The History of Breast Cancer
Who discovered breast cancer? How did they used to treat breast cancer before the invention of modern day technology? Who are the people we can accredit to the advancements that we know and use today? There are some questions that can be answered and others that have been lost throughout history.
The first authentic accounts of breast cancer are found in a text known as the Edwin Smith Surgical Papyrus. This book was from ancient Egypt around 3000 BC. that described examinations, diagnosis, treatment, and prognosis about clinical cases in great detail from head injuries all the way throughout the rest of the body describing other illnesses and injuries such as breast cancer. Within ancient Greece, a Greek temple that housed the god of medicine, Asclepius, showed evidence of offerings in the shape of breasts as a way of encouraging relief from breast abnormalities and illnesses from their gods. Hellenistic writings originate the words carcinoma (karkinoma), scirrhous (hard, Greek skirros) and cacoethes (malignant disease, Greek kakoethes) from the medical lexicon. In 400 B.C. Hippocrates formed a theory on the imbalances of humours noting that blood, phlegm, and yellow and black bile were a cause of disease and also provided descriptions of breast cancer in its progressive stages. In 200 A.D. Galen believed that the build up of black bile attributed to breast cancer and that the disease was systemic meaning it affects the entire body. It was also believed that women that stopped menstruating were somehow linked to cancer but we now know more about the association of cancer due to old age.
There were many advances and discoveries made within the 18th century like the discovery of lymph being the cause of breast cancer instead of the theorized black bile from a Scottish surgeon named John Hunter. During this time there were many other theories that speculated the causes of carcinogenesis such as congealed milk, trauma, personality type, or exposure to air and other infections which we now know today are not true. Explorative surgeries during this time needed to be executed quickly by a skilled surgeon because anesthesia hadn’t yet been discovered and because of this it is interesting to look back and see how far we’ve come since then.
In the nineteenth century safer protocols around surgery such as disinfection and sterilization became common practices improving health outcomes for patients. General anesthesia was also invented during this time which revolutionized surgery as we know it today to be far more humane for patients and surgeons. The identification and differentiation between normal cells and cancerous cells came from Hooke in England in the 17th century and Müller and Virchow in Germany in the 19th century through the use of microscopes. Until Müller, it was believed that the origin of cancer was due to humoral theory from Hippocrates but Müller declared that cancer was composed of living cells and the metastasis of these cancers was due to spread of cancerous cells. It was also during this time that it was discovered that breast cancer spread along the lymphatic system to the axillary nodes.
A name that should be known throughout the entire breast cancer community is William S. Halstead, the professor of surgery at Johns Hopkins hospital. Dr. Halstead was the first to perform what is known as a radical mastectomy in 1894 where the tissue from the breast was removed in one piece as well as the pectoralis major, which is a muscle located within our chest, to prevent recurrence and neglected cancerous tissue. Generations of surgeons followed in Dr. Halsteads footsteps until the late 19th century and early 20th century where Patey and Handley from London and Auchincloss Jr. of New York ushered in the modified mastectomy which preserved the pectoralis major while medical radiation and new forms of chemotherapy worked towards providing a means of killing cancer cells. Surgical management was also modified due to early-cancer detection mammography of smaller lesions.
Cosmetic restoration and reconstruction of the breast began in 1887 when a French surgeon by the name of Verneuil transferred tissue from the normal breast to the diseased breast. From there other surgeons began other restorative procedures such as transferring other muscle and tissue from parts of the body to the breast. In 1979, Holmstrom introduced the transverse rectus abdominis myocutaneous flap known as the TRAM. This process allowed surgeons to use lower abdominal skin and tissue to reconstruct the breast into the familiar mound shape and is still commonly used today with some slight modifications to allow for better blood supply to the area.
In 1963, Cronin and Gerow introduced silicone gel breast implants as a mode for breast reconstruction which took place after the mastectomy. In 1971, immediate reconstruction following a mastectomy was established by Snyderman and Guthrie. By 1986 reconstruction of the nipple and areola were accomplished via tattoos. The first to suggest this method was Becker but Spears popularized this technique within the next several years following Becker's suggestion.
In 1998 the Women’s Health and Cancer Rights Act was passed into federal law that provides protection to patients that choose to have reconstructive surgery in connection with a mastectomy procedure. Coverage must be provided throughout all stages of reconstruction of the breast on which a mastectomy has been performed. Surgery and reconstruction of the other breast to provide a symmetrical appearance is also covered including prostheses as well as treatment of physical complications throughout all stages of the recovery including lymphedema. Group health plans and individual health insurance policies are the two types of insurance coverages that apply to the law. To note: reconstruction and symmetry in male breasts affected by breast cancer are not currently covered by this law.
In 2001 tattoo artist Vinnie Myers began offering reconstructive breast tattoos to replicate realistic nipple and areola on breast cancer patients. His business and specialty grew with clients booking from all over the US and across borders as well providing services to clients as far as from India. After thousands of tattoos, Vinnie decided he would stop providing reconstructive tattoo services but the next day he discovered that his sister was diagnosed with breast cancer. Needless to say Vinnie decided to continue on with his craft and has continued serving breast cancer patients during their last step in the reconstructive process. He has pioneered reconstructive tattoos and has continued to apprentice tattoo artists in this specialty with a goal of making patients and survivors feel whole again.
The images provided below are from Jenean LaCorte who is located in Hampstead, NC and performs restorative tattoos for cancer patients as showcased in the pictures above. Her website is www.RestorativeTattoos.com Jenean’s work is incredibly realistic, likely because she is a classically trained artist, and offers breast cancer patients and survivors a real sense of restoration.
It's amazing to see the progression of knowledge, skills, and techniques used to treat breast cancer over the years. There is still so much we do not know and things we all hope will be solved within our lifetime. By looking back into history and following along with the trends and innovations that have come to be, it's not hard to believe that one day all of our questions will be answered and hopefully one day there will be a cure. But for now we will continue to make strides towards achieving that outcome and are excited to see who discovers the next best practice within our community and celebrate how far the medical community has come.