A historical and palaeopathological perspective on cancer

Cancer is often wrongly considered to be a modern disease in many popular medical venues. Cancers have been known to humanity since ancient times. In fact, its antiquity can be identified through the application of palaeopathological methodologies. The present perspective demonstrates by means of a historical and palaeopathological analysis how oncological manifestations were present long before the emergence of anatomically modern humans and addresses the epidemiological transition from ancient times to the contemporary world. The final section of the article examines breast cancer and its identification in ancient human remains.

Cancer and the emotions in 18th-century literature

This essay argues that the emotional rhetoric of today's breast cancer discourse-with its emphasis on stoicism and 'positive thinking' in the cancer patient, and its use of sympathetic feeling to encourage charitable giving-has its roots in the long 18th century. While cancer had long been connected with the emotions, 18th-century literature saw it associated with both 'positive' and 'negative' feelings, and metaphors describing jealousy, love and other sentiments as 'like a cancer' were used to highlight the danger of allowing feelings-even benevolent or pleasurable feelings-to flourish unchecked. As the century wore on, breast cancer in particular became an important literary device for exploring the dangers of feeling in women, with writers of both moralising treatises and sentimental novels connecting the growth or development of cancer with the indulgence of feeling, and portraying emotional self-control as the only possible form of resistance against the disease. If, as Barbara Ehrenreich suggests, today's discourse of 'positive thinking' has been mobilised to make patients with breast cancer more accepting of their diagnosis and more cooperative with punitive treatment regimens, then 18th-century fictional exhortations to stay cheerful served similarly conservative political and economic purposes, encouraging continued female submission to male prerogatives inside and outside the household.

Still Controversial: Early Detection and Screening for Breast Cancer in Brazil, 1950-2010s

Mammographic screening for breast cancer is a widely used public health approach, but is constantly a subject of controversy. Medical and historical research on this topic has been mainly conducted in Western Europe and North America. In Brazil, screening mammography has been an open topic of discussion and a challenge for health care and public health since the 1970s. Effectively, Brazilian public health agencies never implemented a nationwide population-based screening programme for breast cancer, despite the pressures of many specific groups such as advocacy associations and the implementation of local programmes. This article examines the complex process of incorporating mammography as a diagnostic tool and the debates towards implementing screening programmes in Brazil. We argue that debates about screening for breast malignancies, especially those conducted in the late twentieth and early twenty-first centuries, took place in a context of change and uncertainty in the Brazilian health field. These discussions were strongly affected both by tensions between the public and the private health care sectors during the formative period of a new Brazilian health system, and by the growing role of civil society actors. Our study investigates these tensions and their consequences. We use several medical sources that discussed the topic in Brazil, mainly specialised leading oncology journals published between 1950 and 2017, medical congress reports for the same period, books and theses, institutional documents and oral testimonies of health professionals, patients and associations collected in the framework of the 'The History of Cancer' project from the Oswaldo Cruz Foundation and Brazilian National Cancer Institute.

The History of Estrogen Therapy

INTRODUCTION

Menopausal hormone therapy (MHT) has proven an effective treatment for the amelioration of symptoms of menopause. The idea that a substance was the missing factor in a woman's body after menopause dates to the 1800s, when cow ovarian tissue was injected into German women in a successful attempt to reverse the sexual symptoms of menopause. The early 1900s saw the rise of commercialized menopause "treatments" that ranged in substance and even theoretical efficacy. The role of estrogen was first accurately described in Guinea pigs in 1917 by Dr. Papanicolaou.

AIM

To tell the detailed history of how estrogen was discovered and the controversy surrounding MHT.

METHODS

A literature search was conducted using PubMed to identify relevant studies and historical documents regarding the history of estrogen therapy.

RESULTS

The history of estrogen supplementation and its controversies are interesting stories and relevant to today's ongoing investigation into hormone replacement.

CONCLUSION

The controversy of MHT remained until the first randomized trials examining MHT in the early 1990s that suggested MHT is cardioprotective in postmenopausal women, although this conclusion was contradicted in subsequent trials. In the present day, MHT is approved only for short-term use for the symptomatic treatment of menopause. Kohn GE, Rodriguez KM, Hotaling J, et al. The History of Estrogen Therapy. Sex Med Rev 2019;7:416-421.

Pioneers of Breast Implant-Associated Anaplastic Large Cell Lymphoma: History from Case Report to Global Recognition

The first case of breast implant-associated anaplastic large cell lymphoma (breast implant ALCL) was described by John Keech and the late Brevator Creech in 1997. In the following 2 decades, much research has led to acceptance of breast implant ALCL as a specific clinicopathologic entity, a process that we bring up to life through the memories of 6 persons who were involved in this progress, although we acknowledge that many others also have contributed to the current state of the art of this disease. Dr. Keech recalls the events that led him and Creech to first report the disease. Ahmet Dogan and colleagues at the Mayo Clinic described a series of 4 patients with breast implant ALCL, and led to increased awareness of breast implant ALCL in the pathology community. Daphne de Jong and colleagues in the Netherlands were the first to provide epidemiologic evidence to support the association between breast implants and ALCL. Garry Brody was one of the first investigators to collect a large number of patients with the disease, present the spectrum of clinical findings, and alert the community of plastic surgeons. Roberto Miranda and L. Jeffrey Medeiros and colleagues studied the pathologic findings of a large number of cases of breast implant ALCL, and published the findings in 2 impactful studies in the medical oncology literature. The recognition and acceptance of this disease by surgeons, epidemiologists, and medical oncologists, working together, has led to subsequent studies on the pathogenesis and optimal therapy of this disease.

I Thought I Must Have Expired - Experiences of Surgery Before Anaesthesia

In 1812, Frances (Fanny) Burney (born in 1752 and died in 1840) underwent a mastectomy performed by Larry without anaesthesia. In the days after surgery, Burney wrote a letter to her sister, Esther Burney, describing her experience. In total, the letter is four pages long including information on before, during and after the surgery. Although this letter has been cited in numerous texts, it has yet to be analysed from multiple perspectives, shedding new light on the history of anaesthesia.

Differences in breast cancer incidence among young women aged 20-49 years by stage and tumor characteristics, age, race, and ethnicity, 2004-2013

PURPOSE

Younger women diagnosed with breast cancer have poorer prognoses and higher mortality compared to older women. Young black women have higher incidence rates of breast cancer and more aggressive subtypes than women of other races/ethnicities. In this study, we examined recent trends and variations in breast cancer incidence among young women in the United States.

METHODS

Using 2004-2013 National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program data, we calculated breast cancer incidence rates and trends and examined variations in stage, grade, and tumor subtype by age and race/ethnicity among young women aged 20-49 years.

RESULTS

The majority of breast cancer cases occurred in women aged 40-44 and 45-49 years (77.3%). Among women aged < 45 years, breast cancer incidence was highest among black women. Incidence trends increased from 2004 to 2013 for Asian or Pacific Islander (API) women and white women aged 20-34 years. Black, American Indian or Alaska Native, and Hispanic women had higher proportions of cases diagnosed at later stages than white and API women. Black women had a higher proportion of grade III-IV tumors than other racial/ethnic groups. Across all age groups, incidence rates for triple-negative breast cancer were significantly higher in black women than women of other races/ethnicities, and this disparity increased with age.

CONCLUSIONS

Breast cancer among young women is a highly heterogeneous disease. Differences in tumor characteristics by age and race/ethnicity suggest opportunities for further research into personal and cultural factors that may influence breast cancer risk among younger women.

The Radicalization of Breast Cancer Surgery: Joseph Colt Bloodgood's Role in William Stewart Halsted's Legacy

Johns Hopkins's surgeon William Stewart Halsted is renowned for popularizing the radical mastectomy, a disfiguring procedure that was overutilized during the 1900s. Cancer historians have questioned why Halsted, a meticulous surgical investigator, became more aggressive in his approach to breast cancer surgery when his own data failed to show prolonged patient survival. Joseph Colt Bloodgood, one of Halsted's early surgical residents, Hopkins's head of surgical pathology, and Halsted's primary outcome data analyst, played previously unrecognized roles. Bloodgood was an aggressive surgeon with a "lynch law" approach to breast lesions. As a surgical pathologist, Bloodgood was irrationally opposed to intraoperative frozen section diagnosis. Bloodgood's and Halsted's unwavering trust in each other created an environment where shared beliefs trumped surgical reality. However, after Halsted's death, Bloodgood recognized that they had been wrong and spent the rest of his life trying to reverse the progression while simultaneously "rewriting" details of his own involvement.

State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine» - research activities and scientific advance in 2016

Research activities and scientific advance achieved in 2016 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine» (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident; fulfillment of tasks of «State social program for improving safety, occupational health and working environment in 2014-2018 years».The report also shows the results of scientific organizational and health care work, staff training. The NRCRM Annual Report was approved at the Scientific Council meeting of NAMS on March 17, 2016.

A Consideration on the Origin of Seishu Hanaoka's Nyugan-jun and Nyugan-jun Furoku

Nyugan-jun is a manual that was used at Hanaoka's school, Shunrinken, describing two oral medicines and three ointments routinely administered after breast cancer surgery. Nyugan-jun Furoku is also a manual that was used at the school, depicting a variety of diseases of the breast, and oral concoctions to be administered. The earliest manuscript of both manuals was transcribed in February 1812. A manuscript of Ben-nyugansho narabini Chiho Soko, written by Ryozo Chiba in 1811, includes descriptions of an oral medicine and four ointments routinely given after breast cancer surgery. Although Choeito was only a common oral concoction in Nyugan-jun and Chiba's manuscript, the latter bears an original trace of Nyugan-jun. This indicates that Nyugan-jun and Nyugan-jun Furoku were completed by the end of February 1812, and their completion dates were not before August 1811.

Three Newly-Discovered Copies of the Manuscript Mayaku Ko, Written by Shutei Nakagawa, with Special Reference to their Appearance and Genealogy

Seishu Hanaoka's greatest achievement was the anesthetic Mafutsusan. He developed it and then used it successfully for various operations, primarily breast cancer tumor excisions. The developmental process can be traced in Mayaku Ko, a memorandum written and edited in 1796 by Hanaoka's close friend Shutei Nakagawa. Contained in this document is a list of fourteen prescriptions for earlier attempts by other doctors to create-a general anesthetic. These prescriptions, which Nakagawa had passed along to Hanaoka, were the foundation for the scientific breakthrough. The preface suggests that Hanaoka had nearly perfected Mafutsusan by 1796. Nakagawa's original manuscript has been lost, but copies of it are extant. Until recently, we knew of four, all of them in Japan. I have discovered three more: one in the University of Tokyo Library (Gakken Collection), another in the Keio University Shinanomachi Media Center, and the third in the Asahikawa Medical University Library (Sekiba-Samejima Collection). After carefully examiiing the new ones, I put the seven known copies of Mayaku Ko into four groups, A to D, according to the order in which they were likely transcribed. One of the copies in Group A, which is from the Matsuki Collection, appears to have been the first.

Frances Burney's Mastectomy Narrative and Discourses of Breast Cancer in the Long Eighteenth Century

This paper examines Frances Burney's 1812 mastectomy letter alongside contemporaneous medical treatises on the subject of breast cancer. Burney's letter offers a critique of a medical community that misconstrues her experience and can be viewed as pathography, or disability memoir. Examining the letter and the treatises in this way illuminates the brutality of some medical practices and the frequent incongruity between the patients' and the physicians' understandings of pain. However, the letter and the treatises also share much in common; both at times emphasize the patient's words and experiences, and both reveal the impressive and contradictory range of ideas surrounding breast cancer in the long eighteenth century. The paper ends by suggesting that the complex rapport between the letter and the treatises holds particular interest for the field of disability studies in its confrontations with socio-medical tendencies to normalize the body and downplay the harsh realities of breast cancer.

Development of Mafutsusan by Seishu Hanaoka and General Anesthetics in the Very Early Part of the 19th Century in Japan

Seishu Hanaoka's medicine is famed for its breast cancer surgery. Hanaoka, who,was motivated by Dokushoan Nagatomi's Man-yu zakki, published in 1771, had the idea to excise a breast cancer tumor and not to perform a breast amputation. Because he recognized that general anesthesia was indispensable for performing a surgical operation of the breast, he developed a general anesthetic and surmounted various difficulties: selection of an anesthetic method, anesthetic ingredients, determination of the opti- mal dosage, administration methods, indications and contra-indications, evaluation of the depth of anesthesia, facilitation of the smooth emergence from anesthesia, and postoperative care. I reviewed previous articles on these subjects and, using several unpublished manuscripts, provided new information on disseminated general anesthetics in Japan during the decade after the first general anesthesia for Kan Aiya in 1804.

Ryozo Chiba's Ben-nyugansho narabini Chiho Soko and Nyuganbensho or Nyuganben: The Practice of Hanaoka's Breast Cancer Surgery in 1811

In 1811, Ryozo Chiba (1789-1861) from Sendai Province enrolled in a private school of Shunrinken, presided by Seishu Hanaoka and wrote up a manuscript titled Nanki Seishu Sensei Nyugan Chyutu Koju (the title on the first page is Ben-nyugansho narabini Chiho Soko) in August 1811, only 6 months after enrollment. The manuscript describes Hanaoka's teachings about breast cancer surgery; signs and symptoms of breast cancer, differential diagnosis, preoperative care, administration of Mafutsusan, operative procedures, hemostatic techniques, wound suture; wound dressing, recovery from anesthesia with Mafutsusan, postoperative care, and prescriptions of drugs for internal and external use. After repeated transcriptions and the addition of various papers on other subjects, the title of the manuscript changed to Nyuganbenshio or Nyuganben. Chiba's original manuscript is considered important because the transcriber and the year of transcription of the manuscript are identified, and it unfolds the practice of Hanaoka's breast canicer surgery as of 1811.

Geoffrey Keynes's Two-Fold Vision: Medical Savant-Connoisseur and Literary Bibliographer

During the 1920s and 1930s, the British surgeon Geoffrey Keynes (1887-1982) treated breast cancer with radium instead of the hegemonic radical mastectomy, while vehemently attacking the "radicalists" for mutilating women. Keynes was also a leading bibliographer of literary figures from Sir Thomas Browne to William Blake through Jane Austen. This article argues that these endeavors did not inhabit separate worlds, but rather his bibliographic methods of collecting and sorting were deeply interwoven with his therapeutic practices and medical ways of knowing. The article also examines the profound influence his engagement with the works of William Blake had on his battle against the reigning medical orthodoxy and on the humanity of his relationship with his patients. It concludes that Keynes' story sheds light on a now distant medico-cultural world where literary studies, often centered on book collecting and critique, were not only highly valued, but were influential in guiding the vision and behavior of a number of physicians.

A Study of the Manuscript Nyugan no zu, in the Possession of the National Diet Library: A Comparison with the Manuscript Seishu sensei ryo nyugan zuki

In May 1810, the wife of Rihei Hiroseya, from Takayama, Hida Province, received an excision of a breast cancer tumor at Shunrinken in Hirayama, Kishu Province. Hirose asked Gaku Nomura, one of the Hanaoka's disciples, to make a manuscript describing his wife's surgery. In reply to Hirose's request, Nomura made the manuscript including her history and operative procedures, with illustrations of 13 other surgical cases of breast cancer, and he gave it to him the next month. The manuscript, titled Seishu sensei ryo nyugan zuki, is extant and this is considered to be the one that Nomura gave Hirose because there has been no other manuscript with this title and the manuscript is carefully recorded and bound. This suggests that there must be a draft of Seishu sensei ryo nyugan zuki. A manuscript titled Nyugan no zu is in the possession of the National Diet Library and it is considered to have been originally stitched temporarily, and then bound later. However, the contents of this manuscript are identical to those of Seishu sensei ryo nyugan zuki. In particular, illustrations in both manuscripts are highly likely have been made by the same illustrator, although sentences in both manuscripts are recorded by different hands. Thus, it is likely that Nomura asked an illustrator to make two sets of illustrations and Nomura used one for his presentation to Hirose and another for a draft, and that Nyugan no zu is a draft of Seishu sensei ryo nyugan zuki.

A Consideration of Four Illustrations of Surgical Operation Referred to in Nyugan Chiken Roku

Four illustrations of a breast cancer operation of Kan Aiya in 1804 are referred to as Figures 2 to 5 in the manuscript Nyugan Chiken Roku. One of Hanaoka's disciples depicted them, standing at the patient's feet, in order not to block the sunlight. Thus, the drawings may have been illustrated as viewed from the front. Because the manuscript lacks the original illustrations, Kure transcribed them from other unidenti- fied manuscripts to reproduce them in his monograph Seishu Hanaoka and His Surgery, but they were illustrations viewed from the side, suggesting that they were different from the original figures. A manuscript in the Kyou Library titled Nyuganzu is considered to convey the original style because its illustrations are presented from a front view. Sixteen sheets of drawing, which are in the possession of the Flower Hill Museum, are considered rough sketches for the original illustrations because they are of Hanaoka's family provenance. Careful examination of these manuscripts and the rough sketches leads to further elucidation of the mysteries of Nyugan Chiken Roku.

Kihan Akaishi's Publication Plan of an Illustrated Brochure on Breast Cancer Surgery by Seishu Hanaoka

In 1809, Kihan Akaishi (1785-1847), one of the disciples of Seishu Hanaoka who ran a private medical school "Shunrinken," planed to publish an illustrated brochure, on breast cancer surgery by Hanaoka. It was only two months after he enrolled at the school. Although details remain unknown as to why Akaishi was so active in publishing the brochure, it is likely that he was impressed by the skillful breast cancer surgeries done by Hanaoka and determined to prevail upon him to share information about them among his colleagues. On the request of Akaishi, however, Hanaoka responded with neither "Yes" nor "No" because Hanaoka thought that it was impossible to accurately describe his diverse medical practices. Although Akaishi failed to obtain Hanaoka's permission to publish it, he tried to move further for the publication. He showed a manuscript containing Akaishi's preface and illustrations of 13 cases of breast cancer surgery to Yuya Kishi (1734-1813), asking him to write a foreword to the manuscript. Kishi was a scholar of Chinese literature of the Wakayama domain and a close friend of Hanaoka. A manuscript tentatively titled "Nyugan Zufu" is most likely the manuscript that Akaishi showed to Kishi, and the preface by Akaishi and the foreword by Kishi from other manuscripts elucidated the situation of the unirealized publication of the brochure.

Understanding and effectively addressing breast cancer in African American women: Unpacking the social context

Black women have a higher incidence of breast cancer before the age of 40 years, more severe disease at all ages, and an elevated mortality risk in comparison with white women. There is limited understanding of the contribution of social factors to these patterns. Elucidating the role of the social determinants of health in breast cancer disparities requires greater attention to how risk factors for breast cancer unfold over the lifecourse and to the complex ways in which socioeconomic status and racism shape exposure to psychosocial, physical, chemical, and other individual and community-level assaults that increase the risk of breast cancer. Research that takes seriously the social context in which black women live is also needed to maximize the opportunities to prevent breast cancer in this underserved group. Cancer 2016;122:2138-49. © 2016 American Cancer Society.

Are international differences in breast cancer survival between Australia and the UK present amongst both screen-detected women and non-screen-detected women? survival estimates for women diagnosed in West Midlands and New South Wales 1997-2006

We examined survival in screened-detected and non-screen-detected women diagnosed in the West Midlands (UK) and New South Wales (Australia) in order to evaluate whether international differences in survival are related to early diagnosis, or to other factors relating to the healthcare women receive. Data for women aged 50 - 65 years who had been eligible for screening from 50 years were examined. Data for 5,628 women in West Midlands and 6,396 women in New South Wales were linked to screening service records (mean age at diagnosis 53.7 years). We estimated net survival and modelled the excess hazard ratio of breast cancer death by screening status. Survival was lower for women in the West Midlands than in New South Wales (5-year net survival 90.9% [95% CI 89.9%-91.7%] compared with 93.4% [95% CI 92.6%-94.1%], respectively). The difference was greater between the two populations of non-screen-detected women (4.9%) compared to between screen-detected women, (1.8% after adjustment for lead-time and over-diagnosis). The adjusted excess hazard ratio of breast cancer death for West Midlands compared with New South Wales was greater in the non-screen-detected group (EHR 2.00, 95% CI 1.70 - 2.31) but not significantly different to that for women whose cancer had been screen-detected (EHR 1.72, 95% CI 0.87 - 2.56). In this study more than one in three breast cancer deaths in the West Midlands would have been avoided if survival had been the same as in New South Wales. The possibility that women in the UK receive poorer treatment is an important potential explanation which should be examined with care.

Impact of deprivation on breast cancer survival among women eligible for mammographic screening in the West Midlands (UK) and New South Wales (Australia): Women diagnosed 1997-2006

Women diagnosed with breast cancer in the UK display marked differences in survival between categories defined by socio-economic deprivation. Timeliness of diagnosis is one of the possible explanations for these patterns. Women whose cancer is screen-detected are more likely to be diagnosed at an earlier stage. We examined deprivation and screening-specific survival in order to evaluate the role of early diagnosis upon deprivation-specific survival differences in the West Midlands (UK) and New South Wales (Australia). We estimated net survival for women aged 50-65 years at diagnosis and whom had been continuously eligible for screening from the age of 50. Records for 5,628 women in West Midlands (98.5% of those eligible, mean age at diagnosis 53.7 years) and 6,396 women in New South Wales (99.9% of those eligible, mean age at diagnosis 53.8 years). In New South Wales, survival was similar amongst affluent and deprived women, regardless of whether their cancer was screen-detected or not. In the West Midlands, there were large and persistent differences in survival between affluent and deprived women. Deprivation differences were similar between the screen-detected and non-screen detected groups. These differences are unlikely to be solely explained by artefact, or by patient or tumour factors. Further investigations into the timeliness and appropriateness of the treatments received by women with breast cancer across the social spectrum in the UK are warranted.

From sick role to narrative subject: An analytic memoir

Questions of illness experience and identity are discussed, based on the analysis of a story told by the breast-cancer activist Audre Lorde. Displacing Parsons' conceptualization of illness as a sick role, I understand the ill person as a narrative subject, defined by discursive possibilities. Three discourses of illness are proposed: the medical institutional discourse, the discourse of illness experience, and the pink-ribbon discourse. Each has its preferred narratives. These discourses overlap and mutually affect each other. Problems with the Foucauldian conceptualization of the subject are considered, and a dialogical imagination of relations of governmentality is proposed.

Amputation of the breast

Today we take for granted the blessing of anaesthesia and it is almost impossible for us to imagine the agonies that surgical patients underwent in the past. This description of a mastectomy, performed in 1720 by Lorenz Heister, Professor of Surgery and Anatomy in Altdorf in the republic of Nurnberg, (now part of Germany), gives a vivid idea of major surgery in those days. In this much shortened abstract from his lengthy report, which appears in the 1775 English edition of his textbook entitled 'Medical, Chirurgical and Anatomical cases and Observations' he discusses the preoperative preparation, the mastectomy itself, performed as quickly as possible and the tedious postoperative dressings of the inevitably suppurating wound.

"Entrenched practices and other biases": unpacking the historical, economic, professional, and social resistance to de-implementation

BACKGROUND

In their article on "Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices," Prasad and Ioannidis (IS 9:1, 2014) referred to extra-scientific "entrenched practices and other biases" that hinder evidence-based de-implementation.

DISCUSSION

Using the case example of the de-implementation of radical mastectomy, we disaggregated "entrenched practices and other biases" and analyzed the historical, economic, professional, and social forces that presented resistance to de-implementation. We found that these extra-scientific factors operated to sustain a commitment to radical mastectomy, even after the evidence slated the procedure for de-implementation, because the factors holding radical mastectomy in place were beyond the control of individual clinicians. We propose to expand de-implementation theory through the inclusion of extra-scientific factors. If the outcome to which we aim is appropriate and timely de-implementation, social scientific analysis will illuminate the context within which the healthcare practitioner practices and, in doing so, facilitate de-implementation by pointing to avenues that lead to systems change. The implications of our analysis lead us to contend that intervening in the broader context in which clinicians work--the social, political, and economic realms--rather than focusing on healthcare professionals' behavior, may indeed be a fruitful approach to effect change.

Writing siblings: Alice James and her brothers

This essay addresses the relationship of writing to embodiment, through representations of bodily sensation and fantasy in the journal of Alice James. It considers Alice James's writing in relation to her two writer brothers, William and Henry, and in light of their father's experiences of impairment and breakdown.

[Endocrine therapy for breast cancer: past and present]

The endocrine therapy for breast cancer could be traced back to the excision of the metastatic breast cancer by oophorectomy in a premenopausal women performed by Beatson in 1896. After the development of more than 100 years, endocrine therapy plays an important role in adjuvant therapy, the rescuing treatment of its recurrence due to metastasis, and the new adjuvant endocrine therapy for breast cancer. Through analyzing the changes in the 4 aspects of endocrine treatment of breast cancer, i.e., the original simple excision of the endocrine organs, tamoxifen, drug-induced ovarian castration and the 3th generation aromatase inhibitor, the characteristics of different ages of endocrine therapy can be summarized, which would provide the reference for the new developmental trend of this therapy.

Breast and prostate cancer: an analysis of common epidemiological features in mortality trends in Spain

BACKGROUND

Breast cancer in women and prostate cancer are the first and second leading tumour respectively in terms of incidence world-wide. Our objective is to ascertain the similarities and differences between mortality trends in breast cancer among women and prostate cancer in Spain using age-period-cohort models, and analyse the correlation between incidence of breast and prostate cancer at cancer registries locally and world-wide.

METHODS

We analysed the independent effects of age, period of death and birth cohort on mortality rates for breast cancer in women and prostate cancer in Spain across the period 1952-2011. Segmented regression analyses were performed to detect and estimate changes in period and cohort curvatures. Correlation among age-adjusted incidence rates at 246 population cancer registries world-wide was analysed for the period 2003-2007.

RESULTS

The mortality trend displayed common characteristics in terms of the annual number of deaths due to these tumours, their adjusted mortality rates and the change points detected in the cohort and period effects. The trend in incidence was very different to that in mortality, due to early detection and progressive improvement in survival. Correlation between the incidence rates of both tumours recorded by registries around the world proved to be a generalised phenomenon.

CONCLUSIONS

This study shows that breast cancer mortality in women and prostate cancer mortality and their trends in Spain display visible similarities in terms of the number of deaths due to these tumours, their adjusted mortality rates and the changes experienced by mortality over time. The effects of advances in the diagnosis of both tumours correspond to a decline in mortality which becomes evident after a lag of approximately eight years. Correlation between breast and prostate cancer incidence rates is very high in Spain and at registries on all continents.

[The first mastectomy for breast cancer in America: Aguascalientes, México, 1777]

In this paper we present the first evidence of a mastectomy for breast cancer in America, performed in Aguascalientes, Mexico, in the eighteenth century. This intervention was recorded in an anonymous ex-voto in which Mrs. Josefa Peres Maldonado thanks the Black Christ of Encino and the Immaculate Conception or Virgin of the village for the good results obtained. The French physician and surgeon Peter Maille performed the operation with the help of friars of the convent-hospital San Juan de Dios. We review the history of the surgical treatment of breast cancer, the pictorial structure of the document, the surgical technique proposed by the Royal College of Surgeons (New Spain) at the time, and the association between this event and its time as an example of the impact that the Age of Enlightenment had in New Spain.

Mortality outcome among medically underserved women screened through a publicly funded breast cancer control program, 1997-2007

PURPOSE

The purpose of this study was to assess treatment and mortality differences between women diagnosed with breast cancer through Nebraska's Every Woman Matters (EWM) program and women diagnosed through other sources.

METHODS

A retrospective analysis was performed using 10 years of Nebraska Cancer Registry and EWM program data on women aged 40-74 years. This study used chi-square and multivariate logistic regression with mortality as the outcome of interest.

RESULTS

From 1997 to 2007, 4,739 women were diagnosed with breast cancer, 435 (9.1 %) of whom were diagnosed through EWM. The EWM and non-EWM groups differed significantly in age, race, marital status, location of residence at the time of diagnosis, neighborhood poverty level at the time of diagnosis, tumor stage at diagnosis, and chemotherapy. No significant differences were found between the two groups in radiation therapy, surgical resection, and hormone therapy. In both 1- and 5-year multivariate mortality models, the odds of dying for those in the EWM program were not statistically significantly different from the odds of dying for those not in the EWM program. In the 1-year mortality model, residents of urban metropolitan counties (OR 2.079; 95 % CI 1.663-2.598) had an increased odds of dying compared to residents of rural counties. In the 5-year mortality model, black women (OR 2.239; 95 % CI 1.453-3.450), residents of areas with a high (more than 20 %) neighborhood poverty level at the time of diagnosis (OR 1.589; 95 % CI 1.204-2.097), and unmarried women (OR 1.334; 95 % CI 1.164-1.528) had higher odds of death. Both groups have received similar treatments.

CONCLUSIONS

Targeted outreach to vulnerable groups for cancer screening may improve cancer outcomes and reduce disparities.

Healthy barbs: activism confronts mortality

Barbara Brenner, JD, was the Executive Director of Breast Cancer Action (BCA) from 1995-2010. Before that, she was a longtime activist in the anti-war movement and an attorney who, for most of her career, practiced public policy law. After she was diagnosed with breast cancer in 1993 at the age of 41, she took the helm of BCA. Under her leadership, the organization moved into a position of national advocacy-demanding research on the causes and prevention of breast cancer, including the role of industrial pollutants. Barbara started the "Think Before You Pink" campaign, encouraging people to question whether companies that display pink ribbons actually produce products that harm women's health or generate any funds to fight breast cancer. Her blog, "Healthy Barbs," challenged readers to critique routine healthcare practices and policies. Barbara received numerous awards, including a Jefferson Award for Public Service in 2007, the Smith College Medal in 2012, and the ACLU-Northern California's Lola Hanzel Courageous Advocacy Award in 2012. Barbara had a recurrence of breast cancer in 1996. She died of complications associated with amyotrophic lateral sclerosis, ALS, on May 10, 2013.

Grand slam on cancer

A winner of 59 Grand Slam championships including a record 9 Wimbledon singles titles, Martina Navratilova is the most successful woman tennis player of the modern era. Martina was inducted into the International Tennis Hall of Fame, named "Tour Player of the Year" seven times by the Women's Tennis Association, declared "Female Athlete of the Year" by the Associated Press, and ranked one of the "Top Forty Athletes of All-Time" by Sports Illustrated. Equally accomplished off the court, Martina is an author, philanthropist, TV commentator, and activist who has dedicated her life to educating people about prejudice and stereotypes. After coming out as a lesbian in 1981, Martina became a tireless advocate of equal rights for lesbian, gay, bisexual, and transgender (LGBT) people, and she has contributed generously to the LGBT community. Martina is the author of seven books, including most recently Shape Your Self: My 6-Step Diet and Fitness Plan to Achieve the Best Shape of your Life, an inspiring guide to healthy living and personal fitness. Martina was diagnosed with breast cancer in 2010.

William Sampson Handley (1872-1962): champion of the permeation theory of dissemination of breast cancer

The Halsted radical mastectomy that prevailed in the first half of the 20th century derived its scientific basis from the 'lymphatic permeation theory' of William Sampson Handley, an Honorary Senior Consulting Surgeon and former Vice President of the Royal College of Surgeons. Through his pioneering work in the cancer research laboratories at the Middlesex Hospital in London, Handley propounded the theory of centrifugal lymphatic permeation as the leading mechanism for the spread of cancer. This work won him worldwide renown and celebrated recognition in 1911 from the Royal College of Surgeons of England for the best work in the pathology and therapeutics in cancer. During his active life he was one of the great names and influences in the world of surgery. He held many roles at the Royal College of Surgeons and was involved with the international surgical fraternity. His philosophy of the uniqueness of the individual and his kind and courteous disposition won him praise from juniors, colleagues and patients alike. Although much of his work was rejected later, much still remains noteworthy in the history of surgery and cancer research.

[Screening of breast carcinoma screening in the Czech Republic requires cooperation with surgeons]

Mammographic screening is the only reliable method for reduction of mortality resulting from breast cancer. In the Czech Republic, a countrywide mammographic screening has been in function since 2003. Therefore, a total of 3 056 907 women underwent mammography examination by the end of 2010, with 14 914 breast cancers detected. Vast majority of the malignancies was in early stages with a good chance for effective therapy and excellent prognosis. During 2003-2009, regular and health insurance paid examinations were available to women aged 45-69. Since 2010, the age range eligible for mammographic screening has been extended beyond the age of 69, with no upper limit. The rate of Czech women undergoing mammographic screening exceeded 50 percent already in 2008. The effectiveness of screening, increase of rates of early stages and reduction in breast cancer mortality rates have been regularly audited and evaluated based on data collected from all 70 Czech breast cancer screening units.

The emergence of diagnostic imaging technologies in breast cancer: discovery, regulatory approval, reimbursement, and adoption in clinical guidelines

In this article, we trace the chronology of developments in breast imaging technologies that are used for diagnosis and staging of breast cancer, including mammography, ultrasonography, magnetic resonance imaging, computed tomography, and positron emission tomography. We explore factors that affected clinical acceptance and utilization of these technologies from discovery to clinical use, including milestones in peer-reviewed publication, US Food and Drug Administration approval, reimbursement by payers, and adoption into clinical guidelines. The factors driving utilization of new imaging technologies are mainly driven by regulatory approval and reimbursement by payers rather than evidence that they provide benefits to patients. Comparative effectiveness research can serve as a useful tool to investigate whether these imaging modalities provide information that improves patient outcomes in real-world settings.

Breast cancer in antiquity

Cancer of the breast, seen by Galen as the commonest cancer of his time, was probably first mentioned by Hippocrates in the 5th century BC. A single case history was described but no specific treatment mentioned. For centuries no further cases were described, until Cato, 2nd century BC, advocated cabbage poultices for all tumours and breast cancer in particular. Aëtius of Amida probably first described Paget's cancer of the nipple. By the 2nd century AD treatment comprised a variety of local applications, systemic medicaments, venesection and surgery. Surgical resection first described by Celsus and subsequently by Leonidas (usually combined with cautery) proved curative when applied early in the disease.