Official website of the International Senology Oncology Scientific Community
Editor-in-chief: Dr. Gian Paolo Andreoletti - Oncologist, Science Journalist
History of breast cancer
1600 BC: The Edwin Smith Papyrus describes the earliest known cases of tumors of the breast, that were treated by cauterization with a tool called the "fire drill". The writing says about the breast disease: "There is no treatment".
The Roman physician Aulus Cornelius Celsus (42BC – 37AD) described breast carcinoma in his manuscript “De Medicina”. Celsus defined four stages of disease: cacoethes (early stage and surgically curable tumour), carcinoma without skin ulceration, carcinoma with ulceration and advanced exophytic lesion
Leonides (2nd century AD), a surgeon of the Alexandrian school, was the first to note that breast cancers spread to the axilla
Galen of Pergamum (129–200 BC) noted that breast carcinomas were frequent in patients who had ceased to menstruate. In Galen’s view, menstruation clears the body of excess black bile, whose accumulation causes cancer
Between the seventeen and eighteen hundreds, Jean Petit (Paris) and Benjamin Bell (Edinburgh) were the first surgeons to remove the lymph nodes, breast tissue and chest muscle in an effort to save patients from breast carcinoma
Charles
H. Moore:,
Royal Medical and
Chirugical Society, London, 1867: “On
the influence of inadequate operations on the theory of cancer", Med Chir
Trans 32: 245-80: “Taught
without doubt by foregoing failures, our surgical ancestors adopted a method of
operating which might well have been expected to prove effectual against a local
recurrence of the disease. They transfixed the base of the mamma, and, raising
it with ligatures, swept off the whole organ, together with all the skin that
covered it. The proceeding had a barbarous appearance enough, but it was
promising; and, if their knowledge of the disease had led the Surgeons of the
time to adopt it before the skin was hopelessly infiltrated, they must have met
with more success than they appear to have done. Postponing, however, all
operation until the skin was brawny and covered with tubercles, and the deeper
textures were involved without limit, they failed too often, with even such
extensive cutting as they adopted, to comprehend the entire disease. It was a
mistaken kindness which led to a change of this mode of operating. Under the
influence of a clergyman, who expressed what must have been a prevailing horror
at such Amazonian surgery, the practice was changed to an incision in the
integument, which was reflected in flaps and brought together again after the
removal of the cancerous tumour. There could have been no diminution of
suffering by this prolongation of the operation, and what was gained by it in
neatness was lost in life."
Charles H. Moore:, Royal Medical and
Chirugical Society, London, 1867: “On
the influence of inadequate operations on the theory of cancer", Med Chir
Trans 32: 245-80: “It
is not sufficient to remove the cancer or any portion only of the
breast in which it is situated; mammary cancer requires the careful extirpation
of the entire organ. It is desirable to avoid not only cutting into the tumor
but also seeing it. No actually morbid texture should be exposed, lest the
active microscopic elements in it should be set free and lodge in the wound.
Diseased axillary glands should be taken away at the same dissection as the
breast itself”.
William
S Halsted (New York, 1852-1922), "The
results of radical operations for
the cure of carcinoma of the breast", Ann Surg. July 1907:46(1):1-19:
“Fortunately
we no longer need the proof
which our figures so unmistakably give that the slightest delay is
dangerous and that, other things being equal, the prognosis is quite good
in the early stage of breast cancer, two in three being cured, and bad,
three in four succumbing, when the axillary glands are demonstrably
involved"
William
S Halsted (New
York, 1852-1922), "The
Results of Operations for the Cure of Cancer of the Breast Performed
at the Johns Hopkins Hospital from June, 1889, to January, 1894", Ann
Surg. 1894 November; 20(5): 497–555:
“The
pectoralis major muscle, entire or all except its clavicular portion,
should be excised in every case of cancer of the breast
William
S Halsted (New
York, 1852-1922), "The
results of radical operations for
the cure of carcinoma of the breast", Ann Surg. July
1907:46(1):1-19":
“The
Operation - (...) It must be our endeavor to trace more definitely
the routes travelled in the metastases to bone, particularly to the
humerus, for it is even possible in case of involvement of this bone that
amputation of the shoulder joint plus a proper removal of the soft parts
might eradicate the disease. So, too, it is conceivable that ultimately,
when our knowledge of the lymphatics traversed in cases of femur
involvement becomes sufficiently exact, amputation at the hip joint may
seem indicated"
1968 - Bernard Fisher, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA: "The Halsted radical mastectomy, first described in 1894, is a local form of therapy for mammary cancer which, by itself, can cure only those patients whose tumor is confined to the tissues of the chest wall and axilla removed at surgery. Observation in this study of a 5-year recurrence rate of 20 per cent in patients with negative nodes and close to 70 per cent in those with positive nodes emphasizes the inability of conventional radical surgery to eradicate all cancer cells because of their dissemination prior to or at the time of operation. More extensive regional dissection, carried to the limit of feasibility and sensibility, has not produced a substantial improvement in results". (Fisher B et al.: "Surgical adjuvant chemotherapy in cancer of the breast: results of a decade of cooperative investigation", Ann Surg. 1968 Sep;168(3):337-56
1976 - Gianni
Bonadonna (Milan, Italy):
"Our data indicate that patients with potentially curable
breast cancer and with positive axillary lymph nodes at the time of
mastectomy show a statistically significant reduction in recurrence rate
during the first 27 months after radical mastectomy when treated with
cyclic prolonged combination chemotherapy. At present, the advantage of
CMF appears statistically evident in all subgroups of patients" (Bonadonna
G et al.: "Combination
chemotherapy as an adjuvant treatment in operable breast cancer
", N Engl J Med. 1976 Feb 19;294(8):405-10)
1981 - Umberto Veronesi, National Cancer Institute, Milan, Italy: "A number of different factors may explain the progressive development of new procedures for conservative treatment of breast cancer. The first factor is a better understanding of the natural history of breast cancer and of the fact that the results of treatment are influenced more by distant spread when it occurs than by local or regional control of the disease. The second is the discovery of increasing numbers of cancers of minimal dimensions by means of new diagnostic techniques, especially mammography. The third is the more pressing demand for less mutilating procedures and the increasing requests from patients to be informed of the various possible treatments, including the conservative techniques. Finally, there is a widespread belief that if a conservative treatment could be offered to women with early breast cancer, it would represent a tremendous tool for publicizing self-examination of the breasts and alertness in seeking medical advice at the first appearance of a lump in the breast". (Veronesi U et al.: "Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast", N Engl J Med.1981Jul 2;305(1):6-11)
