Breast Cancer: A Brief and Surprising History

The following is an excerpt from the winner of the Los Angeles Times Book Prize in Science and Technology, Breasts: A Natural and Unnatural History, by Florence Williams (@flowill).

In the course of a lifetime, breasts meet many friends and foes: lovers, babies, ill-fitting undergarments, persistent pollutants, maybe a nipple ring, a baggie of silicone, or a dose of therapeutic radiation. It’s a lot to ask of breasts. Some of them don’t make it to the finish line. Each year in the United States, some seventy-eight thousand women undergo mastectomies of either one or both breasts. Over ten years, that’s enough women to fill the entire city of San Francisco. There are approximately two hundred thousand cases of breast cancer per year and forty thousand deaths in the United States. Globally, breast cancer is the leading cause of cancer-related death in women. One million women get diagnosed each year, and that number is expected to increase 20 percent by 2020. The global rise will largely be due to longer lifespans, obesity, and better screening. In a word, modernity.

Evolutionarily, though, cancer is a fact of life for multicellular organisms. As the pioneering German pathologist Rudolf Ludwig Karl Virchow discovered in 1855, “omnis cellula e cellula,” from one cell grow all cells. We need our cells to divide and replicate. Complex creatures like us would never have seen the sun if it weren’t for the lucky trick of mutations.

“Breast cancer has probably been around for as long as there have been breasts.”

Breast cancer has probably been around for as long as there have been breasts. Humans are just about the only free-ranging animal (other than minks) to get it. Domestic pets, if not spayed, get it. Breast tumors can be artificially induced in many other animals in the lab by feeding them strange carcinogens or implanting rogue cells or tissues or messing with their genes.

In some human populations, breast cancer is virtually unknown. Among the Kaingang women in Paraná, Brazil, there is reportedly no breast cancer. Researchers would love to know why. It’s probably a combination of things: the Kaingang women have a shorter life expectancy, they bear many children whom they breast-feed, and they don’t take oral contraceptives or hormone replacement therapy. Also, spending many hours outdoors, they probably get a lot of vitamin D. They probably don’t wear deodorant or underwire bras, both long-held suspects in the breast cancer mystery, but ones that have been reliably exonerated.

Although breast cancer at the rates we know it today is a modern disease, ancient Egyptian doctors were familiar with it. One papyrus recommends applying a plaster made from cow’s brain and wasp dung to tumors for four days. In the Middle Ages, breast cancer was a known and feared disease. The most advanced treatment at the time was the application of insect feces. Anne of Austria, the mother of King Louis XIV, famously suffered from breast cancer. She died in 1666 after caustic remedies of arsenic paste and a butcherous attempt at surgery (without anesthesia, of course). As barbaric as treatments seem today—slash, burn, and poison—we have it a whole lot better than the king’s mum did.

Bernardino Ramazzini was a Renaissance-era doctor who sought to understand the causes of many diseases, not just their treatments. Born in Capri in 1633, shortly after the teachings of Galileo were banned, he is today considered the father of environmental health. In 1705 he published his life’s work, De Morbis Artificum Diatriba, or the Diseases of the Workplace. It’s a lively and, to modern eyes, very amusing work. One of his chapters is titled “Diseases of Cleaners of Privies and Cesspits.” That one makes me appreciate the writer’s life, until I come to “Diseases of Scribes and Notaries.” In it, he writes, “All sedentary workers . . . suffer from the itch, are a bad colour, and in poor condition.” That one made me get up and go for a hike.

“Ramazzini astutely noticed that breast cancer was most common in nunneries.”

Among the many things that interested Ramazzini were diseases of women, including midwives. In the archaic translation I have, most of the s’s look like f ’s, rendering such pronouncements as, “Nurfes . . . are likewife fubject to various Difeafes in the Courfe of fuckling.” Old-language charms aside, Ramazzini astutely noticed that breast cancer was most common in nunneries. “You’ll scarcely meet with a monastery that has not fresh instances of this cursed [or curfed] plague,” he writes. He admits he does not know the reason, but he calls the breasts and womb the “Fountains of Letchery,” and speculates that it is the “mighty lascivious” among the nuns who will get cancer due to suppression of their sexual drives. Well, he was wrong on the reason, but his observation that nuns were the most vulnerable women remains a critical piece in the modern understanding of this disease.

Women of God did not have a lot of fuckling or suckling going on. What did that mean for the lecherous organs?

“One million women get diagnosed each year, and that number is expected to increase 20 percent by 2020.”

Turns out it was a good question. Even W. H. Auden pondered cancer in 1937: “Childless women get it / And men when they retire; / It’s as if there had to be some outlet / For their foiled creative fire.” Eventually, epidemiologists realized it wasn’t foiled creative fire as much as foiled reproduction that caused the trouble. It was childlessness, not celibacy per se, that increased cancer risk. It took centuries to figure out how hormones are made and used in the body, and in fact, we’re still learning. In the nineteenth century, doctors knew that breast tumors were often larger and more aggressive in premenopausal women, and they also figured out that an individual woman’s tumor was sometimes a different size before her period and after. By 1895, a Scottish physician named George Thomas Beatson had experimented with removing the ovaries of cows and pigs. He saw that doing so made their udders shrink, and he speculated that it might make breast tumors shrink as well.

Doubting the conventional wisdom that the nervous system controlled most bodily functions, Beatson presciently observed, “I am satisfied that in the ovary of the female and the testicle of the male we have organs that send out influences more subtle . . . and more mysterious than those emanating from the nervous system, but possibly much more potent than the latter for good or ill as regards the nutrition of the body.”

Beatson didn’t know those ovarian emanations were estrogen and progesterone. Nor did he know there were hormone receptors in breast tissue and in many tumors, but he witnessed the hormones in action. In the first woman whose ovaries he removed, her breast tumor retreated and she appeared cured. It seemed miraculous, and news of it made a huge splash. Unfortunately, Beatson also did not know that the body partly compensates for the loss of the ovaries by pumping out estrogen and progesterone-related hormones from elsewhere: fat tissues and the adrenal glands. Four years later, his patient’s cancer returned with a vengeance and she died.

It was only the beginning of a long and disappointing legacy of miracle cures turning out not to be so. But Beatson, like Ramazzini before him, was onto something.

Breasts is available wherever books are sold: Amazon | Barnes & Noble | iBookstore | Indiebound | Powell’s

Florence Williams (@flowill) is a contributing editor at Outside magazine, and her articles and essays have been widely anthologized. She lives in Washington, DC.

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