In her acclaimed 2012 book, ” Breasts: A Natural and Unnatural History,” science writer Florence Williams cuts to the chase: ” Breast cancer has probably been around for as long as there have been breasts.”
From what historians tell us, treating the disease in the earliest days wasn’t pretty.
The first known written documentation of patients dealing with breast cancer dates back to an Egyptian scroll from around 1,600 B.C. It contains 48 case histories possibly written between 3,000 and 2,500 B.C.
The Ancient Greeks also knew breast cancer, as did Medieval Europeans. In his 2002 book, ” Bathsheba’s Breast: Women, Cancer & History,” James S. Olson, a cancer survivor himself, writes of many ancient women who battled the disease through the ages and the sometimes deadly ways their doctors tried to help them.
[See: What Not to Say to a Breast Cancer Patient.]
Olson describes the surgical approach that would eventually become the mastectomy in the story of Byzantine empress Theodora. In A.D. 548, she discovered a tumor in her breast, and her physician wanted to perform surgery to treat it. (Theodora declined and died of breast cancer.) The surgeon wrote, “I make the patient lie down, and then I incise the healthy part of the breast beyond the caancerous areas and I cauterize the incised parts. Then I again incise and excise the breadth for its depths and I again cauterize the incised area. And I repeat the procedure often.”
Although ancient surgeons understood the need to remove cancerous tissue from the breast, achieving this goal was challenging at best. A lack of anesthesia meant writhing and screaming patients could become a moving target. Olson writes, “Without anesthesia, patients endured horrible pain, and physicians could never be sure how they would react. More often than not, patients squirmed and grimaced, trying to fend off the scalpel, even while knowing the surgery was necessary.”
Relatively safe and effective anesthesia arrived in 1846 when William Thomas Green Morton, a dentist and surgeon at the Massachusetts General Hospital in Boston, successfully used ether to anesthetize a patient during a surgical procedure. Whereas before anesthesia, surgeons had to be lightning fast and decisive in their cuts to a conscious patient, anesthesia meant physicians could finally proceed with more caution and precision.
However, no matter how methodical they were, the dearth of diagnostic tools such as mammograms and blood tests also meant that physicians were largely guessing as to whether they’d removed all the cancer. Surgical procedures conducted before the development of germ theory — the idea that microbes and bacteria can cause infection made more mainstream in 1881 by Louis Pasteur — were also often deadly affairs for the patient. Infection of surgical incisions claimed many lives. Even after doctors fully understood the need for antiseptic procedures, the antibiotics we use so extensively today to fight infection wouldn’t arrive until penicillin debuted in 1928.
Nevertheless, in 1894, American surgeon William Stewart Halsted published his findings after more than 50 surgeries he’d conducted at Johns Hopkins hospital between 1889 and 1894. All involved the use of a new technique he called “the complete operation,” which eventually came to be known as “the radical mastectomy.” In this procedure, Halstead spared no thought for how the patient would look post-procedure; he simply excised all breast tissue, skin, the pectoralis muscles and all axillary lymph nodes. By completely removing all the tissue that could become cancerous, Halsted discovered that he could all but halt the progression of breast cancer.
In those days, side effects weren’t viewed the way we see them now, and considerations for the emotional well-being of the patient were nonexistent. Despite the brutality of the operation, many women went on to live cancer-free for the rest of their lives.
[See: A Tour of Mammographic Screenings During Your Life.]
Around the same time, a British surgeon, Sir George Beaston, was doing his own radical work on a different piece of the breast cancer treatment puzzle and came up with one of the biggest advancements in breast cancer treatment ever in 1896, says Dr. Robert Wesolowski, assistant professor of medicine at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. That’s when Beaston noticed that women with metastatic breast cancer who underwent removal of their ovaries fared better and lived longer after the procedure than women who didn’t have the oophorectomy. In some cases, the cancer seemed to disappear altogether. “That was a major discovery and really the pivotal point in breast cancer history,” Wesolowski says. “That discovery led to the development of the very first targeted therapies of cancer that inhibit estrogen,” he says.
Also in 1896, Wilhelm Conrad Roentgen, a German physics professor and winner of the Nobel Prize in physics, discovered the X-ray. Within five years, it was being used to treat cancer. It didn’t take long for doctors to realize radiation could cause cancer as well as cure it, but its discovery led to new treatments for an old scourge.
Similarly, chemotherapy entered the discussion of cancer treatment in the 1950s. The American Cancer Society reports that “metastatic cancer was first cured in 1956 when methotrexate [a common chemotherapy drug] was used to treat a rare tumor called choriocarcinoma.”
Building on the hormonal theory Beaston first began outlining in the late 19 th century, anti-estrogen therapies became common in the late 20 th century. In 1977, the revolutionary anti-estrogen drug tamoxifen was approved for use in America and has saved countless lives since. Breatcancer.org reports that tamoxifen, also known by its generic name Nolvadex, “is the oldest and most-proscribed SERM,” or selective estrogen receptor modulator. It works by preventing cancer cells from growing by blocking their ability to use estrogen as a fuel.
[See: 7 Innovations in Cancer Therapy.]
Although the typical approach to treating breast cancer — surgery, chemo, radiation, anti-estrogen therapy used alone or in combination — became well established in the mid to late 20 th century, 21 st century innovations promise to bring the next revolution in cancer care. Targeted, individualized molecular and immunotherapies promise a more humane and effective future for breast cancer care.
Although we’ve been wrestling with the disease for millennia, there’s some hope that our treatments will soon outpace the body’s own evolutionary systems, and one day we’ll be able to treat a case of breast cancer without invasive or damaging procedures. Only time and the continued efforts of research scientists, clinicians and patients can usher in that new era in this evolving field, says Erica Mayer, senior physician at the Dana-Farber Cancer Institute and the Susan S. Smith Center for Women’s Cancers at DFCI in Boston. She notes “the importance of clinical research in advancing our ability to take care of breast cancer patients. All of the treatments and advances reflect the work done by the researchers and the patient volunteers who’ve been in the studies. Our ability to continue to treat breast cancer depends on the partnership between researchers and patients.”
More from U.S. News
A Tour of Mammographic Screenings During Your Life
7 Innovations in Cancer Therapy
What Not to Say to a Breast Cancer Patient
Has Breast Cancer Always Been a Problem? originally appeared on usnews.com
