Cancer in two Renaissance families

We have read the criticism of Philippe Charlier and colleagues regarding our letter about the presence of cancer at the Aragonese court of Naples, but we disagree with their conclusions. First, our brief report exclusively regarded the cases of malignant soft tissue tumours diagnosed by histology, which cannot be found in skeletons, and therefore we have not considered all bone cancer cases present in the literature. The number of soft tissue malignancies is still five, because the mentioned case of metastatic carcinoma in an Egyptian mummy was diagnosed only by CT, without histology. Second, the comparison with the data from the Medici family is misleading and the data shown in the table1 are wrong, because all studied individuals were skeletonised, thus preventing any comparison between the well preserved mummies of Naples and the Medici. Furthermore, two tumours of the Aragonese nobles were limited to soft tissues, without any skeletal involvement. For the same reason, possibility of cancer affecting only the soft tissues cannot be excluded for the oldest members of the Medici family, and therefore it is improper to state that the same habits did not produce the same proportion of cancer cases, as claimed by Charlier and colleagues. In view of these considerations, we confirm that the presence of three cases of cancer in 11 individuals between 55 and 71 years of age showed a prevalence of 27%, very close to the 31% rate of modern countries,6 at least in these Spanish nobles who had peculiar alimentary habits that were extremely rich in meat and potentially carcinogenic, as shown by the KRAS mutation in the neoplastic cells of the adenocarcinoma of King Ferrante I of Aragon.7 We emphasise that the discovery is particularly important in oncology because it has allowed, and will certainly allow in the future with the aid of modern metagenomics, the identification of different carcinogenic factors, such as oncogenetic mutations, oncogenicviruses, and bacteria8, as mentioned in the letter of our colleagues.