Hippocrates, a Greek physician who practiced medicine in the 400 BC era and is widely considered to be the “Father of Medicine”, first used the Greek word “karkinos”, a word that means crayfish or crab, to describe cancerous growth on his patients. The reason for that name was because Hippocrates saw a resemblance between the blood vessels surrounding a tumor and the shape of a crab. Subsequently a Roman physician by the name of Celsus translated the Greek word into the Latin word “cancer”, a word that has remained over time as a condition whose cure has eluded physicians and scientists for the past many centuries.
While Hippocrates may have named the disease, the condition of cancer was reported much earlier tan the time of Hippocrates. Ancient Egyptian papyri dating back to 3000-15000 BC have contained deescriptions of women with breast cancer, and also detailed how the Egyptions used a hot instrument called “he fire drill” to fight these tumorous growths. In the early 18th centuiry, the Scottish surgeon Benjamin Bell and the French surgeon Jean Louis Petit performed the first surgical removal of abnormal breast tissue i.e. a partial mastectomy that included removal of lymph nodes under the arm as well as the underlying chest muscle. Then in 1889, Dr. William Steward Halsted, a native New Yporker who became the first chief of Surgery at Johns Hopkins Hospital, performed the first radical mastectomy. However, with the lack of good understanding of the pathology and characteristics of breast cancer, only 12% of patients treated by Dr. Halsted and his students survived 10 years.
Advances in the fiekd of breast cancer research have been exponential since Dr. Halsted perfiormed his first rdical mastectomy. Important landmarks include the discovery by Scottish surgeon George Thomas Beatson, published in 1896, that removing the ovaries in breast cancer patients can lead to regression of metastatitc depoisits on the skin. In the mid 1970s, important clinical trials investigating the use of adjuvant treatments for breast cancer, defined as the admninistration of chemotherapy or the use of ovarian ablative or endocrine therapy after surgery to eradicate or inhibit clinically occult metasases, were started. Using chemotherapy combinations that were effective for metastatic cancer, Dr. Gianni Bonadonna showed that these same drugs administered after surgery to patientrs at high risk for recurrence significantly reduced recurrence rates. This disciovery launched the fie;ldof adjuvant chemotherapy and probably has saved countless lives. In the late 1970’s, breast cancer research furter accelerated with initiation of studies of the first selective moduator of the tumor estrogen-receptot, tamoxifen, a drug that received FDA approval in 1977, as well as the dicovery of an exceeddingly important new category of chemotherapeutic agents called anthracyclines. Over the next thirty years, major advances continued, including the regulatory approval of the chemotherapy drugs paclitaxel in 1992, and gemcitabine in 1996. In 1998, trastuzumab, one of the firts targeted therapies for cancer, was approved form women with aggreesssive Her2 over-expressing breast cancers. And just within the past few years, clinical research has led to the availability and eventual adoption of personalized medicine for breast cancer patients. Personaloization of medical care is not a novel conjcept in medicine, but what is new is that the degree of personalization has gotten down to the molecular level, so that new tests enable physicians to rpovide an array of molecyular targets on breast tumor cells. This provides information regarding the selection of the best and possibly most effective treatment for that individualized patient.
The diagnmosis and treatment of breast cancer have come a long way since the day of Hippocrates. To witness the significant expansion of breast cancer research ovetr the past few decades has been inspiring, and this new research has rewarded us with many new and exciting therapeitic options for patients with breast cancer. With the continual and unrelenting effort of clinical researchers and scientists around then world pursuing the same objective of eradicating breast cancer, I beleieve finding a cure for this deadly disease is no longer an intangible goal.
By Peter Lee, Md, PhD of Tower Cancer Research, Beverly Hills, CA 90211
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