A Brief History of Metastatic Breast Cancer
Nowadays, we hear “breast cancer” and we think pink ribbons and racing for the cure, as if the disease belongs only to the modern era. But medical pros have been trying to treat metastatic breast cancer (MBC) for millennia. Throughout the ages, there have been real advances, as well as tons of weird theories that actually harmed women more than helped them. Still, we’ve come a long way. Serious scientific breakthroughs can help those with MBC live longer, healthier lives. Take a walk through history—and look at where we're at now with MBC.
The Ancient Egyptians Took Note
3000 B.C. In the surviving pages of an ancient textbook on surgery (written on papyrus), Egyptian doctors described eight cases of breast cancer, and how tumors had been burned off with a tool once used to start fires. “There is no treatment,” they wrote of the disease.
Science says: With today’s treatments, the five-year survival rate of all breast cancer patients is 90%—meaning most patients are just as likely to live five years after their diagnosis as women who don’t have breast cancer, according to the American Cancer Society. The five-year survival rate for MBC is 27%.
The First Known Case of MBC
2200 B.C.: We don’t know much about the aristocratic woman who had MBC except that she lived during the time of the pharaohs and was buried in a tomb in southern Egypt. The skeleton, discovered in 2015, showed the type of bone deterioration that experts now know is typical of the disease.
Science says: According to a study in the journal eCancer Medical Science, breast cancer most likely spreads to your bones if it metastasizes—something that holds true for 70% of all MBC patients.
The Black Bile Theory
460 B.C.: Greek physician Hippocrates believed the body was made up of four “humors”—blood, phlegm, yellow bile, and black bile—with too much black bile leading to cancer. His treatment advice? Cutting or burning tumors, or leaving patients alone if their cancer was metastatic. His theory lasted centuries.
Science says: Uncontrollable growth of abnormal cells causes cancer. Treating it early can help stop the spread through the lymphatic system and bloodstream, leading to cancer in other organs, bones, and tissue.
The Royal Treatment
1664-1666: Anne of Austria, the mother of King Louis XIV of France, found a lump on her breast. Already 63, she retired to a monastery to cope with extreme fatigue as the cancer spread. She received the most cutting-edge treatment of her day for MBC: arsenic paste applied to her breasts, blood lettings, and enemas. None of these worked, and she died in January 1666.
Science says: About 70% of MBC patients experience fatigue and 12% report extreme exhaustion, according to Sloan Kettering Cancer Center in New York.
Nun the Wiser
1713: Italian doctor Bernardino Ramazzini noticed that nuns got breast cancer more often than married women. He blamed celibacy, believing that without sexual intercourse, the reproductive organs, including the breasts, decay and become diseased. Misguided, yes, but Ramazzini was on to something.
Science says: Pregnancy and breastfeeding help lower your risk of breast cancer after menopause—the fewer periods you have, the less estrogen you’re exposed to. So, not having kids—as opposed to lack of sex—was the real reason behind the increased rates among nuns.
The First Radical Mastectomy
1882: William Stewart Halsted, a surgeon at Johns Hopkins medical school, was the first M.D. to surgically remove the entire breast and surrounding tissue, lymph nodes, and pectoral muscles. He believed that breast cancer cells spread slowly and methodically, first to the lymph nodes before traveling to other parts of the body.
Science says: Dr. Halstead was onto something: Women diagnosed with early-stage breast cancer who get a mastectomy reduce their risk of MBC by 75%, according to Canadian researchers.
The Father of the Hormonal Theory
1896: Thomas Beatson, a British doctor, reported that two patients with metastatic breast cancer seemed to go into remission (at least for a few years) after he surgically removed their ovaries. The reason? He believed that the hormones being secreted by the ovaries could spur the growth of cancer.
Science says: He wasn’t right, but having a family history of either breast or ovarian cancer raises your risk for getting these diseases. The common denominator: genetic mutations, most often in the BRCA1 and BRCA2 genes.
Changing the Surgical Game
1960s and ’70s: American surgeon Bernard Fisher believed that cancer cells spread through the body via the blood and lymph system much earlier than previously thought. He proved that lumpectomy followed by radiation or chemotherapy was just as effective as a radical mastectomy in early-stage breast cancer.
Science says: Despite similar survival rates for the lumpectomy and radical mastectomy, more women are now opting for the later as a preventative measure—rates have tripled since 1998, one study found.
The Introduction of Hormone Therapy
1978: The U.S. Food and Drug Administration (FDA) approved the drug tamoxifen, originally a birth control pill, for breast cancer treatment. An anti-estrogen, it was the first in a class of drugs called SERMs: selective estrogen receptor modulators, which block estrogen from attaching to cells in the breast tissue, stopping any signals from the hormone to grow and multiply.
Science says: Nolvadex and Soltamox (tamoxifen) are still used to treat MBC, as well as breast cancer in its early stages, according to BreastCancer.org.
MBC and Activism
2009: Nine members of the Metastatic Breast Cancer Network successfully lobbied Congress to declare October 13 as National Metastatic Breast Cancer Awareness Day. One key reason for their activism: Scientists still don’t know how, exactly, breast cancer metastasizes, leaving gaping holes in treatment.
Science says: Only an estimated 7% of all money raised for breast cancer research in the U.S. and UK goes to studies on metastasis, according to an MBC Alliance report.
New Drugs for MBC
2019-2020: Immunotherapy—using your immune system to produce antibodies that target cancer cells—is the newest way to treat Stage 4 cancers, especially aggressive forms, such as triple-negative breast cancer (affecting 10% to 15% of patients) and HER2-positive breast cancer, which affects one in five patients.
Science says: In the past two years, new drugs have been approved for MBC patients with these more aggressive forms of cancer. These include Trodelvy (sacituzumab govitecan-hziy), which treats metastatic triple-negative breast cancer, as well as Enhertu (fam-trastuzumab deruxtecan-nxki), Nerlynx (neratinib), and Tukysa (tucatinib), all three of which treat women with HER2-positive MBC.
The Future of Treating MBC
In 2021, science says: Two important developments will go a long way to stop breast cancer from spreading. The first is using artificial intelligence to read mammograms alongside a radiologist, upping the accuracy of diagnosis to nearly 90%. The second is a simple blood test using a new method for finding residual cancer cells anywhere in the body, which was tested in a small sample of women who’d had chemotherapy for their stage 1 through 3 breast cancer. These two breakthroughs are in the earliest stages of research right now—but they’re so promising they may be in widespread use in a few years.
History of Breast Cancer (1.): BBA Clinical (2017). “Understanding breast cancer—the long and winding road.” DOI: 10.1016/j.bbacli.2017.01.001
History of Breast Cancer (2.): National Cancer Institute (n.d.). “Cancer: A Historic Perspective.” training.seer.cancer.gov/disease/history/
Bone Cancer and MBC: Ecancer Medical Studies (2017). “Bone metastasis risk factors in breast cancer.”
Egyptian and Greek History of Cancer: American Cancer Society (2018). “Early history of cancer.” cancer.org/cancer/cancer-basics/history-of-cancer/what-is-cancer.html#:~:text
History of MBC Causes: American Cancer Society (2014). “Early Theories about Cancer Causes.” cancer.org/cancer/cancer-basics/history-of-cancer/cancer-causes-theories-throughout-history.html
Greek and Roman Theories about Cancer: Cancer (2004). “Greco-Roman thought about cancer.” acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.2019
Anne of Austria: JBUON (2005). History of Oncology. (2005.) “Anne of Austria (1601-1666), queen of France: died of breast cancer.” jbuon.com/archive/10-2-285.pdf
Fatigue and MBC: Psychooncology (2012). “And Examination of Distress, Sleep, and Fatigue in Metastatic Breast Cancer Patients.” ncbi.nlm.nih.gov/pmc/articles/PMC3756885/
Mastectomy Statistics (1): Breast Cancer Research and Treatment (2018). “Is Invasion a necessary step for metastases in breast cancer?” ncbi.nlm.nih.gov/pmc/articles/PMC5882625/
Mastectomy Statistics (2): Mayo Clinic (2021). “Preventive (prophylactic) mastectomy: Surgery to reduce breast cancer risk.” mayoclinic.org/tests-procedures/mastectomy/in-depth/prophylactic-mastectomy/art-20047221
Lumpectomy and Breast Cancer: BreastCancer.org (2019). “Mastectomy vs. Lumpectomy.” breastcancer.org/treatment/surgery/mast_vs_lump
Rising Rates of Preventative Mastectomies: Annals of Surgery (2017). “Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer.” doi: 10.1097/SLA.0000000000001698
BCM Research: Metastatic Breast Cancer Analysis (2014). “Changing the Landscape for People Living With Metastatic Breast Cancer.” mbcalliance.org/wp-content/uploads/Executive-Summary_Dec2014_published.pdf
AI and Mammograms: JAMA Oncology (2020). “External Evaluation of 3 Commercial Artificial Intelligence Algorithms for Independent Assessment of Screening Mammograms.” jamanetwork.com/journals/jamaoncology/article-abstract/2769894
Blood Test for Circulating DNA: Science and Translational Medicine (2019). “Personalized circulating tumor DNA analysis to detect residual disease after neoadjuvant therapy in breast cancer.” stm.sciencemag.org/content/11/504/eaax7392