Breast Cancer: The Past

Through the Ancient Times

As scientists discover more about breast cancer and as the public gains awareness, the roots are often forgotten. The history of breast cancer is long and extensive, dating back to 3000 to 2500 BC when Imhotep, a Greek physician, first documented breast cancer in the Edwin Smith Surgical Papyrus, where all illnesses were reported in that time period. It was easy to identify and was simply considered fatal when the spread on the breasts was bulging and cool to the touch. In Greece, people presented breast-shaped offerings to Asclepius (the Greek god of medicine) in hopes of healing their cancer.

Later, in 400 BC, Hippocrates (the father of medicine) proposed the theory of the four humours (blood, phlegm, yellow & black bile), and explained how an imbalance of them caused the illness and could worsen in “stages.”

In the first century AD, Leonides of Alexandria (Greek Christian martyr) believed that surgery (the removal of tissue through the use of incisions) and cautery (burning the affected tissues) could stop the spread of the sickness.

In 200 AD, a Greek physician named Galen of Pergamon began to advance the knowledge about the unfamiliar illness. He coined the term “cancer” — meaning “crab” in Greek — as the tumours were shaped like the legs of a crab. He explained that cancer was caused by excess black bile in the body, and he let surgical wounds bleed freely to rid the body of excess black bile. He also speculated that it must have occurred after menopause, after a trend he observed, but this theory was dismissed as it was just more common among older people.

From 476 to 1500 AD, Early Christians believed that medicine was tied to religious beliefs and kept their trust in healing miracles, avoiding surgical treatments. However, the Islamic world preserved the early Greek knowledge, which was further developed by Avicenna (Persia), Albucasis (Spain), and Maimonides (Spain). Along with the cautery method, they used caustic pastes, connecting to the idea of chemotherapy, where a tumour is reduced before the removal of the full tissue.

Golden Age of Surgery

The 16th to 18th centuries were the time period when the craft of surgery began to transition into true medical science, though people had many theories about what caused cancer: curdled milk, trauma, personality, air exposure and infection.

• Analysis of Cooper’s ligaments (breast structure) & Sappey’s lymphatics (a complex system of lymphatics in the nipple of the breast) continued to explain how cancer spreads and changed the way physicians had always viewed breast cancer

• John Hunter (the Scottish ‘father’ of investigative surgery) explained how cancer wasn’t caused by excess black bile, but by lymph, which moved away from the humour theory of Hippocrates

• Andreas Vesalius was a Belgian anatomist & physician whose strong human anatomy analysis helped advance surgery

  • For example, lumpectomies (removing tissue of the breast) and removal of pectoralis (amputations of chest muscles)

  • These surgeries were done without anesthesia, so skill & speed were essential for surgeons

  • Non-surgical treatments: ligatures (tight ties) or lead plates to cut off blood circulation to tumours to avoid full breast amputations

    
    

Leading up to the Present Day

In the 19th century, surgery became safer because of disinfection, sterilization, sterile gloves, and anesthesia. Blood transfusions had also become safer after Karl Landsteiner discovered blood groups in the early 20th century, but were first tried in 1818 by James Blundell. Scientists like Hooke, Müller, and Virchow proved that cancer was made of living cells (not black bile or humours) and that it spread through lymph nodes, which changed how breast cancer surgery worked. Muller further stated that metastasis — when cancer spreads from one body part to another — occurs due to the spread of living cells.

Surgeons started to perform huge and complicated operations:

• Charles Moore, Kuster & Volkmann: large tumour removals

• William Banks (1882): axillary lymph nodes to study how cancer spreads

• William S. Halsted (1894): brought radical mastectomy to light — removing the breast, chest muscles & lymph nodes in one piece to reduce the likelihood of spread and happening again. This became the ideal treatment for decades from the turn of the century

  • Surgeons didn’t even do biopsies first because they thought that cutting into the tumour would spread it

• New techniques like ligatures (tying blood vessels) enhanced post-surgery healing by reducing infections. This ended Galen’s idea of leaving wounds open

  
  

20th Century

• Hormones & Treatments:

  • Doctors believed breast cancer was caused solely due to hormones because it was prevalent in young women

  • Beatson (1906) removed ovaries/adrenals (endocrine surgery), but then the surgery was replaced by hormone-blocking drugs

    • Estrogen receptor modulators (block estrogen activity)

    • LH-releasing hormone agonists (suppress hormone production)

    • Aromatase inhibitors (prevent estrogen from being made)

• Less Invasive Surgeries: Evidence showed smaller surgeries worked if radiation, chemo or hormone therapy were all put into action together

• Mammography: earlier detection, so less tissue could be removed

• Systemic Disease Understanding: 1980s Fisher trials proved breast cancer spreads systemically (not just breasts, but throughout the body), and physicians realized that simple surgeries (like removing only part of the breast or just the first lymph node) worked just as well as radical mastectomies, so fewer side effects were possible

• Appearance & Reconstruction: TRAM flap (1979), implants and other methods gave women options beyond just curing the cancer

  • 1887: Verneuil (a French surgeon) moved healthy breast tissue to the failed one

  • This allowed the discovery of new methods using the body’s own tissue (muscle, skin flaps, fat, omentum) and later synthetic materials

  • TRAM flap (1979): using the abdominal muscle and skin became very popular

  • Some used implants or fillers like silicone (early experiments included petroleum jelly, glass balls, ivory or rubber too)

    
    

References

Ritu Lakhtakia. (2014). A Brief History of Breast Cancer: Part I: Surgical domination reinvented. Sultan Qaboos University Medical Journal, 14(2), e166. https://pmc.ncbi.nlm.nih.gov/articles/PMC3997531/