Breast cancer: Looking for the “Magic Bullet”

UNITED STATES, WASHINGTON (OBSERVATORY HEALTH) — Breast cancer is the most common cancer among women. Experts from the International Agency for Research on Cancer in 2012 estimated that 1.3 million cases of the disease with this form of cancer are registered in the world every year, and about half a million sick women die.

Oncologists note that it is possible to reduce mortality from breast cancer – this is facilitated by early diagnosis programs that can detect the disease in the early stages when therapy is most effective.

It is also important that the methods of treating breast cancer are constantly being improved. The arsenal of doctors is replenished with a variety of methods, the use of which allows you to fight the disease more effectively.

Over the years, the attitude of both doctors and patients towards breast cancer has changed – gradually the opinion that the oncological diagnosis – the death sentence – has receded into the past, and a different point of view has come to replace it – recovery is possible.

From hot iron to mastectomy

It turned out far from immediately. Ancient Renaissance doctors and physicians tried to treat breast tumors by performing manipulations, during which the gland affected by the tumor was cut off or burned with a hot iron. There was no question of any pain medication, and before the discovery of antibiotics, there were still several centuries left – rare patients who could be saved from cancer with such an operation could die (and die) from developed infections and other complications.

The first to take a different approach to the surgical removal of tumors were the Frenchman Jean-Louis Petit and the Scot Benjamin Bell. Independently of each other, they performed operations, which can be called the prototype of modern mastectomy, during which the tumor tissue of the mammary gland, pectoral muscles, and also lymph nodes were removed.

In addition, Petit was the first to start leaving the nipple and a non-tumor fragment of the skin back in the 18th century, in fact, proposing an organ-preserving operation.

However, then the method of Petit was not widespread – contemporaries preferred more barbaric methods. However, at the end of the 19th century, another physician, William Halsted, an American, managed to introduce mastectomy into routine practice.

He was one of the first to use anesthesia and also take care of sterility, which reduced the risk of infection. It is Halstead who is considered the author of the radical mastectomy technique used today. Its use, along with the observance of the principles of asepsis and the appointment of anesthetics, helped to significantly increase the survival rate in breast cancer: from 10%, it increased to 50%.

Note that at present, radical mastectomy is not performed very often – doctors perform a gentle operation, during which the number of tissues removed is determined individually in each case.

Rabbits and estrogen

The end of the 19th century was marked by other discoveries that made possible the emergence of other approaches to the treatment of breast cancer.

One of them was performed by Thomas Beatson, who showed the stimulating effect of estrogen on the development of breast tumors. Interestingly, this discovery was made before the discovery of estrogen itself.

At first, Beatson noticed that the removal of ovaries in rabbits leads to a cessation of milk production. The observations were continued: it turned out that a similar operation improved the condition of patients diagnosed with breast cancer.

Beatson’s work became the basis of hormone therapy – an approach that is used in the treatment of hormone-dependent breast tumors.

Amazing rays

X-ray detection is another important discovery. The find of Wilhelm Rengten quickly began to be used both for diagnosis and for the treatment of tumors.

Initially, no one thought about safety measures when working with X-rays, and therefore doctors and laboratory assistants working with X-rays and selecting an effective dose of radiation in their own palm often got cancer.

Years passed before the rules for working with x-ray, and then with other types of ionizing radiation, were developed.

In addition, radiation therapy devices have been improved and continue to improve. Now the radiation can be sent exactly to the location of the tumor: in this way the cancer cells will be destroyed, and healthy tissues will not be affected.

New weapon

The development of chemistry and the pharmaceutical industry in the 20th century naturally led to the discovery of many new molecules and substances that possessed a variety of properties. Among them were those that blocked cell division and growth. Drugs based on them began to be used to fight tumors.

Chemotherapy has been and is being used as an independent method of treatment, but besides this, it has often been used as part of combination therapy.

It was in the treatment of breast cancer that adjuvant therapy was first tested – chemotherapy prescribed after surgical treatment. She helped destroy those cells that were not removed during the operation. The approach was successful and soon the method began to be used in the fight against other forms of cancer.

Neoadjuvant therapy has also spread – in this case, chemotherapy drugs are prescribed before surgery or a course of radiation therapy.

Those same “bullets”

At the beginning of the 20th century, the German doctor Paul Erlich introduced the phrase “magic bullet”: he called a hypothetical drug that would independently find and destroy the cause of the disease.

The search for such a “bullet” was carried out by a variety of specialists in different fields, including oncologists. In the 70s, a technique for producing monoclonal antibodies was developed. They became the very “bullet” in the treatment of certain tumors.

Their production and use, however, was not possible without the development of molecular biology and histology, as well as other fields of science. Surgical treatment, chemotherapy, hormonal and radiation therapy did not require studying the cells of the tumor itself, because during the treatment the tumor was simply tried to destroy or remove from the body.

For the use of monoclonal antibodies and their creation, it was important to know the structural features of the cells of a particular tumor. Antibodies are able to bind specifically to cancer cells, connecting with specific proteins located on their surface – antigens. As a result, they inhibit the growth and division of tumor cells without affecting healthy ones.

Most monoclonal antibodies used in oncology are simple – they are not connected to any cytotoxic (detrimental to cells) drug. The second type of monoclonal antibody is conjugated, the molecules of which are bound to some substance (toxin or radioactive particle). Monoclonal antibody-based drugs are used in mono mode, as well as in combination therapy.

As a drug, monoclonal antibodies were first registered specifically for the treatment of breast tumors.

Today it is becoming possible to choose the right regimen for the treatment of many forms of breast cancer – this can reduce mortality, increase survival without progression, and reduce the likelihood of side effects.

For example, recent studies show that with advanced breast cancer, combination therapy, including the use of antibodies and hormone therapy, increases patient survival by more than one and a half times.

The future has come

Science does not stand still – new methods of treating various tumors are already appearing, as well as old ones are being improved, which gives hope to many patients.

For example, for those who have been diagnosed with hormone-dependent advanced breast cancer — mostly young active women who have a career and a family — until recently, only chemotherapy was available. Other methods often proved to be ineffective at this stage of cancer.

Recent studies of innovative targeted drugs for the treatment of breast cancer in this group of patients have shown outstanding results not only in terms of overall survival, but also in quality of life.

For example, the data obtained in the Monaleesa-7 study showed that after 42 months of follow-up, 70.2% of women who received combined drug treatment in combination with endocrinotherapy were alive compared to 46.0% of women who received only endocrinotherapy 1 .

In addition, modern methods of therapy can improve the patient’s well-being during treatment, which means that she can spend more time with her family, do what she loves and fulfill her dreams. It is the patient’s quality of life, along with the effectiveness of treatment, that is today the most important factor for choosing a therapy.

The emergence of new treatment methods that prolong the life of patients with such a diagnosis gives women the hope that they have been deprived of before, and also changes the existing understanding of cancer and its treatment.


This article is written and prepared by our foreign editors writing for OBSERVATORY NEWS HEALTH from different countries around the world – material edited and published by OBSERVATORY staff in our newsroom.

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