Breast cancer is the most common cancer in women around the world. It has been widely studied throughout history.
How we treat breast cancer has changed in many ways from the cancer’s first discovery. But other findings and treatments have remained the same for years.
Read on to learn how breast cancer treatments have evolved to what we know today.
Humans have known about breast cancer for a long time. For example, the Edwin Smith Surgical Papyrus
In ancient Greece, people made votive offerings in the shape of a breast to the god of medicine. And Hippocrates described the stages of breast cancer in the early 400s B.C.E.
In the first century, doctors experimented with surgical incisions to destroy tumors. They also thought that breast cancer was linked with the end of menstruation. This theory may have prompted the association of cancer with older age.
In the beginning of the Middle Ages, medical progress was intertwined with new religious philosophies. Christians thought surgery was barbaric and were in favor of faith healing. Meanwhile, Islamic doctors reviewed Greek medical texts to learn more about breast cancer.
The Renaissance saw a revival of surgery, with doctors exploring the human body. John Hunter, known as the Scottish father of investigative surgery, identified lymph as a cause of breast cancer. Lymph is the fluid carrying white blood cells throughout the body.
Lumpectomies were also performed by surgeons, but there was no anesthesia yet. Surgeons had to be fast and accurate to be successful.
Our modern approach to breast cancer treatment and research started forming in the 19th century. Consider these milestones:
- 1882: William Halsted performed the first radical mastectomy. This surgery will remain the standard operation to treat breast cancer until into the 20th century.
- 1895: The first X-ray is taken. Eventually, low-dose X-rays called mammograms will be used to detect breast cancer.
- 1898: Marie and Pierre Curie discover the radioactive elements radium and polonium. Shortly after, radium is used in cancer treatment.
- 1932: A new approach to mastectomy is developed. The surgical procedure is not as disfiguring, and becomes the new standard.
- 1937: Radiation therapy is used in addition to surgery to spare the breast. After removing the tumor, needles with radium are placed in the breast and near lymph nodes.
- 1978: Tamoxifen (Nolvadex, Soltamox) is approved by the Food and Drug Administration (FDA) for use in breast cancer treatment. This antiestrogen drug is the first in a new class of drugs called selective estrogen receptor modulators (SERMs).
- 1984: Researchers discover a new gene in rats. The human version, HER2, is found to be linked with more aggressive breast cancer when overexpressed. Called HER2-positive breast cancer, it isn’t as responsive to treatments.
- 1985: Researchers discover that women with early-stage breast cancer who were treated with a lumpectomy and radiation have similar survival rates to women treated with only a mastectomy.
- 1986: Scientists figure out how to clone the HER2 gene.
- 1995: Scientists can clone the tumor suppressor genes BRCA1 and BRCA2. Inherited mutations in these genes can predict an increased risk of breast cancer.
- 1996: FDA approves anastrozole (Arimidex) as a treatment for breast cancer. This drug blocks the production of estrogen.
- 1998: Tamoxifen is found to decrease the risk of developing breast cancer in at-risk women by 50 percent. It’s now approved by the FDA for use as a preventive therapy.
- 1998: Trastuzumab (Herceptin), a drug targeting cancer cells that are over-producing HER2, is also approved by the FDA.
- 2006: The SERM drug raloxifene (Evista) is found to reduce breast cancer risk for postmenopausal women who have higher risk. It has a lower chance of serious side effects than tamoxifen.
- 2011: A large
meta-analysisfinds that radiation therapy significantly reduces the risk of breast cancer reccurrence and mortality.
- 2013: The four major
subtypesof breast cancer are defined as HR+/HER2 (“luminal A”), HR-/HER2 (“triple negative”), HR+/HER2+ (“luminal B”), and HR-/HER2+ (“HER2-enriched”).
- 2017: The first biosimilar drug,
Ogivri(trastuzumab-dkst), is approved by the FDA for breast cancer treatment. Unlike generics, biosimilars are copies of biologic drugs and cost less than branded drugs.
- 2018: A clinical trial suggests that chemotherapy after surgery doesn’t benefit 70 percent of women with early-stage breast cancer.
Enhertuis approved by the FDA, and this drug proves to be very effective in treating HER2-positive breast cancer that’s metastasized or can’t be removed with surgery.
- 2020: The drug Trodelvy is approved by the FDA for treating metastatic triple-negative breast cancer for people who haven’t responded to at least two other treatments.
Breast cancer treatment is becoming more personalized as doctors learn more about the disease.
It’s now seen as a disease with subtypes that have different patterns and ways of acting on the body. The ability to isolate specific genes and classify breast cancer is the beginning of more-tailored treatment options.
Special tests can also tell doctors more about breast cancer.
For example, the Oncotype DX gene profile test can examine part of a tumor to find out which genes are active in it.
Less invasive and less toxic techniques
Studies have also found that shorter courses of radiation and more targeted forms of radiation therapy can be just as effective as longer courses of radiation. This includes delivery radiation therapy during surgery for some patients.
Additionally, targeted and biologic therapies may allow doctors to avoid chemotherapy in certain situations. A large 2018 study indicated that adjuvant endocrine therapy and chemoendocrine therapy were similarly effective in certain types of breast cancer.
We’ve come a long way since ancient Greece, but we still have a lot to learn about how breast cancer forms and how to treat it.
According to the American Cancer Society, 268,600 women and 2,670 men were diagnosed with breast cancer in the United States in 2019.
Early detection and treatment is still considered the best line of defense against breast cancer. Current technology lets researchers learn at a faster pace than they did decades ago.
As technology evolves, more treatments — and, perhaps, methods of prevention — will be uncovered.