Breast cancer historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Assistant Editor(s)-In-Chief: Jack Khouri
Overview
Breast cancer may be one of the oldest known forms of cancer tumors in humans.
Historical Perspective
The oldest description of cancer (although the term cancer was not used) was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization.The writing says about the disease, "There is no treatment."[1] For centuries, physicians described similar cases in their practices with the same sad conclusion. It wasn't until doctors achieved greater understanding of the circulatory system in the 17th century that they could establish a link between breast cancer and the lymph nodes of the armpit. The French surgeon Jean Louis Petit (1674-1750) and later the Scottish surgeon Benjamin Bell (1749-1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. He became known for his Halsted radical mastectomy, a surgical procedure that remained popular up until the 1970s.
Because of its visibility, breast cancer was the form of cancer most often described in ancient documents.[2] Because autopsies were rare, cancers of the internal organs were essentially invisible to ancient medicine. Breast cancer, however, could be felt through the skin, and in its advanced state often developed into fungating lesions: the tumor would become necrotic (die from the inside, causing the tumor to appear to break up) and ulcerate through the skin, weeping fetid, dark fluid.[2]
Ancient medicine, from the time of the Greeks through the 17th century, was based on humoralism, and thus led to the belief that breast cancer was generally caused by imbalances in the fundamental fluids,especially an excess of black bile, that control the body.[3] Alternatively, patients often saw breast cancer as divine punishment.[4] In the 18th century, a wide variety of medical explanations were proposed, including: a lack of sexual activity; too much sexual activity; physical injuries to the breast; curdled breast milk; and various forms of lymphatic blockages, either internal or due to restrictive clothing.[3][5] In the 19th century, the Scottish surgeon John Rodman said that fear of cancer caused cancer, and that this anxiety, learned by example from the mother, accounted for breast cancer's tendency to run in families.[5]
Although breast cancer was known in ancient times, it was uncommon until the 19th century, when improvements in sanitation and control of deadly infectious diseases resulted in dramatic increases in lifespan. Previously, most women died too young to have developed breast cancer.[5] Additionally, early and frequent childbearing and breastfeeding probably reduced the rate of breast cancer development in those women who did survive to middle age.[5]
Because ancient medicine believed that the cause was systemic, rather than local, and because surgery carried a high mortality rate, the preferred treatments tended to be pharmacological rather than surgical. Herbal and mineral preparations, especially involving the poison arsenic, were relatively common.
Mastectomy for breast cancer was performed as early as AD 548, when it was proposed by the court physician Aetios of Amida to Theodora.[2] It was not until doctors achieved greater understanding of the circulatory system in the 17th century that they could link breast cancer's spread to the lymph nodes of the armpit. The French surgeon Jean Louis Petit (1674–1750) and later the Scottish surgeon Benjamin Bell (1749–1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle.[6]
Their successful work was carried on by William Stewart Halsted who started performing radical mastectomies in 1882. William Stewart Halsted was helped greatly by advances in general surgical technology, such as aseptic technique and anesthesia. The Halsted radical mastectomy often involved removing both breasts, associated lymph nodes, and the underlying chest muscles. This often led to long-term pain and disability, but was seen as necessary in order to prevent the cancer from recurring.[7] Before the advent of the Halsted radical mastectomy, 20-year survival rates were only 10%; Halsted's surgery raised that rate to 50%.[8] Extending Halsted's work, Jerome Urban promoted superradical mastectomies, taking even more tissue, until 1963, when the ten-year survival rates proved equal to the less-damaging radical mastectomy.[7]
Radical mastectomies remained the standard of care in America until the 1970s. In Europe, however, breast-sparing procedures, often following radiation therapy, were generally adopted in the 1950s.[7] One reason for this striking difference in approach may be the structure of the medical professions: European surgeons, descending from the barber surgeon, were held in less esteem than physicians; in America, the surgeon was the king of the medical profession.[7] Additionally, there were far more European women surgeons; some European breast cancer wards boasted a medical staff that was half female. Less than one percent of American surgical oncologists were female.[7] American health insurance companies also paid surgeons more to perform radical mastectomies than they did to perform more intricate breast-sparing surgeries.[7]
Breast cancer staging systems were developed in the 1920s and 1930s.[7]
During the 1970s, a new understanding of metastasis led many to perceive cancer as a systemic illness, as well as a localized one; more sparing procedures were developed that proved equally effective. Modern chemotherapy developed after World War II.[9]
The French surgeon Bernard Peyrilhe (1737–1804) realized the first experimental transmission of cancer by injecting extracts of breast cancer into an animal.
Prominent women who died of breast cancer include: Anne of Austria, the mother of Louis XIV of France; Mary Washington, mother of George; and Rachel Carson, the environmentalist.[10]
The first case-controlled study on breast cancer epidemiology was done by Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health.[11]
In the 1980s and 1990s, thousands of women who had successfully completed standard treatment demanded and received high-dose bone marrow transplants, thinking this would lead to better long-term survival. However, it proved completely ineffective; 15–20% of women died because of the brutal treatment.[12]
The 1995 reports from the Nurses' Health Study and the 2002 conclusions of the Women's Health Initiative trial conclusively proved that hormone replacement therapy significantly increased the incidence of breast cancer.[12]
Cultural References
In the month of October, breast cancer is recognized by survivors, family, friends of survivors, and/or victims of the disease. A pink ribbon is worn to recognize the struggle that sufferers face when battling the cancer.
Pink for October is an initiative started by Matthew Oliphant, who asks that any sites willing to help make people aware of breast cancer change their template or layout to include the color pink, so that when visitors view the site, they see that the majority of the site is pink. Then, after reading a short amount of information about breast cancer, or being redirected to another site, they are aware of the disease itself.
The patron saint of breast cancer is Saint Agatha of Sicily.
References
- ↑ "The History of Cancer". American Cancer Society. 2002-03-25. Retrieved 2006-10-09.
- ↑ 2.0 2.1 2.2 Olson, James Stuart (2002). Bathsheba's breast: women, cancer & history. Baltimore: The Johns Hopkins University Press. pp. 9–13. ISBN 0-8018-6936-6.
- ↑ 3.0 3.1 Olson 2002, pp. 32–33
- ↑ Yalom, Marilyn (1997). A history of the breast. New York: Alfred A. Knopf. p. 234. ISBN 0-679-43459-3.
- ↑ 5.0 5.1 5.2 5.3 Aronowitz, Robert A. (2007). Unnatural history: breast cancer and American society. Cambridge, UK: Cambridge University Press. pp. 22–24. ISBN 0-521-82249-1.
- ↑ "History of Breast Cancer". Random History. 2008-02-27. Retrieved 2010-05-08.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Olson 2002, pp. 102–6
- ↑ Olson 2002, p. 1
- ↑ Marc Lacroix (2011). A Concise History of Breast Cancer. USA: Nova Science Publishers. pp. 59–68. ISBN 978-1-61122-305-7.
- ↑ Olson 2002, pp. 26,28,229
- ↑ Alfredo Morabia (2004). A History of Epidemiologic Methods and Concepts. Boston: Birkhauser. pp. 301–302. ISBN 3-7643-6818-7. Retrieved 2007-12-31.
- ↑ 12.0 12.1 Sulik, Gayle A. (2010). Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health. USA: Oxford University Press. pp. 200–3. ISBN 0-19-974045-3. OCLC 535493589.