Peto's paradox

Peto first formulated the paradox in 1977.{{Cite journal |last=Nunney |first=Richard |doi=10.1111/eva.12018 |pmid=23396311 |pmc=3567467 |title=The real war on cancer: the evolutionary dynamics of cancer suppression |journal=Evolutionary Applications |volume=6 |issue=1 |pages=11–19 |date=January 2013|bibcode=2013EvApp...6...11N }} Writing an overview of the multistage model of cancer, Peto noted that, on a cell-for-cell basis, humans were much less susceptible to cancer than mice. Peto went on to suggest that evolutionary considerations were likely responsible for varying per-cell carcinogenesis rates across species.

Within members of the same species, cancer risk and body size appear to be positively correlated, even once other risk factors are controlled for.{{cite journal |last1=Caulin |first1=Aleah |last2=Maley |first2=Carlo |date=April 2011 |title=Peto's Paradox: Evolution's Prescription for Cancer Prevention |journal=Trends in Ecology and Evolution |volume=26 |issue=4 |pages=175–182 |doi=10.1016/j.tree.2011.01.002 |pmc=3060950 |pmid=21296451|bibcode=2011TEcoE..26..175C }}

A 25-year longitudinal study of 17,738 male British civil servants, published in 1998, showed a positive correlation between height and cancer incidence with a high degree of statistical confidence, even after risk factors like smoking were controlled for.{{cite journal |last1=Smith |first1=George |last2=Shipley |first2=Martin |date=14 November 1998 |title=Height and mortality from cancer among men: prospective observational study |journal=BMJ |volume=317 |issue=7169 |pages=1351–1352 |doi=10.1136/bmj.317.7169.1351 |pmc=28717 |pmid=9812932}} A similar 2011 study of more than one million British women found strong statistical evidence of a relationship between cancer and height, even after controlling for a number of socioeconomic and behavioral risk factors.{{cite journal |author=Jane Green |author2=Benjamin J Cairns |author3=Delphine Casabonne |author4=F Lucy Wright |author5=Gillian Reeves |author6=Valerie Beral |date=August 2011 |title=Height and cancer incidence in the Million Women Study: prospective cohort, and meta-analysis of prospective studies of height and total cancer risk |journal=Lancet Oncology |volume=12 |issue=8 |pages=785–794 |doi=10.1016/S1470-2045(11)70154-1 |pmc=3148429 |pmid=21782509}} A 2011 analysis of the causes of death of 74,556 domesticated North American dogs found that cancer incidence was lowest in the smaller breeds, confirming the results of earlier studies.{{cite journal |last1=Fleming |first1=J.M. |last2=Creevy |first2=K.E. |date=25 February 2011 |title=Mortality in North American Dogs from 1984 to 2004: An Investigation into Age-, Size-, and Breed-Related Causes of Death |journal=Journal of Veterinary Internal Medicine |volume=25 |issue=2 |pages=187–198 |doi=10.1111/j.1939-1676.2011.0695.x |pmid=21352376 |s2cid=29868508 |doi-access=free }}

Across species, however, the relationship breaks down. In a 2015 study, the San Diego Zoo surveyed results from 36 different mammalian species, ranging in size from the 51-gram striped grass mouse to the nearly 100,000 times larger 4,800-kilogram elephant. The study found no statistically significant relationship between body size and cancer incidence, offering empirical support for Peto's initial observation.{{citation |last=Schiffman |first=Joshua |date=8 October 2015 |title=Potential Mechanisms for Cancer Resistance in Elephants and Comparative Cellular Response to DNA Damage in Humans |journal=JAMA |volume=314 |issue=17 |pages=1850–60 |doi=10.1001/jama.2015.13134 |pmid=26447779 |pmc=4858328}}

The evolution of multicellularity has required the suppression of cancer to some extent,{{Cite journal |last1=Caulin |first1=A. F. |last2=Maley |first2=C. C. |doi=10.1016/j.tree.2011.01.002 |title=Peto's Paradox: Evolution's prescription for cancer prevention |journal=Trends in Ecology & Evolution |volume=26 |issue=4 |pages=175–182 |year=2011 |pmid=21296451 |pmc=3060950|bibcode=2011TEcoE..26..175C }} and connections have been found between the origins of multicellularity and cancer.{{cite journal |last1=Kobayashi |first1=H |last2=Man |first2=S |date=15 April 1993 |title=Acquired multicellular-mediated resistance to alkylating agents in cancer |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=90 |issue=8 |pages=3294–8 |doi=10.1073/pnas.90.8.3294 |pmid=8475071 |pmc=46286 |bibcode=1993PNAS...90.3294K |doi-access=free }}{{cite journal |last1=Domazet-Lošo |first1=Tomislav |last2=Tautz |first2=Diethard |date=21 May 2010 |title=Phylostratigraphic tracking of cancer genes suggests a link to the emergence of multicellularity in metazoa |journal=BMC Biology |volume=8 |issue=66 |pages=66 |doi=10.1186/1741-7007-8-66 |pmid=20492640 |pmc=2880965 |doi-access=free }} In order to build larger and longer-lived bodies, organisms required greater cancer suppression. Evidence suggests that large organisms such as elephants have more adaptations that allow them to evade cancer.{{cite journal |last=Dang |first=Chi |date=2012 |title=Links between metabolism and cancer |journal=Genes & Development |volume=26 |issue=9 |pages=877–90 |doi=10.1101/gad.189365.112 |pmid=22549953 |pmc=3347786}} The reason that intermediate-sized organisms have relatively few of these genes may be because the advantage of preventing cancer these genes conferred was, for moderately-sized organisms, outweighed by their disadvantages—particularly reduced fertility.{{cite journal |url= http://www.nature.com/news/massive-animals-may-hold-secrets-of-cancer-suppression-1.12258 |title=Massive animals may hold secrets of cancer suppression |journal=Nature News |date=21 January 2013 |accessdate=12 March 2014 |last=Gewin |first=Virginia| doi=10.1038/nature.2013.12258 |s2cid=87061133 |url-access=subscription }}

Various species have evolved different mechanisms for suppressing cancer.{{cite news |last=Zimmer |first=Carl |date=October 8, 2015 |title=Elephants: Large, Long-Living and Less Prone to Cancer |url= https://www.nytimes.com/2015/10/13/science/why-elephants-get-less-cancer.html |newspaper=The New York Times |access-date=October 13, 2015}} A paper in Cell Reports in January 2015 claimed to have found genes in the bowhead whale (Balaena mysticetus) that may be associated with longevity.{{cite journal |last1=Keane |first1=Michael |last2=Semeiks |first2=Jeremy |last3=Webb |first3=Andrew E. |last4=Li |first4=Yang I. |last5=Quesada |first5=Víctor |last6=Craig |first6=Thomas |last7=Madsen |first7=Lone Bruhn |last8=van Dam |first8=Sipko |last9=Brawand |first9=David |last10=Marques |first10=Patrícia I. |last11=Michalak |first11=Pawel |last12=Kang |first12=Lin |last13=Bhak |first13=Jong |last14=Yim |first14=Hyung-Soon |last15=Grishin |first15=Nick V. |last16=Nielsen |first16=Nynne Hjort |last17=Heide-Jørgensen |first17=Mads Peter |last18=Oziolor |first18=Elias M. |last19=Matson |first19=Cole W. |last20=Church |first20=George M. |last21=Stuart |first21=Gary W. |last22=Patton |first22=John C. |last23=George |first23=J. Craig |last24=Suydam |first24=Robert |last25=Larsen |first25=Knud |last26=López-Otín |first26=Carlos |last27=O’Connell |first27=Mary J. |last28=Bickham |first28=John W. |last29=Thomsen |first29=Bo |last30=de Magalhães |first30=João Pedro |title=Insights into the Evolution of Longevity from the Bowhead Whale Genome |journal=Cell Reports |date=6 January 2015 |volume=10 |issue=1 |pages=112–122 |doi=10.1016/j.celrep.2014.12.008 |pmid=25565328 |pmc=4536333}} Around the same time, a second team of researchers identified a polysaccharide in the naked mole-rat that appeared to block the development of tumors.{{cite journal |last1=Xian |first1=T. |last2=Azpurua |first2=J. |date=27 January 2015 |title=INK4 locus of the tumor-resistant rodent, the naked mole rat, expresses a functional p15/p16 hybrid isoform. |journal=Proceedings of the National Academy of Sciences |volume=112 |issue=4 |pages=1053–8 |doi=10.1073/pnas.1418203112 |pmid=25550505 |pmc=4313802|bibcode=2015PNAS..112.1053T |doi-access=free }} In October 2015, two independent studies showed that African elephants have 20 copies of tumor suppressor gene TP53 in their genome, Asian elephants have 15 to 20, where humans and other mammals have only one.{{cite journal |last=Callaway |first=E. |title=How elephants avoid cancer: Pachyderms have extra copies of a key tumour-fighting gene. |journal=Nature |date=8 October 2015 |volume=526 |doi=10.1038/nature.2015.18534 |s2cid=181698116 }} Additional research showed 14 copies of the gene present in the DNA of preserved mammoths, but only one copy of the gene in the DNA of manatees and hyraxes, the elephant's closest living relatives.{{cite journal |first1=Michael |last1=Sulak |first2=Lindsey |last2=Fong |first3=Katelyn |last3=Mika |first4=Sravanthi |last4=Chigurupati |first5=Lisa |last5=Yon |first6=Nigel P. |last6=Mongan |first7=Richard D. |last7=Emes |first8=Vincent J. |last8=Lynch |date=September 19, 2016 |volume=5 |page=e11994 |title=TP53 copy number expansion is associated with the evolution of increased body size and an enhanced DNA damage response in elephants |journal=eLife |biorxiv=10.1101/028522 |doi=10.7554/eLife.11994 |pmid=27642012 |pmc=5061548 |doi-access=free }} The TP53 tumor suppressor gene specifies a protein that senses damaged sites in DNA, or a cell experiencing stress. The TP53 protein then either slows the growth of the cell for a brief period during which DNA damage is repaired, or it triggers cell death (apoptosis) if the damage is overwhelming. Enhanced capability to repair DNA damage may explain the observed cancer suppression in elephants. The results suggest an evolutionary relationship between animal size and tumor suppression, as Peto had theorized.{{cn|date=May 2023}}

A 2014 paper in Evolutionary Applications by Maciak and Michalak emphasized what they termed "a largely underappreciated relation of cell size to both metabolism and cell-division rates across species" as key factors underlying the paradox, and concluded that "larger organisms have bigger and slowly dividing cells with lower energy turnover, all significantly reducing the risk of cancer initiation."{{Cite journal |doi=10.1111/eva.12228 |pmid=25667599 |pmc=4310577 |title=Cell size and cancer: A new solution to Peto's paradox? |journal=Evolutionary Applications |volume=8 |issue=1 |pages=2–8 |year=2015 |last1=Maciak |first1=S. |last2=Michalak |first2=P. |bibcode=2015EvApp...8....2M }}

Maciak and Michalak argue that cell size is not uniform across mammalian species, making body size an imperfect proxy for the number of cells in an organism. (For example, the volume of an individual red blood cell of an elephant is roughly four times that of one from a common shrew.{{cite web|url= http://www.genomesize.com/cellsize/mammals.htm |title=Mammal erythrocyte sizes |last=Gregory |first=T. Ryan |date=3 February 2004 |website=Genome Size |access-date=13 October 2015

}}) Furthermore, larger cells divide more slowly than smaller ones, a difference which compounds exponentially over the life-span of the organism. Fewer cell divisions means fewer opportunities for cancer mutations, and mathematical models of cancer incidence are highly sensitive to cell-division rates.{{cite journal |last1=Calabrese |first1=Peter |last2=Shibata |first2=Darryl |date=5 January 2010 |title=A simple algebraic cancer equation: calculating how cancers may arise with normal mutation rates |journal=BMC Cancer |volume=10 |issue=3 |pages=3 |doi=10.1186/1471-2407-10-3 |pmid=20051132 |pmc=2829925 |doi-access=free }} Additionally, the basal metabolic rates of larger animals are generally lower, following a well-defined inverse logarithmic relationship, which is typically associated with reduced oxidative stress. Consequently, their cells will incur less damage over time per unit of body mass{{citation needed|date=January 2024}}. Combined, these factors may explain much of the apparent paradox.

Large animals' apparent ability to suppress cancer across vast numbers of cells has spurred an active medical research field.

In one experiment, laboratory mice were genetically altered to express "always-on" (always on meaning it doesn't get deactivated by the MDM2 gene) active TP53 tumor antigens,{{clarify|date=March 2020}} similar to the ones found in elephants. The mutated mice exhibited increased tumor suppression ability, but also showed signs of premature aging.{{cite journal |last1=Tyner |first1=Stuart D. |last2=Venkatachalam |first2=Sundaresan |last3=Choi |first3=Jene |last4=Jones |first4=Stephen |last5=Ghebranious |first5=Nader |last6=Igelmann |first6=Herbert |last7=Lu |first7=Xiongbin |last8=Soron |first8=Gabrielle |last9=Cooper |first9=Benjamin |last10=Brayton |first10=Cory |last11=Hee Park |first11=Sang |last12=Thompson |first12=Timothy |last13=Karsenty |first13=Gerard |last14=Bradley |first14=Allan |last15=Donehower |first15=Lawrence A. |title=p53 mutant mice that display early ageing-associated phenotypes |journal=Nature |date=January 2002 |volume=415 |issue=6867 |pages=45–53 |doi=10.1038/415045a |pmid=11780111 |bibcode=2002Natur.415...45T |s2cid=749047 }}

Another study placed p53 under normal regulatory control and did not find signs of premature aging. It is assumed that under its native promoter p53 does not cause premature aging, unlike constitutively expressed p53.{{cite journal |last1=García-Cao |first1=Isabel |last2=García-Cao |first2=Marta |last3=Martín-Caballero |first3=Juan |last4=Criado |first4=Luis M. |last5=Klatt |first5=Peter |last6=Flores |first6=Juana M. |last7=Weill |first7=Jean-Claude |last8=Blasco |first8=María A. |last9=Serrano |first9=Manuel |title='Super p53' mice exhibit enhanced DNA damage response, are tumor resistant and age normally |journal=The EMBO Journal |date=15 November 2002 |volume=21 |issue=22 |pages=6225–6235 |doi=10.1093/emboj/cdf595 |pmid=12426394 |pmc=137187 }}

• Comparative oncology
• Metabolic theory of ecology
• Tumor suppressor gene

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Category:Carcinogenesis

Category:Epidemiology

Category:Health paradoxes