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In October 2022, breast cancer remains the most prevalent cancer in women worldwide. It is estimated that approximately 2.3 million women will be diagnosed with breast cancer by the end of this year, and 685,000 women who have been battling this awful disease will lose the war against breast cancer. Ten years ago, there were 1,671,100 cases, including 521,900 deaths. That means approximately 163,100 more women will die this year than 10 years ago.
Sex and age play major roles in breast cancer. Since age is involved, let's go back to the ages when breast cancer was first recorded to learn more.
Ancient Egypt
Breast cancer has been diagnosed in women for thousands of years. The first mention in the history of any type of cancer or disease was breast cancer. In 1860, an ancient Egyptian papyrus was found in an Egyptian tomb that contains the oldest known descriptions of signs and symptoms of several medical conditions. This papyrus is believed to be a 1600 B.C. copy of the original 3000 B.C. version. Papyrus is a type of paper made from the papyrus plant. In ancient Egyptian text, the papyrus describes a tumor on a woman’s breast, a clear indication of the early discovery of breast cancer. The papyrus was purchased in 1862 by Edwin Smith, an American dealer, and collector of antiques. It is known as the Edwin Smith papyrus and is the oldest known medical discovery of breast cancer.
Ancient Greece
In ancient Greece, people made votive offerings in the shape of a breast to give to the God of medicine. Votive offerings, such as a sculpture of a breast made from clay, were placed in religious sanctuaries in hopes that the medicine God would bless them with a cure.
In early 400 B.C., Hippocrates assumed breast cancer developed in stages and described breast cancer as a humoral disease. Hippocrates theorized that the body consisted of four humors: blood, phlegm, yellow bile, and black bile. These four humors were studied to determine the health of an individual.
According to his theory, the four humors must be in balance for a person to be healthy. Hippocrates suggested that breast cancer was caused by an excess of black bile, due to the blackish appearance of the breast where the cancerous tumor was located.
Hippocrates named cancer Karkinos, a Greek word for “crab”, because cancerous tumors seemed to have legs like a crab. Hippocrates was an outstanding human being with several medical achievements for his time. Hippocrates will forever be known as the father of modern medicine.
150 B.C. to 500 A.D.
Hippocrates' theories influenced medical standards for hundreds of years into the Greco-Roman era, 150 B.C. to 500 A.D. In the first century, doctors experimented with surgical incisions to destroy tumors. They also thought that breast cancer was linked to the end of menstruation. This theory may have prompted the association of cancer with older age.
30 A.D.
Roman physician Aurelius Celsus wrote De Medicina, describing an unusual swelling of the breast with twisting and winding veins and ulcers. He realized that breast cancer had a high risk of recurrence and did not agree with surgical procedures for treatment.
129–216 A.D.
Galen, a Greek physician, and philosopher from Turkey is one of the most influential and important ancient medical scholars. Galen supported Hippocratic humoral theory and paid close attention to black bile’s supposed carcinogenic effects. He described breast cancer as swelling with distended veins, which he also compared to a crab.
Leonidas, referred to as the first oncologic surgeon and the first to break the Hippocratic teachings, provided the original detailed description of a mastectomy. His findings included the first explanation of nipple retraction as a clinical sign of breast cancer. Leonidas followed Galen in advocating breast cancer excision via a wide cut through normal tissues but recommended alternate incision and cauterization. Cauterization, meaning the use of a heated instrument, an electrical current, or a chemical to burn, dissolve or remove tissue, became the standard for the next 15 centuries.
Middle Ages 500-1399
In the beginning of the Middle Ages, medical progress was associated with new religious philosophies. Christians thought surgery was barbaric and were in favor of faith healing. This is because doctors would burn away parts of the breast to remove the disease.
In the late 1200s, Henri de Mandeville, a surgeon to the lord of France, refined Galen's dark bile theory with a connection between dark bile from the liver. The dark bile from the liver made a hard tumor in the chest which eventually metastasized. He described breast cancer as being ulcerated with thick edges and barring a sour scent.
Scientific understanding and the medical management of breast cancer evolved slowly since being discovered in the ancient Egyptian papyrus. Because these periods are marked by the absence of any scientifically verifiable understanding of the pathology of breast cancer, there was a lack of effective treatments. However, all these periods led to better understanding of breast cancer for the centuries that followed.
Renaissance 1400–1600 A.D.
The Renaissance saw a revival of surgery, with doctors exploring the human body. John Hunter, known as the Scottish father of investigative surgery, identified lymph as a cause of breast cancer. Lymph is the fluid carrying white blood cells throughout the body.
Lumpectomies were performed by surgeons, but anesthesia was not available, so surgeons had to be fast and accurate to be successful. These primitive practices have thankfully given way to safer, more effective methods for treating breast cancer as well as many other cancers.
Michael Servetus, a Spanish physician, who studied in Paris, was the first to advocate for an axillary node dissection, as well as removal of a portion of the pectoralis muscles when removing breast tumors. In 1509. A year later, Ambrose Paré, who also studied in Paris, was the first to notice swelling of the axillary glands in advanced breast cancer.
In 1590, Bartoleny Gabrol from Montpellier, France advocated for radical mastectomy, which was made popular by Halsted 300 years later. However, the lack of anesthesia and the high number of infections post-surgery were a serious issue for the surgeons of that time. Performing such surgeries were considered heroic but primitive and even inhumane by today’s standards.
1700
In the 1700s, discoveries in medicine and surgery were slow to develop. Yet, major contributions in lymph node mapping during this period are attributed to Pieter Camper and Paolo Mascagni who defined the internal mammary and pectoral lymph nodes.
In 1713, Bernardino Ramazzini developed a hypothesis that a high frequency of breast cancer in nuns was due to lack of sex.
Henri Le Dran (b. 1685) wrote that cancer begins as a local disease but then spreads via lymph, which conveyed a grave prognosis. Le Dran’s colleague, Jean Petit (b. 1674), recommended breast, pectoral muscle, and axillary lymph node removal to help manage breast cancer. However, without reconstructive capabilities, the chest wall was often left disfigured with a large gaping wound. Mastectomies were common in the early 1700s; however, a mastectomy procedure was rare by the end of the century.
Breast Cancer Research Achievements
Our more modern approach to breast cancer treatments and research started forming in the 19th century. The history of breast cancer is filled with important discoveries and patient bravery such as:
1804 Japanese surgeon Seishu Hanaoka performed the world's first procedure under general anesthesia, a mastectomy.
1882 William Halsted performed the first radical mastectomy. This will remain the standard operation to treat breast cancer until the 20th century.
1895 The first X-ray was taken by Wilhelm Röntgen’s discovery. Eventually, low dose X-rays called mammograms, would be used to detect breast cancer.
1898 Marie and Pierre Curie discover the radioactive elements radium and polonium. Shortly after, radium is used in cancer treatment.
1902 Physicist S. Goldberg used radiation for breast cancer treatment, a year later the first radiotherapy department was built at the Cancer Hospital in London.
1913 The inaugural mammography study which looked at 3,000 mastectomies, was performed by a German surgeon, Albert Salomon.
1932 A new approach to mastectomy is developed. The surgical procedure is not as disfiguring and becomes the new standard.
1937 Radiation therapy is used with surgery to save breasts after removing tumor needles with radium placed in the breast near lymph nodes.
1948 Modified radical mastectomy, which spared the pectoralis muscles, was introduced by Patey and Dyson from London. The same year simple mastectomy combined with radiotherapy was introduced by McWhirter in Edinburgh.
1960 Chemotherapy was used for the first time as a treatment for breast cancer in combination with surgery or radiotherapy treatments.
1970 Modified radical mastectomy became the standard treatment for women with stage I and II breast cancer.
1978 Tamoxifen is FDA approved for breast cancer treatment. This anti-estrogen drug was the first in a new class of drugs known as Selective Estrogen Receptor Modulators (SERM).
1980 Chemotherapy became the standard for early breast cancer. However, side effects remain a concern and chemotherapy does not benefit most patients.
1984 Researchers discover a new gene in rats. The human version, HER2, is found to be linked with more aggressive breast cancer when overexpressed. HER2-positive breast cancer isn’t as responsive to treatments.
1985 Early-stage breast cancer treated with a lumpectomy and radiation have similar survival rates to women treated with only a mastectomy.
1986 Scientists figure out how to clone the HER2 gene.
1990 Sentinel node biopsy permitted avoidance of axillary dissection if the sentinel node was disease-free.
1995 Scientists clone the tumor suppressor genes BRCA1 and BRCA2. Inherited mutations in these genes can predict high risk of breast cancer.
1996 FDA approves anastrozole (Arimidex) as a treatment for breast cancer. This drug blocks the production of estrogen.
1998 Tamoxifen is found to decrease the risk of developing breast cancer in women by 50%. It is approved by the FDA for use as a preventive therapy.
1998 Trastuzumab (Herceptin), a drug targeting cancer cells that are over
producing HER2, is also approved by the FDA.
2006 The SERM drug raloxifene (Evista) is found to reduce breast cancer for postmenopausal women who are higher risk. It has a lower chance
of serious side effects than tamoxifen.
2011 A large meta-analysis finds that radiation therapy significantly reduces the risk of breast cancer recurrence and mortality.
2017 The first biosimilar drug, Trastuzumab-Dkst is FDA approved for breast cancer treatment. Unlike generics, biosimilars are copies of biological drugs and cost less than branded drugs.
2018 A clinical trial suggests that chemotherapy after surgery doesn’t benefit 70% of women with early-stage breast cancer.
2019 Enhertu is FDA approved and is very effective in treating HER2-positive breast cancer that’s metastasized or can’t be removed with surgery.
2020 Trodelvy is FDA approved for treating metastatic triple negative breast cancer for women who haven’t responded well to at least two other treatments.
Breast cancer continues to be a deadly disease, no matter how much modern medicine advances. Breast cancer is projected to be the most diagnosed cancer among American women by the end of 2022, and that about 30% of newly diagnosed cancers will be breast cancers.
It is estimated that 339,250 total new cases of breast cancer will develop, and of those 339,250 cases, 43,250 women will die from breast cancer this year.
There is now more access to information and support for doctors and scientists than ever before. This information used for early detection, treatment, and prevention of this malignant disease has helped save many lives.
Awareness and Early Detection is a Lifestyle. Lifestyle is the Solution.
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The History of Breast Cancer
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