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Mon, Feb. 24

History of breast cancer and treatment

More than 3,500 years ago, ancient Egyptians discovered and documented the existence of breast cancer, a disease they determined had no cure.

Hippocrates also made note of the disease, using the Greek term for "crab" to describe tentacle-like tumors that in some women were physically visible, representing the latest stages of the disease. The father of Western medicine's determination of the cause, an imbalance of bodily fluids, has over time been discounted as inaccurate, according to various medical websites.

"Breast cancer has been known to mankind since ancient times," wrote Dr. Ananya Mandal, a physician and medical writer for the website. "It has been mentioned in almost every period of recorded history."

In those ancient times, however, breast cancer was a taboo topic, an embarrassment such that detection and diagnosis were rare, Mandal said.

The advent of women speaking out against the disease is a far more recent phenomenon. It was in the 1990s that the symbol of breast cancer - the pink ribbon - started a revolution against this form of cancer, Mandal said.

In ancient days, suggested treatment for what is now known as late stage breast cancers were opium, castor oil, licorice, Sulphur, and various salves. At that time, breast cancer was viewed as a disease that affected the entire body and surgery was not considered an option, medical websites state.

In the mid-1700s a French physician suggested surgical removal of tumors as a potential breast cancer treatment. He too recommended removal of infected lymph nodes, according to online medical websites. His theories were later backed up by another French physician who deemed surgery the sole therapy for breast cancer, a theory that lasted into the 20th century, according to medical journals.

In 1880, Dr. William Halsted of New York is credited with making radical mastectomy, the removal of the breast, armpit lymph nodes and chest muscles the "gold standard" of breast cancer treatment, a treatment method that was pretty much traditional protocol for a century, states medical history literature.

Early mastectomy was deemed to be the best chance for a woman's survival. Still, many women eschewed such an option because they did not wish to be disfigured or left dealing with other severe side effects, including pain and swelling in their arm caused by lymph node removal, the websites report.

Another late 19th century treatment, albeit one that posed a dilemma for pre-menopausal women who might wish to have children, was removal of the ovaries to limit estrogen believed to feed the growth of breast cancer tumors. Following that same kind of thinking, in the early 1950s Dr. Charles Huggins favored removal of a woman's adrenal glands to starve breast tumors of estrogen, websites report.

By the 1970s, physicians were beginning to rethink a woman's surgical options, with tumor removal beginning to replace a full mastectomy. Radiation and chemotherapy drugs were also becoming prevalent in the treatment protocol; by the 1980s this was the expected treatment, according to numerous medical journal websites.

In 1983, the drug Tamoxifen was deemed effective in survival rates for women whose cancers were detected in the early stages, according to various medical websites. By the late 1990s, Tamoxifen was viewed as a drug that taken over at least a several year period could halt recurrences of cancer and extend survival rates.

Twenty-five years later, less than 10 percent of women diagnosed with breast cancer undergo mastectomies, with lumpectomies followed by radiation a more typical treatment process, journals said.

Indeed, medical journals state that radiation is used in about 50 percent of all breast cancer cases, particularly for those whose cancer is detected in the early stages.

The 1990s also saw a big push toward prevention, with mammography screenings available for early detection of cancer and the development of novel therapies such as hormone treatments. Scientists also isolated genes known to cause breast cancer, according to national and local oncology experts.

In the ensuing 25 years, treatments and theories about the roots of breast cancer have expanded such that as much as any cancer diagnosis is unwanted, doctors have many more medical tools, including targeted tumor therapy, to combat the disease. Remission is far more common; life expectancies are far longer than were considered even a decade ago, said medical experts.

The mortality rate in women with breast cancer has been declining in this nation since the mid-1990s, experts said.

The downside of improvements, however, is that breast cancer patients are almost required to make treatment a full-time job, and the cost of these treatments can be expensive, even prohibitive, for women without insurance, according to medical journal websites.

Prescott oncologist, Dr. Iyad Hamarneh, credits a determined lobby of "enthusiastic women" with helping turn the tide and enabling the ongoing progress in research and treatment.

"We're doing so much better with breast cancer in comparison to other cancers," Hamarneh said, noting the advances in breast cancer research and resources suggest the ability to "change the nature of the disease."

Hamarneh highlighted the ongoing progress with genetic tests. Better knowledge of the biology of cancer and genetics is enabling better treatment options, ones that can be individualized rather than have all patients treated the same, he said. Insurance coverage, too, for treatment has also improved, he said.

Even the fast-moving, aggressive breast cancers that were such a devastating diagnosis a decade ago now have treatment options with far better survival rates, Hamarneh said. He said there are more drugs to target the proteins that can "significantly improve survival" in women diagnosed with such cancers.

"That is huge progress," he said.

Breast cancer is not a new disease, but Hamarneh has high hopes that in the years to come it will not be the dreaded illness that it has been since ancient Egyptians discovered it so long ago.

"Treatments have gotten better, the understanding of chemotherapy is better, and supportive medications are better," Hamarneh said.

"Now the focus is on long-term survivorship and helping patients get back to their life."

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