People have known about breast cancer since ancient times. For most of that time, there were no effective treatments. However, in the last 120 years, advances in surgical and medical treatments have meant that today, 98 percent of patients with localized breast cancer survive at least five years after diagnosis. The following timeline shows the development of breast cancer treatments.
|3000 to 2500 BC||An Egyptian papyrus gives the earliest known mention of breast cancer. There is no treatment.|
|460 BC||The Greek physician Hippocrates coins the term karkinoma for carcinoma or cancer, and describes the stages of breast cancer, but proposes no cure. He believes that disease results from an imbalance of four “humours” or body fluids: blood, phlegm, yellow bile, and black bile.|
|168 BC||The Greek physician Galen believes that breast cancer develops from too much black bile in the blood and that it is a systemic disease. He uses surgery to remove breast tumours and lets the incisions bleed to get rid of the black bile.|
|476 to 1500||Early Christians believe that disease comes from God and the only treatments come from faith and miracles.|
|10th to 15th centuries||Islamic physicians Ibn Sina and Abu Al-Qasim Al-Zahrawi revive Greek medicine and write important medical books. They perform limited surgery for breast cancer. Their ideas eventually spread throughout Europe.|
|16th to 18th centuries||The Enlightenment brings advances in the understanding of anatomy and disease. Suspected causes of cancer included evaporated milk, trauma, personality type, exposure to air, and infection. Breast surgery becomes more widespread. Scottish surgeon John Hunter proposes staging; if the tumour is moveable, there is “no impropriety in removing it,” he states. However, due to the lack of anaesthesia, surgeons must work quickly and skillfully.|
The belief in humours (blood, phlegm, yellow bile & black bile) as the cause of cancer disappears in light of the new understanding of cancer cells. Metastasis through the blood and lymph vessels becomes known.
Surgery improves with the development of anaesthesia, surgical gloves and garments, and disinfection. In 1894, American surgeon William Halsted develops the radical mastectomy, which removes the whole tumour in one piece along with the pectoral muscles, lymphatic vessels, and the axillary lymph nodes. For the first time in history, breast cancer can be systematically treated and cured.In 1896, British surgeon Thomas Beatson reports that oophorectomy reduces tumours in advanced breast cancer.
|Early 20th century||Radiation is first used to shrink tumours.|
|1932||The modified radical mastectomy is developed to spare the chest muscles.|
|1940s||Chemotherapy is introduced.|
|1962||American doctor Robert Egan reports the first case of breast cancer detected by mammography.|
|1967||American cancer researcher Elwood Jensen describes the estrogen receptor, which leads to the development of estrogen-blocking drugs.|
|1970s||Italian oncologist Gianni Bonadonna produces the first report on adjuvant chemotherapy for breast cancer, using cyclophosphamide, methotrexate, and fluorouracil (CMF). The Italians and others experiment with combinations of radiation, chemotherapy, and tamoxifen, along with partial breast surgery and sentinel lymph node dissection, which prove as effective as the radical mastectomy. Personalized medicine, with surgery type and adjuvant treatment tailored to each patient, has arrived.|
|1977||Tamoxifen is approved by Health Canada to be used in the metastatic setting.|
|1979||The first modern autologous breast reconstruction is performed. Previously, implant-based reconstruction was used. The emergence of autologous reconstruction allowed for more natural feeling breast forms but with it came larger scars, a riskier surgery and longer recovery.|
|1995||Mutations in the BRCA1 and BRCA2 genes that increase the risk of breast cancer are discovered.|
|1998||Tamoxifen was approved for use to prevent recurrence of breast cancer.|
|1999||Herceptin, a breakthrough biologic drug that has significantly improved the treatment outcomes for women with HER2+ breast cancer, is approved by Health Canada.|
|2000||Breast cancer subtypes (estrogen receptor positive, progesterone receptor positive, HER2 positive, triple negative) are classified.|
|2007||New genetic tests (Oncotype DX for estrogen receptor positive breast cancer and MammaPrint for distant metastasis) are introduced.|
|2013||New standard classification of breast cancer subtypes is established: luminal A, luminal B, luminal B-like, HER2-positive, and triple negative.|
|2018||Several targeted therapies for metastatic breast cancer have been developed and are providing additional treatment options for women with HER2+ and HR+ breast cancers. Better treatment options for triple negative breast cancer continue to be explored in later phase clinical trials.|