History of breast cancer therapy

Introduction Breast cancer is an ancient disease and was described by the Egyptians 3000 years before Christ. Subsequently various articles about breast cancer and its treatment were written by Greek and Roman physicians. Surgery is the oldest method of treating breast cancer with diVerent operations described which sometimes reXected beliefs held about its causes and natural history. However, a variety of ‘medical’ therapies have also been described, especially in the Middle Ages, which to the modern observer were more akin to witchcraft than the application of scientiWc knowledge to the treatment of the disease. Changing fashions in the treatment of breast cancer have reXected not only changes in beliefs regarding its pathogenesis but also a growth in knowledge about the disease as well as advances in science and technology. Thus four periods can be discerned in the evolution of treatment over the centuries. The Wrst period could be described as the Empiric era of the pre-Galen period. Subsequently, breast cancer was regarded as a systemic disease and this characterized the Pessimistic period. By the eighteenth century, breast cancer was thought to be a local disease leading to the Optimistic era in which it was believed that larger operations than performed previously could eradicate the disease. By the twentieth century, knowledge about the biology of breast cancer had started to grow which led to a realization that breast cancer was a more complex disease than previously had been supposed and led to the establishment of the Realistic era in which we now Wnd ourselves. The twentieth century also saw the introduction of radiotherapy in the treatment of breast cancer, and medical therapy began to emerge from its primitive treatment concepts of the Dark Ages to emerge as a major new therapeutic tool. Philosophically, the emergence of medical therapy was conceptually diVerent to that of surgery (apart from surgical endocrine manipulation) in that it was a systemic therapy as opposed to a local therapy. The emergence of these non-surgical modes of