Breast cancer 2000 BC to 2000 AD--time for a paradigm shift?
In this paper I trace the history of the development of the treatment of breast cancer over a 4000-year period. I point out that there have basically been three paradigms within which we have studied and developed treatment for this disease. Clinical trials over the last twenty years as an expression of the scientific method in action, have demonstrated the limited success of the contemporary paradigm with its therapeutic sequelae of breast conserving surgery and adjuvant systemic therapy. At the same time a critical review of the natural history of breast cancer and the results of current treatments suggest logical inconsistencies in the model. I have therefore constructed a novel paradigm which better fits the available information by suggesting that metastases are not only a result of cellular transmission of breast cancer but sub-cellular transmission using the mechanism of in vivo transfection. Although this may sound far fetched, there are a series of remarkable studies in the literature which supports this conceptual revolution. This is surely a fertile field for research and the therapeutic consequences would be obvious. They might suggest that more aggressive adjuvant systemic chemotherapy based on the conventional model is unlikely to achieve any additional benefit, whereas therapy based on anti-viral drugs might produce the next therapeutic advance. It is not the intention of this article to persuade readers that the alternative paradigm is true but merely to open minds to the study of history and scientific philosophy to ensure that we do not repeat the errors of the past.
Baum
M
M
Department of Surgery, Royal Marsden Hospital, London, England.
D001943:Breast Neoplasms / Q000188:drug therapy / Q000266:history* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans