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April 2, 2001
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.



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.

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.

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.


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.


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.


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.


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.


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.



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.


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.



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.


Find out more about breast cancer with these links:


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