What Is the History of Breast Cancer?

Cancer is as old as humanity, and breast cancer is a fantastic example of how our thinking about what causes cancer and how to treat it has changed over the centuries.

Medicine has changed greatly since the ancient Egyptians. Even in the last few decades, there’s been a revolution in cancer care, with new treatment types and approaches to even the most tenacious metastatic foe.

This article reviews the history of breast cancer research and developments in caring for breast cancer patients. Read on to learn what’s been discovered about the risk of developing breast cancer and how treatments have changed over the years.

From Ancient to Modern Times 

The first recorded reports of breast cancer and its treatment were discovered on ancient papyrus out of Egypt. The Edwin Smith papyrus is dated 1600 BCE, but was possibly a copy of an older document, maybe as old as 2500 or 3000 BCE.

The papyrus described several cases of tumors growing in the breast and how they were treated using a “fire drill”—a tool that burnt the skin to destroy the cancerous tissue. The text describes the condition as untreatable.

The term cancer wasn’t coined until 400 BCE by Hippocrates, who hypothesized it was an imbalance of humors (blood, phlegm, yellow bile, and black bile). 

Starting with Hippocrates’s humors, the road to understanding breast cancer is paved with many ideas which seem odd to modern minds:

• It was thought in ancient times that possibly menopause caused cancer—which makes sense since cancers are more likely to develop as we age.
• In 1680, Francois de la Boe Sylvius hypothesized that the body’s lymphatic fluids turned acidic, leading to cancer.
• Claude-Deshais Gendron built on this lymphatic theory, suggesting that cancers arise when the nerve and glandular tissue are mixed with lymph.
• In 1713, Bernardino Ramazzini hypothesized that nuns developed more breast cancers because of their celibacy. While this seems a little out there, we actually now know that hormonal changes during pregnancy, childbirth, and breastfeeding have a protective effect against breast cancers.
• Breast cancer doesn’t just happen in celibate females, though, so Frederich Hoffman of Prussia suggested that sexually active females who develop breast cancer get this disease because the sex they’re having is “too vigorous” and blocks their lymph from draining.
• Italian physician Giovanni Morgagni blamed curdled milk in the breast for causing cancers, building off hundreds of autopsies of patients.
• Johannes de Gorter proposed pus-filled inflammations as leading to cancer in the breast.
• French surgeon Claude-Nicolas Le Cat suggested that depressive mental disorders led to breast cancer. During the 1750s, he and other surgeons pursued breast cancer surgeries that removed the breast, lymph nodes, and muscles.

Notable Scientists 

William Halsted, Johns Hopkins: Building off of the work of surgeons including Le Cat, Halsted developed the radical mastectomy in 1894. This surgery removed not only the breast, but also the underlying muscles and nearby lymph nodes. While disfiguring, this surgery was the most effective treatment for breast cancer for decades to come.

J. Collins Warren, Harvard Medical School: In the 1930s, Warren developed the needle biopsy and started using a frozen sectioning technique to diagnose breast cancer under the microscope. This technique is still used today as a simple, reliable tool to diagnose tumors in the breast.

Sir Geoffrey Keynes, St. Bartholomew’s Hospital in London: In 1937, Keynes described additional therapies, including medical radiation, being used to treat any cancer remaining after breast-sparing surgery.

Robert Egan, University of Texas: In 1962, Egan showed mammograms could detect undiscovered cancers and other breast tumors. This imaging test allows early detection of small breast tumors and helps improve breast cancer surgery. Egan’s studies led to mammography being widely used as a screening tool through the 1960s.

Elwood Jensen, University of Cincinnati: In 1967, Jensen first described finding estrogen and progesterone receptors in breast cancers. These receptors communicate with the body’s hormones and help the cancers grow. The discovery of drugs that block these hormones or their receptors revolutionized breast cancer treatment.

Gianni Bonadonna, Istituto Nazionale dei Tumori: In 1975, Bonadonna was the first to show chemotherapy treatment with cyclophosphamide, methotrexate, and fluorouracil could treat breast cancers—an important shift away from radical surgical approaches to breast cancer treatment.

Hans Holmström, University of Gothenburg: As surgeries for breast cancer became less invasive, Holmström developed new techniques for breast reconstruction, publishing the transverse rectus abdominis myocutaneous (TRAM) flap surgery in 1973.

Dora Richardson and Arthur Walpole, ICI Pharmaceuticals: Chemist Richardson first synthesized the drug Nolvadex (tamoxifen) in 1962 while developing birth control. A research team led by Walpole developed the drug as a breast cancer treatment.

Tamoxifen is a hormone therapy that blocks the action of estrogen in the body, can shrink breast tumors, and increases the survival of breast cancer patients with hormone-reactive tumors. The drug, first launched in the UK in 1973 and approved by the Food and Drug Administration (FDA) in 1977, changed breast cancer treatment.

Robert Weinberg Lab, Massachusetts Institute of Technology: This team discovered the HER2 gene in the early 1980s. Between 20% and 25% of breast cancers over-express this gene, leading to aggressive disease and worse outcomes. This discovery led the way to understanding that several distinct subclasses of breast cancer react to treatments in specific ways. Understanding the genetics of any given tumor has helped doctors treat individual patients in personalized ways.

Bernard Fischer, University of Pittsburgh: Fisher’s study, the National Surgical Adjuvant Breast and Bowel Project, was published in 1989. It scientifically compared different treatments for breast cancer. The results provided scientific support that combining surgery, chemotherapy, and radiation lengthened life in breast cancer patients, even those with advanced cancers.

Mary-Claire King, UC Berkeley: In the 1990s, King’s group discovered the BRCA1 mutation, linked to a hereditary disease that increases a person’s risk of developing breast, ovarian, and other cancers. Her work on hereditary breast cancers reinforced the importance of genetics on cancer development. BRCA1 and BRCA2 were cloned by a team led by​​ Mark Skolnick at Myriad Genetics in the mid-1990s.

Advancements in Care

Chemotherapy

Starting in the 1970s, the first drugs were developed as cancer treatments. These chemotherapies, including Adriamycin (doxorubicin), killed any fast-growing cells in the body and therefore had side effects. Other notable chemotherapies include Taxol (paclitaxel), released in 1994, and Xeloda (capecitabine), released in 1998.

Hormonal Therapy

Later in the 1970s, hormonal therapies, including tamoxifen, showed promise for treating breast cancers and eventually keeping them in check after remission.

In 1996 another hormone therapy, Arimidex (anastrozole), was used successfully to treat estrogen receptor-positive advanced breast cancer in postmenopausal females. Anastrozole was the first aromatase inhibitor (a drug that blocks estrogen production in the body) to be approved for cancer therapy.

Surgery

The 1980s saw improvements in surgery options for people with breast cancer. In 1985, surgeons developed breast-conserving surgery, also called a lumpectomy.

Instead of removing the entire breast, the lumpectomy aims to remove just the cancerous tissue. It’s often used alongside radiation and chemotherapies with similar rates of overall and disease-free survival.

Biologics and Targeted Therapy

In the 1990s, biologics for breast cancer entered the treatment scene. These drugs are actually antibodies, very similar to the antibodies your immune system makes naturally. Antibodies are very specific to the target they are created against, so they tell the body to attack cancer cells without hurting other cells.

Released in 1998, Herceptin (trastuzumab) is a biologic that targets cancer cells that over-express the HER2 gene. It is used to treat females with HER2-positive metastatic breast cancer. In 2013, improvements to the original drug were released as Kadcyla (also known as ado-trastuzumab emtansine or T-DM1), an antibody linked to a drug that can kill cancer cells.

Other important improvements in targeted therapies in the last few years have played an important role in improving breast cancer survival.

In 2019 a new therapy targeted against the PIK3CA mutation was approved by the FDA. Between 30% and 40% of breast cancer patients have a mutation in the PIK3CA gene. The drug Piqray (alpelisib) can slow the growth of advanced hormone receptor-positive and HER2-negative (HR+/HER2-) breast cancers and improve progression-free survival.

Another new target for breast cancer therapies is cyclin-dependent kinases. These are important for cell growth, so inhibiting them can slow the progression of HR+/HER2- advanced breast cancers. Drugs that act against this target include Ibrance (palbociclib) and Kisqali (ribociclib), both of which are given alongside hormone therapies.

A third new target for breast cancer treatment is the enzyme PARP, which normally acts to help repair damaged genes. Blocking this repair mechanism can help kill cancer cells that have BRCA mutations because their genes have too many mistakes to keep functioning.

Targeted therapies including Lynparza (olaparib), Rubraca (rucaparib), Zejula (niraparib), and Talzenna (talazoparib) are all important new treatments for BRCA-positive breast cancers.

Genetic Profiles

The most recent advancements in breast cancer treatment involve the implementation of genetic information to the personalization of breast cancer treatment. An article published in the journal Nature in 2000 changed the game on cancer genetics by creating “molecular portraits” of breast cancer.

The researchers found specific genes expressed by cancer cells that give doctors a better idea of if cancer will come back after treatment. These gene profiles were developed into tests that doctors can use to help guide treatment decisions and are even used in breast cancer staging.

One of the biggest advancements in breast cancer treatment has been using genetic information to make treatment decisions—not only in determining the potential recurrence of cancer, but also in determining what treatments might work best against any given cancer.

By analyzing the genetic attributes of a person’s cancer, doctors can separate patients into multiple breast cancer subtypes. Breast cancer is no longer considered one disease but rather a mixture of at least four diseases:

• Hormone receptor-positive and HER2-negative cancer
• Hormone receptor-positive and HER2-positive cancer 
• Hormone receptor-negative and HER2-positive cancer
• Triple-negative cancer

Different treatments are useful for each of these cancer subtypes. For example, for hormone therapy to work, the cancer cells need to be hormone receptor-positive. For HER2-targeted therapies to work, the patient’s cancer needs to be expressing higher-than-normal levels of the HER2 protein.

Altogether, our understanding of breast cancer and the best approaches for treating it have improved greatly, even to the point where some patients with advanced cancers no longer need chemotherapy.

Advancements in Identifying Population Risk 

In addition to the impact of genetic analysis on breast cancer treatment, another significant advancement in breast cancer care is identifying specific groups at high risk of developing breast cancers or that are more at risk of dying from them.

Ensuring that these groups have adequate access to and guidelines for screening and other preventative measures is important in helping improve breast cancer survival rates and care.

An American Cancer Society report from 2017 indicated that while breast cancer survival is up, Black females are 42% more likely to die from breast cancer than White females.

Breast cancer rates have also been rising in Asian American females for multiple decades. Specifically, immigrant Asian American females have about a three times higher risk of developing breast cancer than Asian American females who lived more than half their lives in the United States.

Certain ethnicities, including Ashkenazi Jewish, are at a higher risk of carrying inherited breast cancer genes, like the BRCA1 and BRCA2 mutations. Researchers estimate that one in 40 individuals of this population carries a BRCA mutation.

The medical community has also been learning more about males who get breast cancer. Typically one in 1,000 males will be diagnosed with breast cancer. These cancers are typically diagnosed at a more advanced stage and have fewer effective treatment options. Males with the BRCA mutations are at a higher risk of developing breast and several other cancers.

Having a Family History of Breast Cancer 

Multiple genes, including the BRCA genes, can cause inherited breast cancers to run in families.

The BRCA mutations are the best known and increase the risk of developing breast, ovarian, and other cancers. But this risk can be mitigated to an extent with lifestyle changes, preventative surgeries and therapies, regular checkups, and screening scans for cancer development.

It also isn’t a given that you’ll develop breast or another cancer just because you have a BRCA mutation, another inherited cancer syndrome, or a family history of breast cancer.

Having a family history of breast cancer means some of your blood relatives have had breast cancer. If that relative is closely related, like a mother or sister, or developed breast cancer before 50, there may be more reason to suspect a genetic link.

But this doesn’t mean that you will necessarily have breast cancer or that you have a genetic variant that’s likely to increase your risk. A family history of breast cancer is just a signal to your doctor that this may be worth watching or testing.

Only about 10% of breast cancer patients have a family history of the disease, so it’s not as telling of an indicator as you might think.

Summary 

Breast cancer has a long and winding history. Ancient Egyptians documented the condition, but it was considered incurable. Surgery was developed as a treatment in the 1700s and refined in the late 1800s. In the 1930s and following decades, radiation therapy and chemotherapy were developed, along with diagnostic techniques.

Major advancements have disrupted how we manage and treat this cancer over the last several decades. These include hormonal therapy, targeted therapy, and genetic profiling.

These days, breast cancer has a high five-year survival rate and effective treatment options because of years of research into new drugs, new surgeries, and new approaches to diagnosing and understanding breast cancer.

A Word From Verywell 

One thing is for sure when you’re researching breast cancer treatments: You’re not alone. More than a quarter of a million females are diagnosed with breast cancer every year in the United States.

The sheer volume of breast cancer patients means that even hard-to-treat breast cancers are continually reaping the benefits of research advancements and ongoing clinical trials.

Breast cancer has paved the way for researchers to understand other types of cancers and how best to treat them. New types of drugs and diagnostics can help improve outcomes.