification process. The effects of natural and anthropogenic mummification on soft tissue tumors are unknown and could affect the appearance of tumors in mummies examined through CT imaging analysis.
An experimental mummification project was undertaken by the authors in order to understand how cancerous tissues change in different mummification scenarios. Mice (provided by a cancer research laboratory) that contained human tumors were mummified in four different cultural and environmental conditions: 1) anthropogenic mummification in the ancient Egyptian style, 2) natural desiccation using a controlled heat source, 3) frozen at a static temperature, and 4) naturally preserved in an anaerobic bog environment. Prior to mummification, the mice were documented using a microCT scanner, and they were scanned again at intervals after the mummification process was complete. The size and shape of the tumors were documented in each scan, along with changes in the radiological appearance of different tissues. This research demonstrates the value of experimental mummification projects to paleopathological research, especially regarding the study of cancer in the ancient world.

The salivary glands perform a function essential to digestion and the maintenance of oral health,... more The salivary glands perform a function essential to digestion and the maintenance of oral health, yet they are often overlooked in bioarchaeology due to a lack of surviving soft tissues in the archaeological record. This paper will present a comprehensive review of clinical literature regarding neoplastic disease and other abnormal growths affecting the salivary glands. Afflictions will be described in detail and considered with regard to diagnostic features useful for the development of differential diagnoses in skeletal and mummified human remains. The importance of clinical studies and current medical consensus will be emphasized for their essential role in revisiting and redefining diagnostic criteria and prevalence rates for the identification of neoplastic disease in human remains.

The importance of research regarding rare neoplastic disease, like salivary gland tumors, will also be emphasized, as it is essential for the development of accurate differential diagnoses. The reliance of differential diagnoses on updated, reliable and relevant prevalence rates will also be discussed, as this study concluded that these rates can vary significantly according to epidemiological methods, differences in epigenetic factors within specific study samples, and advances in medicine and diagnostic technology.

Additionally, sialolithiasis (a condition where a calcified mass, or sialolith, develops within a salivary gland) will be discussed in relation to the difficulties of differential diagnosis and the possibility for confusion between neoplastic diseases and non-neoplastic growths. This study aims to facilitate the improvement of differential diagnosis, while promoting discussion about the challenges associated with differential diagnoses for neoplastic disease.

Cancer accounted for 7.6 million deaths globally in 2008 and its prevalence increases each year (... more Cancer accounted for 7.6 million deaths globally in 2008 and its prevalence increases each year (WHO). Oncological research has become increasingly vital in the goal to save lives and improve quality of life. The detection and understanding of ancient neoplasms, both malignant and benign, and their effects on early societies will not only provide us with valuable insights into the evolution of perceptions and treatments of the disease, but also may demonstrate how cancer has been influenced by genetic, cultural, and environmental factors. Currently, the study of palaeo-‐oncology lacks a synthesis of information and a variety of limitations in the field are preventing the accurate interpretation of results. The interdisciplinary collaboration of researchers is greatly needed for there to be significant progress on this important subject. The objective of this symposium is to facilitate meaningful dialogue between bioarchaeologists concerning the study of neoplastic disease in skeletal remains, on the topics of: education, innovative methodology, standardization, differential diagnosis, interdisciplinary collaboration, population studies, and exploration of new techniques for analyses. This open dialogue will seek to encourage further research into aspects of cancer that have been previously unexplored.

Through meta-analysis, it is apparent that the existing subadult dental age estimation standards ... more Through meta-analysis, it is apparent that the existing subadult dental age estimation standards are the most accurate and specific aging standards based on macroscopic features of subadult human remains. However, some of the methods and reference samples used for the creation of these standards may have contributed to bias within the resulting age estimation standards. This study presents a new method for the development of subadult age estimation standards based on dental development. This method engages with disparate data sets through the pairing of modern public oral health research and the study of bioarchaeological methodology.

Site 117 is Nubia’s oldest known cemetery and is most famously believed to be the world’s earlies... more Site 117 is Nubia’s oldest known cemetery and is most famously believed to be the world’s earliest possible evidence of large scale violence (or perhaps warfare). Excavation of this Upper Paleolithic cemetery revealed many skeletons with evidence of trauma, some with embedded lithics, and a total of 189 lithic artifacts found in direct or possible association with the burials. Site 117 was excavated through salvage archaeology by the ‘Combined Prehistoric Expedition’ prior to the completion of the Egyptian High Dam in 1970, which submerged the site in the resulting reservoir.
This study explores the lives and deaths of the individuals interred at Site 117 through a macroscopic analysis of the skeletal collection and a re-examination of archival materials stored at The British Museum. This re-analysis and reinterpretation of the available evidence focusses on archaeological and paleopathological factors indicating possible settlement patterns, subsistence methods, burial traditions, population morbidity and possible causes for the observed evidence of trauma.
The low prevalence of dental and skeletal indicators of physiological stress and malnutrition observed in this study does not support the hypothesis asserting that there was a long-term depletion of nutritional resources, which may have resulted in violent competition between tribes. More technologically advanced studies may, however, reveal additional evidence of physiological stress than that which is observable through macroscopic analysis. While it remains possible that the majority, if not all, of the individuals interred at the site were fatally injured, this study supports the hypothesis that this cemetery was revisited and reused.

The Lancet Neurology, 2020

In, K. Muhlestein, K.V.L. Pierce, B. Jensen (eds.), Excavations at the Seila Pyramid and Fag el-Gamous Cemetery. Boston: Brill, pp. 249-284., 2020

ΑΚΑΔΗΜΙΑ ΑΘΗΝΩΝ (Special Issue on Palaeo-oncology: Proceedings of the 2nd International Symposium of the European Society of Oncology History), pp. 49-66, 2020

Head and Neck Pathology, 2020

International Journal of Osteoarchaeology, 2018

International Journal of Paleopathology, 2018

International Journal of Paleopathology, 2019

International Journal of Paleopathology, Special Issue "Paleo-oncology: Taking Stock and Moving Forward", 2018

http://ir.lib.uwo.ca/totem/vol15/iss1/4/

University of Basel Research Showcase "Studying Graeco-Roman Egypt: New Approaches in a New Generation" , 2017

83rd Annual Meeting of the American Association of Physical Anthropologists, 2014

The Antiquity of Cancer – A colloquium hosted by the European Society for the History of Oncology, 2018

This poster includes the description and differential diagnosis of a probable pituitary dwarf fro... more This poster includes the description and differential diagnosis of a probable pituitary dwarf from a Third Intermediate Period cemetery from Ain Tirghi in the Dakhleh Oasis, Egypt. The skeleton is an adult female estimated to be in the third decade of life. Most medical literature defines a variation of 2 standard deviations below the population mean as an indicator for clinically short stature, with some identifying severe short stature at 3 standard deviations from the population mean. Some bioarchaeologists have chosen not to make this distinction, and prefer to use only the more cautious level of 3 standard deviations to designate shortness. In any case, the individual at Ain Tirghi presents a difference satisfying either criteria when compared with the adult female population mean for measurements of the radii and femora, as well as the summed measurements of the femora and tibiae. Through further calculations, it was revealed that her limb proportions fell within the normal range. Normal proportions and a lack of morphological abnormality were also observed through macroanalysis of the skeletal remains. Consequently, conditions leading to disproportionate short stature could be ruled out. A differential diagnosis for an individual with short stature, normal proportions and a lack of osteoporosis indicates this individual likely represents a unique case of pituitary dwarfism, or hypopituitarism, in the Egyptian archaeological record.

Subadult age is most commonly estimated from human remains using ‘universal’ dental development s... more Subadult age is most commonly estimated from human remains using ‘universal’ dental development standards based on North American and European reference populations. Recent studies have indicated a need for region-specific subadult dental age estimation standards. In preparation for the creation of a new standard for Egyptian and Middle Eastern subadults, a meta-analysis of past standards was conducted and a new model was developed for the creation of subadult dental age estimation standards. The introduction of the new model will be accompanied by the introduction of an online reference, comparing aspects of age estimation standards based on the new model with those of past age estimation standards based on dental development.
The proposed new model involves the formation of new panoramic dental radiographic reference collections with more precise age and sex attributions. A new region-specific, not population-specific, subadult dental aging standard will then be created based on the radiographic study of 1020 modern Egyptian subadults, with 60 subjects (30 males and 30 females) forming a representative sample for each year of subadult life. Volunteers and/or their guardians will also be asked to complete a questionnaire regarding demographic and health history information along with socio-cultural and environmental factors that may affect dental development and dental health.
Following radiographic data collection, the new model requires that dental development be recorded for individual teeth using calcification and eruption scoring systems. Bayesian statistics will then be used to create a region-specific aging standard that compensates for any population distribution bias. During the development of the dental aging standard for Egypt and the Middle East, variations of the Bayes Theorem will be applied and tested using a bootstrapping statistical method in order to determine the most accurate, specific and unbiased statistical method for use in the development of future region-specific dental age estimation standards. The new standard should better represent regional epigenetic factors affecting dental development and provide sex-specific age calculations based on more systematic data collection methods and improved statistical methods. An improved subadult dental age estimation standard will have important applications to forensics, bioarchaeology, paleopathology, dentistry, orthodontics, socio-cultural anthropology and law.

The Theban necropolis, including the modern town of Qurna, is an important cultural and archaeolo... more The Theban necropolis, including the modern town of Qurna, is an
important cultural and archaeological site as well as an area inhabited by Egyptian families. During the New Kingdom, the Theban necropolis was the burial place for elite ancient Egyptians. The area was re-used throughout the Greco-Roman period and was inhabited by Copts prior to the modern occupation. The modern Qurnawis can trace their arrival to the area back several generations; their culture has been influenced by their landscape and the Qurnawis have, likewise, influenced the archaeological landscape. The Qurnawi self-description continues to be based largely on the villagers’ relationships with the archaeological ruins, while they are now infamous to outsiders for their alleged role in the antiquities trade. In recent years, the residents of Qurna have been relocated and the hill-side houses demolished in order to preserve the archaeological features of the landscape.

This paper will examine some of the many relationship dynamics between Qurnawis and their archaeological surroundings, including how the landscape is categorized and by whom, in the context of the rise of archaeology and archaeotourism. Attention will be directed toward issues affecting the categorization of historic and archaeological sites, and the invisible, dynamic line separating modern, historic and archaeological space and objects. The importance of local narratives and engagements with archaeological sites and objects will also be discussed. The Qurnawi’s copious knowledge of the landscape and skilled archaeological work as well as the underrepresentation of that work in archaeological publications will be considered.

The study of cancer in antiquity, or paleo-oncology, has revealed over forty cases of probable ca... more The study of cancer in antiquity, or paleo-oncology, has revealed over forty cases of probable cancer in ancient Egypt, mostly in skeletal remains (Hunt 2012). In 2011, a study by Prates et al. used CT imaging to identify a case of probable metastatic cancer in a Ptolemaic Egyptian mummy, demonstrating the value of non-invasive medical imaging techniques in mummy studies.

This poster details the methods and samples in a paleo-oncological study; a large-scale survey of cancer in ancient Egypt through the use of CT imaging technology and the IMPACT Radiological Mummy Database. Until recently, large-scale investigations into the prevalence of cancer in antiquity were limited due to a variety of factors. Contributions to the field of paleo-oncology have thus predominantly consisted of individual case studies, with little focus on the broader impact of cancer on ancient populations. CT imaging is ideal for the non-invasive analysis of natural and anthropogenic mummified human remains, in which both bone and soft tissue are preserved, increasing the range of cancers that may be detected.

This study will demonstrate the usefulness of paleoradiological diagnosis for the survey of ancient pathologies, such as cancer. Furthermore, knowledge gained through this study will contribute to the general paleopathological knowledge of Egyptian mummies without compromising the integrity of existing wrappings, human remains, and other artifacts of mummification. Lastly, this study will contribute to the field of paleo-oncology through the expansion of knowledge regarding the presence and impact of cancer in ancient Egypt, and by extension, the ancient world.

Masters Thesis, Swansea University, 2009

The following study used a multidisciplinary method to reconstruct aspects of the diet, culture a... more The following study used a multidisciplinary method to reconstruct aspects of the diet, culture and lifestyle of the deceased of site 117. Archaeological, geological, technological, palaeopathological, palaeonutritional and palaeodemographical analyses were used to determine the environment in which the deceased of site 117 lived and their adaptations to this environment.
Essential (i.e. necessary to sustain life) and non-essential cultural aspects were theorized based on the resulting observations in an effort to understand the circumstances of life and death for this population. Ethnographical comparisons were also used to support several of the theories put forth. In addition to their role in forming these theories, the palaeopathological, palaeonutritional and palaeodemographical analyses were used to determine the effects of the environment and the aforementioned cultural adaptations on the nutrition, morbidity and mortality of the population. Together, these observations were used in an effort to reconstruct the settlement pattern, subsistence methods, burial traditions and possible causes for interpersonal violence evident at this cemetery.
This study and reinterpretation of the available evidence suggests that the deceased of site 117 belonged to a semi-nomadic hunter-gatherer-fisher group. The majority, if not all, of the population interred at the site were fatally injured during battle or a massacre. There is no evidence to support the hypothesis that there was a depletion of resources leading to competition between tribes. Instead, the violence was likely a result of personal disagreements or other matters of control or honour. While it has been suggested that all deaths occurred during the same massacre this study suggests that this cemetery was revisited and reused. This cemetery also shows evidence of several possible traditions or rituals which have also been interpreted in an effort to understand the ideology of the population.

Doctoral Dissertation, University of Western Ontario, 2019

Can be found with Appendix 7 (bottom of page) at: https://ir.lib.uwo.ca/etd/6472/ This disserta... more Can be found with Appendix 7 (bottom of page) at: https://ir.lib.uwo.ca/etd/6472/

This dissertation investigates the use of dental anthropological methods for estimating chronological age-at-death in ancient Egypt, and determines whether these methods can be improved. Tooth calcification, emergence and eruption standards are time honoured in their ability to accurately age subadults though they are compromised by the fact that populations and the sexes vary in their developmental timing. Determining sex in subadults, particularly in the infant and child cohorts, in all populations is not possible, though advances in ancient DNA methods hold promise. This dissertation provides a feasible and ethical model for developing a sex-and region-specific standard for age estimation of subadults for use on ancient Egyptian samples.This method rectifies methodological errors affecting the accuracy of pre-existing standards; and thus, demonstrates that macroscopic subadult dental age estimation methods can be improved.
Moreover, using a photographic sample of occlusal dentition from the Kellis 2 cemetery population in Roman Period Egypt, a new method for adult dental age estimation is designed and tested. To this end, the percentages of exposed occlusal dentine in first and second molars were calculated through photogrammetry, in a technique shown to have little intra- and inter-observer error. These data showed a strong linear correlation with skeletal age estimates, and varied significantly from the popular Brothwell (1963a) standard for age estimation based on dental wear. Dental caries and antemortem tooth loss were similarly tested for correlation with skeletal age, with only antemortem tooth loss showing a strong correlation. As a result, linear regression models were designed and tested for quantified first and second molar wear as well as antemortem tooth loss. Multiple regression models for all combinations of these dental indicators of age were also designed and tested. Although it is also recommended that these models are revised with expanded reference samples, these standards improve the ability to estimate age in individuals from the Kellis 2 cemetery population. It is recommended that these standards are tested and modified for use on geographically- and temporally-diverse populations to determine the boundaries of its application beyond a single population sample.
In summary, this study rejects the null hypothesis (Ho): ‘Current dental age estimation standards cannot be improved’. Consequently, this dissertation serves to encourage the creation of more accurate and precise subadult and adult macroscopic dental age estimation standards.