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April 2, 2001
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WOMEN'S HEALTH
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A
Test of Time: Breast Cancer Awareness and Treatment Through the
Ages
Story
by Leah Shafer
Illustrations
by Carrie Cox
For
centuries, breast cancer has affected women's bodies and lives,
and until recent decades, they suffered in silence with a disease
largely considered "untouchable." With no effective treatment
available until the latter half of the twentieth century, the cancer
manifested itself in grotesque disfigurement of the breast and a
painful death behind closed doors.
Those
doors have opened, and medical and social advances have moved this
issue from obscurity to one of America's top health priorities.
Although breast cancer still claims thousands of lives every year,
many women survive the disease with one of many effective forms
of treatment -- among them, mastectomy, lumpectomy, chemotherapy,
and immunotherapy. But the path to today's treatments has been paved
by thousands of years of traditions and ideas about the breast and
just how to treat this disfiguring and deadly cancer.
In
the timeline below, you'll read about some absurd treatments for
breast cancer, such as the exorcisms done in the Middle Ages, and
some strokes of sheer genius, like the discovery of the X ray in
1895, which lead to the first mammograms. We look to future developments
to increase survival rates, especially in women with advanced cancer,
and perhaps bring us greater understanding about how to prevent
breast cancer from occurring in the first place.
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3000-2000
B.C.
The
Ancient Egyptians were the first to recognize and treat breast
cancer. Although the Babylonians had some knowledge of the body
and performed simple surgical operations, the Egyptians were the
first to develop a specialized medical profession and a written
knowledge of anatomy and surgery. The Egyptians' treatment for
breast cancer was to cut off the diseased tissue -- a rudimentary
form of mastectomy done without anesthesia and no understanding
of sterility -- and then to cauterize the wound. And as for the
origin of breast cancer, as well as other diseases, the Egyptians
blamed foreign gods and prayed to the gods Bes and Sekhmet to
protect them.
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400
B.C.
In
Greece, Hippocrates (460-377 B.C.) took the idea of illness as
science further than the Egyptians had. He discredited supernatural
powers as the source for disease and urged observation, diagnosis,
and treatment. Illness occurred, he believed, if one of the body's
"four humors" -- black bile, yellow bile, phlegm, and blood --
was out of balance.
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A.D. 500-1400
The
Middle Ages were generally a time of great superstition in disease
treatment, and treatment for breast cancer was no exception. The
power of the Roman Catholic Church permeated all scientific endeavors,
and illness was often seen as a result of sin, influence of the
devil, and punishment from God. Also at this time, superstitions
about disease revolved around planetary alignment and astrology.
Pictures of a "zodiac man" in some books showed parts
of the body affected by the different zodiac signs.
Some
doctors in the Middle Ages, however, embraced the scientific method
and were devoted to works of Greek physician Claudius Galen (c.
129-216), who believed that melancholia -- what is now known as
depression -- could be the primary cause of breast cancer. They
acted on Galen's recommendations, which included special diets
for breast cancer patients, the use of topical applications, and,
occasionally, an old-fashioned exorcism to restore breast health.
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1400-1700
The
Renaissance was a time of great progress in the treatment of breast
cancer. It was during this time that doctors made the critical
discovery that breast cancer could spread to the lymph nodes under
the arm and to other areas of the body. They also noted that this
spread represented a poor prognosis for the patient.
Great
strides were also made in pain reduction following removal of
the cancerous breast. For centuries, the common practice had been
cauterization of the wound -- searing it shut with a red-hot iron
or boiling oil. As an alternative to this intensely painful procedure,
Flemish anatomist Andreas Vesalius (1514-1564) recommended sutures
to control bleeding after mastectomy. A professor of anatomy at
Padua University, in Italy, Vesalius urged physicians to know
the human body through dissection, but the Church's ban on dissection
made it necessary to be stealthy; he often took bodies from graves
and even stole from the gallows. His book about anatomy, de Humani
Corporis Fabrica, showed greater bodily detail than ever before
recorded. Another Renaissance figure, Ambroise Paré (1510-1590),
discovered an additional alternative to cauterization; his mixture
of egg white, turpentine, and rose oil was a more effective and
less painful way to seal a wound.
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1700-1900
In
the mid-1700s, doctors started keeping detailed records of breast
cancer, noting recurrence rates and survival after surgical removal
of the breast, the only viable treatment option available.
By
the late 1800s, it was common practice for doctors to remove the
affected breast and surrounding glands and nodes -- essentially,
what is now known as a modified radical mastectomy -- in an attempt
to stave off any further progression of the malignancy.
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Early
1900s
In
1917, Dr. William Stewart Halstead (1852-1922), professor of surgery
at Johns Hopkins, performed the first radical mastectomy -- which
involves resection not only of the entire breast and auxiliary
contents (lymph nodes of the armpit) but of both underlying pectoralis
muscles and surrounding soft tissue of the breast. But the odds
were slim: Patients had about a three-year survival rate. Surgery
alone obviously was not enough, and scientific discoveries soon
created many more options for breast cancer treatment.
One
of these discoveries was the X ray. Shortly after their discovery
in 1895, X rays were used in treatment of inoperable breast cancer.
In 1916, Dr. James Murphy (1884-1950) conducted clinical tests
with X rays on breast cancer patients who had recently undergone
a radical mastectomy. This was probably the first attempt at adjuvant
therapy for breast cancer patients.
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Mid-1900s
Between
1920 and 1960, radiation became a popular, powerful therapy used
in conjunction with mastectomy. The National Cancer Institute
began research into possible uses of chemotherapy in 1955.
The early and middle part of this century also brought important
strides in breast cancer awareness. Until now, the experience
of breast cancer had largely been one of silence for women, with
the breast sexualized and the disease taboo. The first stories
written by breast cancer survivors began appearing in the 1930s.
The decades thereafter marked a time of outreach for patients with
breast cancer and increased awareness about the importance of
early detection. Taking a social risk, radiologist Alfred Popma
created a 16-millimeter film about breast self-examination. The
film showed a woman correctly performing a BSE, and Popma knew
it would raise many an eyebrow. "Many people thought this
would be immoral, photographing a woman's breasts … they
didn't think we could show it without creating trouble,"
he said.
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1950s
The
use of mammograms for early detection met a lukewarm response
until the late 1950s, when Dr. Robert Egan, a physician at M.D.
Anderson Hospital in Texas, used mammograms to correctly identified
238 out of 240 tumors, which were confirmed by biopsy.
In
addition to emphasis on early detection, this time period also
marked a burgeoning scientific understanding of the body's intricate
workings. English scientists discovered DNA, the building block
of all living things, in 1953.
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1970s-1980s
Given
the growing number of women with breast cancer, a whole infrastructure
began to grow around prevention, research, and treatment of the
disease in the 1970s. The National Cancer Act in 1971 nearly doubled
funding to the National Cancer Institute (NCI), and the United
States began to sponsor major clinical trials funded through the
NCI, the American Cancer Society, and the National Surgical Adjuvant
Breast and Bowel Project. Regular media coverage of breast cancer
lessened the erotic nature of the breast and placed the disease
squarely in the scientific arena.
First
ladies Betty Ford and Nancy Reagan were diagnosed with breast
cancer a decade apart, and both underwent a radical mastectomy
and shared their story with the public. While they may not exactly
be representative of the 2 million American women who live with
breast cancer, their exposure lessened the stigma. Other activists,
like Rose Kushner, moved the personal narrative into a public
forum, encouraging patients to be informed and redefining what
it means to be a cancer patient.
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2000
Less
than 50 years after the discovery of DNA, scientists have a rough
map of the entire human genome. Two genes for breast cancer, BRCA1
and BRCA2, are known to dramatically increase a women's chance
of developing the disease -- in some cases, the lifetime risk
increases 30 to 50 percent, and in families in which several members
have cancer, 80 percent. But women have a better chance of surviving
breast cancer than at any other time in history, with five-year
survival rates of early-stage breast cancer at more than 95 percent.
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No
amount of change and progress has altered the fundamental truth:
Breast cancer is still a frightening disease that claims the
lives of a quarter of the women who get it. But treatment options
have come a long way, from breast amputation without knowledge
of sterility or access to anesthesia to high-dose chemotherapy,
radiation, bone marrow transplants, lumpectomy, and more.
And
due to the efforts put forth by breast cancer researchers and
pioneering women fighting the disease, survivors' voices have
been amplifying, building to a crescendo of narratives that
have taken the disease from shameful secrecy to open discussion
and active patient participation.
All
of these advances in breast cancer -- scientific and social
-- have taken us closer to the ultimate goal: a cure.
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Find
out more about breast cancer with these links:
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