By Dr Ananya Mandal, MD
Breast cancer has been known to mankind
since ancient times. It has been mentioned in almost every period of recorded
history. Because of the visible symptoms especially at later stages the lumps
that progress to tumors have been recorded by physicians from early times. This
is more so because, unlike other internal cancers, breast lumps tend to
manifest themselves as visible tumors.
Earlier, however, it was a matter of
taboo and embarrassment that meant detection and diagnosis was rare. The
mention of breast cancers in literature beyond medical journals and books was
rare. Involvement of more women and actively bringing out the disease into the
open is a recent phenomenon that is around three or four decades old. In the
1990’s the symbol of breast cancer - the pink ribbon – brought out a revolution
against this cancer.
Ancient
Greece and Egypt
Ancient Egyptians were the first to note
the disease more than 3,500 years ago. The condition was described fairly
accurately in both Edwin Smith and George Ebers papyri. One of the descriptions
refers to bulging tumors of the breast that has no cure.
In 460 B.C., Hippocrates, the father of
Western Medicine, described breast cancer as a humoral disease. He postulated
that the body consisted of four humors - blood, phlegm, yellow bile, and black
bile. He suggested that cancer was caused by the excess of black bile. In
appearance of the breast cancer too black, hard tumors are seen that burst
forth if left untreated to yield a black fluid. He named the cancer karkinos, a
Greek word for “crab,” because the tumors seemed to have tentacles, like the
legs of a crab.
Thereafter in A.D. 200, Galen described
the cancer as well. He also suggested excessive black bile but, unlike
Hippocrates, he postulated that some tumors were more dangerous than others. He
suggested medications like opium, castor oil, licorice, sulphur, salves etc.
for medicinal therapy of the breast cancers. During this time of history breast
cancer was a disease that affected the whole body and thus surgery was not
considered.
Breast
cancer in the 17th and 18th Century
Until the 17th century Galen’s theories
on breast cancer were believed. In 1680, French physician Francois de la Boe
Sylvius began to challenge the humoral theory of cancer. He hypothesized that
cancer did not come from an excess of black bile. He suggested it came from a
chemical process that transformed lymphatic fluids from acidic to acrid. In
1730s, Paris physician Claude-Deshais Gendron also rejected the systemic theory
of Galen and said that cancer developed when nerve and glandular tissue mixed
with lymph vessels.
In 1713 Bernardino Ramazzini's developed
a hypothesis that high frequency of breast cancer in nuns was due to lack of
sex. Ramazzini said that without regular sexual activity, reproductive organs,
including the breast may decay and develop cancers. Yet another researcher Friedrich
Hoffman of Prussia postulated that women who had regular sex but still
developed cancer were practicing “vigorous” sex. This could be leading to
lymphatic blockage.
Other theories included Giovanni
Morgagni blaming curdled milk, Johanes de Gorter blaming pus-filled
inflammations in the breast, Claude-Nicolas Le Cat from Rouen blaming
depressive mental disorders, Lorenz Heister blaming childlessness, and yet
others blaming sedentary lifestyle.
It was in 1757 when Henri Le Dran, a
leading French physician suggested that surgical removal of the tumor could
help treat breast cancer, as long as infected lymph nodes of the armpits were
removed. Claude-Nicolas Le Cat argued that surgical therapy was the only method
to treat this cancer. This lasted well into the twentieth century and led to
the creation of the radical mastectomy or extensive removal of the breast.
The
19th and 20th Century
By mid-nineteenth century, surgery was
the available option for breast cancer. The development of antiseptic, anesthesia
and blood transfusion during this time also made survival after a surgery more
possible.
William Halstead of New York made
radical breast surgery the gold standard for the next 100 years. He developed
radical mastectomy that removed breast, axillary nodes (nodes in the armpits),
and both chest muscles in a single en bloc procedure or in a single piece to
prevent spread of the cancer while removing each of these individually.
Radical mastectomy was the mainstay of
treatment for the initial four decades of the twentieth century. Although
radical mastectomy helped women survive longer, especially if performed early,
many women did not choose it since it left them disfigured. In addition there
were problems like a deformed chest wall, lymphedema or swelling in the arm due
to lymph node removal and pain.
In 1895, Scottish surgeon George Beatson
discovered that removing the ovaries from one of his patients shrank her breast
tumor. As this caught on, many surgeons began removing both ovaries and
performing a radical mastectomy for breast cancers. This reduction of the tumor
after removal of the ovaries was due to the fact that estrogen from ovaries
helped in growth of the tumor and their removal helped reduce the size of the
tumor.
What came next was that in these women
without ovaries, estrogen was produced by the adrenal glands. In 1952 Charles
Huggins began removing a woman’s adrenal gland (adrenalectomy) in an effort to
starve the tumor of estrogen. Rolf Lefft and Herbert Olivecrona began removing
the pituitary gland – another site of estrogen production stimulation.
Development
of the systemic theory
In 1955, George Crile suggested that
cancer was not localized but rather is spread throughout the body. Bernard
Fisher also suggested the capability of cancer to metastasize. In 1976, Fisher
published results using simpler breast-conserving surgery followed by radiation
or chemotherapy. He noted that these were just as effective as radical
mastectomy.
With advent of modern medicine, by 1995,
less than 10 percent of breast cancer-inflicted women had a mastectomy. This
time also saw the development of novel therapies for breast cancer including
hormone treatments, surgeries and biological therapies. Mammography was also
developed for early detection of the cancers. Scientists then isolated the
genes that cause breast cancer: BRCA 1, BRCA2 and ATM
Reviewed by April Cashin-Garbutt, BA
Hons (Cantab)
Sources
http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/index
assets.cambridge.org/97805214/96322/excerpt/9780521496322_excerpt.pdf
www.cancer.org/acs/groups/cid/documents/webcontent/002048-pdf.pdf
http://www.randomhistory.com/1-50/029cancer.html
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