Which U.S. presidents have had cancer and why wasn’t it diagnosed?

During his vice presidency, Joe Biden championed what the Obama administration called a “Cancer Moonshot,” which he led as a tribute to his son Beau Biden, who had died of cancer in 2015.

“Several cutting-edge areas of research and care — including cancer immunotherapy, genomics, and combination therapies — could be revolutionary,” said Biden at the time. “Innovations in data and technology offer the promise to speed research advances and improve care delivery.”

It’s likely that Biden, 82, will himself benefit from some of that technology as he battles an aggressive, hormone-sensitive form of prostate cancer. While survival when the cancer has spread to other parts of the body — in his case, the bones — is not as likely as when it’s detected at an earlier stage, survival rates for the disease can be “measured in years now, not months,” As Dr. Daniel W. Lin, a University of Washington prostate cancer specialist, told The New York Times.

In the same article, Dr. Judd Moul, a prostate cancer expert at Duke University, said he has many patients with stage 4 cancer like Biden’s and he’s “much more optimistic now than ever before.”

Presidents who also had cancer

At least seven U.S. presidents have had some type of cancer, some cases more serious than others, according to news reports and historical records. Among them:

• Ulysses S. Grant, the 18th president, had tongue cancer and died at age 63, according to the Roswell Park Comprehensive Cancer Center. He died a year after diagnosis.
• Grover Cleveland, who was both No. 22 and No. 24, had a mass on the roof of his mouth and had a secret surgery aboard a yacht in 1893, according to The Surgery Journal. Part of his jaw and several of his teeth were removed, then a New York dentist created a rubber implant that allowed normal facial control and speech. The journal article reported that just two weeks after a second operation, Cleveland was described as “well-tanned,” “in perfect health,” “looking well and not the least weary.” Cleveland lived another 15 years and died of a heart attack. It was long after the surgeries that the public learned he’d had them.
• The 31st president, Herbert Hoover, had early-stage colon cancer that was diagnosed because of anemia and gastrointestinal bleeding, according to Labroots. Part of his colon was removed and he lived another two years, but died of related internal bleeding.
• Lyndon B. Johnson, No. 36, had basal cell skin cancer, which he kept secret. Four years after he died of a heart attack in 1973, the U.S. Navy said that he’d had skin cancer.
• Jimmy Carter, No. 39, was very public with his cancer, which struck many years after he’d left office. He said that malignant melanoma had moved to his liver and his brain. For three months, he endured immunotherapy and radiation and after three months, he was declared cancer free, according to the American Association for Cancer Research. Despite the poor prognosis that often accompanies a metastasized melanoma diagnosis, Carter said he benefited from breakthrough immunotherapy.
• Ronald Reagan, the 40th president, had both colon and skin cancer during his presidency and survived both types, which are not related. He died 19 years later as a result of pneumonia.
• Bill Clinton, No. 42, was treated for actinic keratosis and basal cell cancer, according to the Journal of the American Academy of Dermatology.

There are other suspected cancer cases among presidents. Per Labroots, “Medical advances in diagnosing cancer have significantly evolved since George Washington was inaugurated in 1789. The list of presidents with cancer would likely be longer if all benefited from modern medicine. For example, historians believe that Thomas Jefferson (No. 3) suffered from undiagnosed prostate cancer. Likewise, scientists suspect that Abraham Lincoln (No. 16) may have died of thyroid cancer had he not been assassinated."

As for Lincoln, Roswell Park reported that if he had cancer, he likely didn’t know it. “At 6-foot-4, Lincoln was the tallest president, and also had unusually long and thin hands, feet, neck and face. Some doctors have suggested that he might have had Marfan syndrome, a genetic disorder of the connective tissue. Others have attributed his characteristics to multiple endocrine neoplasia type 2 (MEN2), a hereditary condition that affects hormone-producing glands and which can cause cancer in addition to muscle, joint and digestive problems.”

Some believe that George Washington had skin cancer — and he thought so, too. According to George Washington’s Mount Vernon website, in 1794, Dr. James Tate, a former Revolutionary War surgeon, “treated George Washington for a skin malady Washington believed to be cancerous — perhaps even a form of melanoma. As accounts described, Washington urged Dr. Tate to cut even deeper into his flesh so as to fully extract the cancer and thereby prevent its return." He also thereafter wore a hat when he was outside in the sun.

Knowing that some presidents have hidden a cancer diagnosis has naturally led to questions about whether “some (diagnoses) may remain hidden today.”

What kind of screening had Biden had?

MSNBC in a YouTube video reported that former Obama health advisor Dr. Zeke Emanuel said there’s no evidence in available medical records that Biden had ever had a prostate-specific antigen (PSA) test that is used to help detect prostate cancer. He noted some men choose not to get one and many doctors don’t offer them unless a patient has symptoms.

One commenter noted that his father-in-law had the test every year, but the PSA didn’t show cancer until it was too late. “Fast-growing small cell prostate cancer often doesn’t raise PSA until it metastasizes,” the individual wrote.

The PSA test doesn’t actually diagnose cancer. It shows how much of the protein-specific antigen is in the blood. And other things can cause an elevated reading, including an enlarged prostate, which is very common in older men, or an infection.

According to Memorial Sloan Kettering Cancer Center, many people believe that routine PSA testing is a bad idea because it leads to overdiagnosis and overtreatment. The center’s Dr. Andrew Vickers said offering it to the right patients who are most at risk changes that. “When PSA is being offered only to patients in the appropriate age range — meaning between the ages of 45 and 70 — the amount of overdiagnosis and overtreatment will also go down,” he said in 2022.

It can’t be overlooked, however, that the former president is well over the age for testing under that guideline. It’s possible that when he was in that age group, he didn’t have prostate cancer and it would not have been detected by a PSA.

The recommended age has been capped around 70 because most people diagnosed after 70 will die with but not of prostate cancer, which is generally slower growing. Biden, however, has an advanced case of an aggressive form.