A Brief History of Cancer

Overview

This history follows the research breakthroughs that built our understanding of cancer — and how steady progress in science has lowered cancer risk, found cancer sooner, improved treatment and helped people with cancer live longer.

When Cancer Was Discovered

Cancer has affected animals for millions of years; scientists have found it in dinosaur bones 70 to 80 million years old. The earliest signs in humans are tumors in fossilized bones and mummies from ancient Egypt, around 3000 BCE. The oldest written description, in the Edwin Smith Papyrus from about 3000 BCE, describes a "bulging tumor of the breast." The Greek doctor Hippocrates (460–370 BCE) first used the word for cancer, calling tumors carcinos and carcinoma — Greek for crab — because they looked like a moving crab. The Roman doctor Celsus (25 BCE–50 CE) later translated this into the Latin word cancer. The Greek doctor Galen (130–200 CE) first used oncos, Greek for swelling, which gives us "oncology" and "oncologist."

Early Theories

Ancient Egyptians blamed cancer on the gods. Hippocrates believed it came from an imbalance of body fluids. From the 1500s to the 1700s, scientists thought it might come from lymph fluid problems, long-term inflammation, injury, or an infection passed between people.

Groundwork for Modern Oncology

Pathology and the microscope. The Italian doctor Giovanni Morgagni did the first autopsies in 1761, linking illness to cause of death; his reports began scientific oncology. The modern microscope of the 1800s showed that cancer is made of cells, that every cell comes from another cell, and that cancer cells look different from normal cells. Pathologists could then diagnose cancer in tissue removed at surgery and tell surgeons whether all of it was out.

Epidemiology. In 1713, Bernardino Ramazzini noted that nuns rarely had cervical cancer but often had breast cancer, pointing toward the roles of hormones and sexually transmitted infections. In 1775, Percival Pott showed that soot caused scrotal cancer in chimney sweeps, opening the study of job-related exposures. The National Cancer Act of 1971 created a network of cancer registries and the SEER (Surveillance, Epidemiology, and End Results) Program to track cancer rates and survival.

Carcinogens. Tobacco was linked to cancer in 1761. In 1911 a virus was found that caused cancer in chickens, which led to links between viruses and human cancers — hepatitis B with liver cancer, and Epstein-Barr virus with non-Hodgkin lymphoma. In the 1980s the bacterium H. pylori was shown to raise stomach cancer risk. In 1991, research showed that environmental exposures damage DNA and make cells more sensitive to carcinogens such as UV radiation and cigarette smoke. In 1999, HPV was found in 99.7% of cervical cancers, which led to the HPV vaccine in 2006.

Genes. The discovery of DNA's structure in the mid-20th century showed how gene changes, inherited or caused by carcinogens, lead to cancer, and that cancer cells with damaged DNA do not die as normal cells do. In the 1970s scientists identified oncogenes and tumor suppressor genes; inherited BRCA1 and BRCA2 changes, for example, raise breast and ovarian cancer risk. The Human Genome Project, completed in 2000, helped find more cancer-related gene changes and develop better treatments.

Finding Cancer Early

Screening tests find cancer in people without symptoms, often before it spreads, and some — for cervical and colorectal cancer — find growths before they become cancer. The Pap test, developed in the 1920s, was the first widely used screening test and cut cervical cancer rates by more than half. The discovery that HPV causes most cervical cancers led to guidelines for a primary HPV test, with or without a Pap test. The mammogram, developed in the 1960s, is still the most reliable breast cancer screening test. Colonoscopy and stool-based and blood-based tests now screen for colorectal cancer, and low-dose chest CT screens people at higher risk of lung cancer. Multi-cancer early detection (MCED) tests look for signs of many cancers in blood and other fluids; some are available, but they are expensive and not yet FDA-approved.

History of Treatment

• Surgery and anesthesia. Early surgery often did more harm than good, and Galen believed cancer could not be cured. Effective anesthesia in 1846 let surgeons remove tumors and lymph nodes more completely and safely. The radical mastectomy came in the late 1800s; a century later, breast-conserving surgery proved to work as well. Today CT, MRI and PET scans locate tumors without surgery, and robotic systems operate through openings little bigger than a keyhole.
• Hormone therapy. In 1895, removing the ovaries was shown to slow breast cancer. In 1977 the FDA approved tamoxifen, which blocks hormone activity without surgery. For prostate cancer, surgical castration in the 1940s gave way to medicines that suppress or block male hormones.
• Radiation therapy. X-rays were discovered in 1895 and soon used to treat cancer. Brachytherapy (internal radiation) treated cervical and prostate cancers in the early 1900s while external beam radiation improved. Proton beams in the 1960s added precision, and conformal and intensity-modulated radiation in the 1990s spared more healthy tissue.
• Chemotherapy. Military research found that nitrogen mustard shrank lymphomas; it was approved in 1949. Aminopterin and methotrexate then treated childhood leukemia, and by the 1960s and 1970s chemotherapy was curing Hodgkin disease, childhood acute lymphoblastic leukemia (ALL) and testicular cancer.
• Stem cell and bone marrow transplants. First done in 1957, they return healthy blood stem cells after disease, chemotherapy or radiation destroys the marrow, and are now a key treatment for blood cancers.
• Targeted therapy, immunotherapy and precision medicine. Targeted therapies began in the 1980s; trastuzumab, approved in 1998, blocks the HER2 protein in some breast cancers. Two decades later, pembrolizumab became the first treatment approved for a tumor's genetic changes rather than where it started. Immunotherapy began with interferons for hairy cell leukemia in 1986, followed by BCG for some bladder cancers, interleukins for kidney cancer, monoclonal antibodies such as rituximab for lymphoma, cancer vaccines for prostate cancer, checkpoint inhibitors for melanoma, and cell therapies such as CAR T-cell therapy for some blood cancers and TIL therapy for some solid tumors. Precision medicine now ties these together by testing the genes and proteins in a tumor or blood to choose the treatments most likely to work.

Survivorship

More than 18 million cancer survivors were living in the US in 2022, and the number is expected to pass 22 million by 2035. The National Coalition for Cancer Survivorship (now Cancer Nation) was founded in 1986. The National Cancer Institute created its Office of Cancer Survivorship in 1996. In 2006 the Institute of Medicine's report "From Cancer Patient to Cancer Survivor: Lost in Transition" called for transition plans and better coordination between cancer teams and primary care after treatment ends.

The Future of Cancer Research

Research continues to find new ways to prevent, find and treat cancer, to meet survivors' needs, and to improve outcomes and access to care for all groups. Current examples include how physical activity affects cancer risk, new ways to calculate breast cancer risk to personalize screening, how inadequate health insurance affects survival, and new gene tests that may personalize ovarian cancer care.

Questions to Ask Your Doctor

• Which cancer screening tests are recommended for someone of my age and risk?
• Is my cancer one that can be found early with screening, and how often should I be screened?
• Which of today's treatments — surgery, radiation, chemotherapy, hormone therapy, targeted therapy or immunotherapy — fit my cancer?
• Should my tumor be tested so that a precision medicine treatment can be chosen?
• Is there a clinical trial of a newer treatment that I could join?

Source: https://www.cancer.org/cancer/understanding-cancer/history-of-cancer.html