March is Women’s History Month. The history of women and the history of breast cancer go hand in hand. But how far back does the history of breast cancer go? How long have we known about it, and how long have we been able to treat it? This article will discuss treatments and diagnoses of breast cancer since antiquity.
Who first discovered breast cancer?
When did breast cancer start?
Breast cancer, and cancer as a whole, has likely been around as long as humanity has. Evidence of prostate cancer has been found on skeletons of both a Russian king (approximately 2,700 years old) and an Egyptian mummy (about 2,200 years old). But the earliest record we have of breast cancer can be found on the Edwin Smith Surgical Papyrus, an Egyptian papyrus dating back to 3000-2500 BC. While the papyrus does not offer much in the way of treatment options, it does give a way to identify an incurable disease as “cool to touch, bulging and spread all over the breast.”
Ancient Greece, around 460 BC, gave us the term carcinoma (karkinoma). Carcinoma is a cancer that starts in skin or organ tissue cells rather than in structures like blood vessels or bones. However, breast cancer treatment was still relatively unsuccessful as it was believed that disease was caused by imbalances of the four humours, phlegm, yellow bile, black bile, and blood. To treat illnesses, one had to remove or increase the humours within the body. Galen, a well-known Greek physician from around 168 BC, claimed that breast cancer was caused by too much black bile and began to treat the condition with surgery to remove the tumor, though he let the incisions bleed to continue removing excess bile.
While the surgery that Galen performed spread throughout Greece, the increase in religious philosophies and medical approaches prevented the practice from going much further. Early Christianity believed surgery to be more barbaric than their faith healing preference, a tradition that persisted through much of the world between 476 and 1500 AD. However, between the 10th and 15th centuries, Abu Al-Qasim Al-Zahrawl and Ibn Sina, a pair of Islamic physicians, revived the Greek practices, including surgery, and wrote many medical texts. Their ideas and practices spread throughout Europe.
The 16th, 17th, and 18th centuries, known more commonly as the Renaissance period, saw a growth in surgical practice. Where once ‘surgeon’ was simply a title tagged onto the end of ‘barber’, and a procedure could be performed after a haircut, surgeons now had their own trade. John Hunter, a Scottish surgeon, proposes the first idea of breast cancer in stages. While not as clearly defined as those we have today, there were some stages where surgery was necessary, while others were not. This was also a time of no anesthesia, so these early lumpectomies and mastectomies had to be performed quickly and accurately.
As the 19th century rolled around, significant improvements were made to the safety of surgery. With the introduction of hygiene to medical practices (albeit slowly), disinfection and surgical garments became more common. Anesthesia was also developed, helping prevent patient shock and give the doctors more time to perform the breast cancer surgery. William Halsted, an American surgeon, developed the radical mastectomy procedure in 1894. This procedure removes the entire tumor in a single piece together with the breast, the axillary lymph nodes, lymphatic vessels, and pectoral muscles. This was the first time breast cancer was considered treatable and even curable. Two years later, Thomas Beatson, a British surgeon, announces that oophorectomies–operations to remove one or both ovaries– can reduce tumors in advance breast cancer.
Modern Breast Cancer Treatments
The 20th century brought vast change to breast cancer treatment. Tumors were shrunk using radiation. Chemotherapy was introduced in the 1940s, and Robert Egan introduced mammography as a breast cancer detection option in 1962. The first modern autologous breast reconstruction was performed in 1979, allowing for more natural feeling breasts. More medications, procedures, and treatments for breast cancer have been researched and implemented, as well as potential causes and risk factors. The BRCA1 and BRCA2 genes–commonly known as the breast cancer gene– were discovered in 1995. A few years later, new breast cancer subtypes–HER2 positive, triple-negative, progesterone receptor-positive, and estrogen receptor-positive–were classified in 2000.
Even today, new research is still being performed to improve upon the surgeries, treatments, and post-op for breast cancer patients to have the best possible results. Dr. Gorman was involved in a study using the Biozorb implantable marker that helps target radiation therapy as well as post-operation imaging. She also contributes to the study on Accelerated Partial Breast Irradiation, or APBI, a method that shortens the amount of time the patient needs to spend getting radiation therapy and uses a higher dose of radiation in a more targeted beam–assisted by the Biozorb marker. She also uses oncoplastic techniques which help with postoperative cosmesis.
Breast Cancer Treatment Today
With today’s understanding of the disease, treatment is far more effective than it has been in the past. One primary reason for this is the improved breast cancer screening guidelines and understanding of breast cancer risk factors such as family history or having the so-called ‘breast cancer genes’. Knowledge of these risk factors can help set up specific screening procedures for those with a higher risk of breast cancer while still having a standard screening arrangement for those with lower risk. Getting a regular mammogram and breast self exam are easy steps to keep an eye out for early potential signs and symptoms. The sooner breast cancer is caught, the easier it is to treat.
Once a breast cancer diagnosis is reached, a treatment plan is agreed upon; no patient’s treatment plan and recovery are exactly alike. Treatment plans can–but do not necessarily–include breast surgery, radiation therapy, chemotherapy, hormone therapy, targeted medical therapy, as well as cosmetic surgery to aid in the patient’s self-image after an oncological procedure. Each of these treatment options has benefits and downsides and side effects and is more useful in some situations than others. The different surgical approaches can be applied depending on the tumor’s size and how far the breast cancer cells have spread. There are options to save more of the breast tissue and chest muscles if the breast cancer is caught early enough.
Combination treatments–surgery accompanied by radiation therapy or chemotherapy alongside medical therapy, for example–can help by approaching the breast cancer from different angles, ensuring thorough results with no cancer cells left behind and decreasing recurrence. With a combined effort from a full oncological team, the survival and recovery rates have increased exponentially since the days of the Edwin Smith Surgical Papyrus.
Dr. Gorman and her team at the Texas Breast Center work together to treat breast cancer from all angles. Dr. Gorman focuses on treating from the surgical side and works closely with medical and radiation oncologists to form a personalized treatment plan best suited to each patient. She also looks to the future of treatment by keeping aware of current and ongoing breast cancer research to best treat her patients. If you have questions or are ready to find your next steps in treatment, reach out to the Texas Breast Center. The team is prepared to help.