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A medieval description of metastatic breast cancer; from Avicenna's view point
The Breast 31 (2017) 20e21
Contents lists available at ScienceDirect
The Breast journal homepage: www.elsevier.com/brst
Viewpoints and debate
A medieval description of metastatic breast cancer; from Avicenna's view point Mohammad M. Zarshenas a, b, Afshin Mohammadi-Bardbori c, * a
Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran c Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 15 September 2016 Received in revised form 13 October 2016 Accepted 22 October 2016
Historically, one of the earliest breast cancer case descriptions comes from an Egyptian manuscript so called “the Edwin Smith Papyrus” dating back to the Pyramid Age. However, apart from all respective documents remained from the antiquity, concepts and standpoints of Avicenna (Ibn Sina; a famous Persian physician) in regard of the cancer are interesting. A case of breast cancer and metastatic condition has been reported by Avicenna in the Canon of Medicine. This report can be considered as a very early report of metastatic or stage IV breast cancer. He underlined that cancer should be diagnosed and cured in the early stages. With views of Avicenna, cancer is an atrabilious (black bile) swelling (tumor) which sometimes may be accompanied by pain or swelling. He also mentioned that some vessels may be appeared around the cancerous part. Avicenna extrapolated the cancer with legs of cancer crab which can to grow around the other organs and tissues. © 2016 Elsevier Ltd. All rights reserved.
Keywords: Metastatic breast cancer Avicenna's view point
Introduction Cancer is a cohort of diseases (over 100 various types of cancer are known so far) in which abnormal cells start to divide without any control. The cancerous cell obtains a potential ability to grow beyond their usual boundaries, to invade neighboring parts of the body and to spread to other organs [1]. As a leading cause of death, cancer strikes more than one third of the population (more than 20% of all deaths). The most common cancer worldwide among female is breast cancer (521000 deaths in 2012) [2]. This cancer is also the most commonly diagnosed types (25.2% of total). Worldwide age-standardized incidence and mortality rate of breast cancer among female was reported at least 43.3 and 12.9 per 100,000 women respectively in 2012 [2]. Historically, one of the earliest breast cancer case descriptions comes from an Egyptian manuscript so called “the Edwin Smith Papyrus” dating back to the Pyramid Age [3]. Another similar case was reported by Herodotus (Book 3; 133; Greene's 1987 translation). He remarked a possible breast cancer of Queen
* Corresponding author. Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, P.O Box: 71345-1583, Iran. E-mail address: [email protected] (A. Mohammadi-Bardbori). http://dx.doi.org/10.1016/j.breast.2016.10.019 0960-9776/© 2016 Elsevier Ltd. All rights reserved.
Atossa, the daughter of Cyrus and spouse of Darius, who had a swelling on her breast, cured by Democedes, the most skillful physician of his time [Chapter 134]. Actually, the clinical explanation of the lesion brings doubt to the mind that her lesion could not be a breast cancer (it might be an abscess). However, it is not clear that how long Atossa was alive after being operated and thus, drawing a conclusion from that report might not reflect the reality [4]. In this regard, we tried to filter the medieval description of cancer and metastatic conditions which may have been mentioned by outstanding Persian scholars to report their findings evidently. Methods The medieval medical encyclopedia, Canon of Medicine is one of the almost 450 treatises authored by Ibn-Sina (Known as Avicenna in the western world) in the golden ages of the Islamic era (9e11th centuries A.D.). For more than a half of a millennium, this textbook was a standard medical compendium and the largest medieval encyclopedia through the medical history. The book composes of five separated volumes, containing medical and pharmaceutical knowledge [5,6]. We studied the third and fourth volumes focused on the medical information.
M.M. Zarshenas, A. Mohammadi-Bardbori / The Breast 31 (2017) 20e21
Results and discussion
confirmed the final draft.
Apart from all respective documents remained from the antiquity, concepts and standpoints of Avicenna (Ibn Sina; a famous Persian physician) in regard of the cancer are interesting [7]. A case of breast cancer and metastatic condition has been reported by Avicenna in the Canon of Medicine. In the eighth chapter of the second section in the fourth volume of his Canon; he has reported a patient with breast cancer who had been undergone to mastectomy before. He illustrates the condition: “The patient had been cured by surgery. Later, the other breast was affected by the tumor. Regarding, I say that the other breast was also affected as well or cancerous matters were in the way from the first breast or other organs to the second, before cutting [mastectomy]. In my opinion the recent theory is more likely”. This report can be considered as a very early report of metastatic or stage IV breast cancer. On the previous page, Avicenna meticulously has mentioned that hardly a physician can eradicate the cancer. In these conditions, he underlined that cancer should be diagnosed and cured in the early stages. With views of Avicenna, cancer is an atrabilious (black bile) swelling (tumor) which sometimes may be accompanied by pain or swelling. He also mentioned that some vessels may be appeared around the cancerous part. Avicenna extrapolated the cancer with legs of cancer crab which can to grow around the other organs and tissues [7,8]. It is significant that over 1000 years ago, an early physician and scholar simply but admirably defined and discussed the metastatic condition in breast cancer. Avicenna has undoubtedly been a pioneer in medical sciences in his era. However, many of his medical concepts are still remained undiscovered [9]. Therefore, comprehensive investigations of such medieval documents, other than the historical elucidation, may lead to many fruitful medical and pharmaceutical approaches to progress and promote development in medical sciences.
Declaration of conflicting interests
Author contributions AMB designed the structure of the paper. AMB and MMZ studied the medieval manuscripts and collected the data. MMZ and AMB wrote the draft of the article. Both authors have reviewed and
21
Authors of this manuscript have no competing financial, professional or personal interests. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Ethical approval Since this work was a book chapter review, no ethical approval was needed. Acknowledgement Authors of this manuscript wish to express their appreciation to Shiraz University of Medical Sciences, Shiraz, Iran. References [1] Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011;144:646e74. [2] Stewart Bernard W, Wild Christopher P, editors. World Cancer report. IARC. Wild BWSaCP; 2014. [3] Feldman RP, Goodrich JT. The Edwin Smith surgical Papyrus. Child's Nerv Sys 1999;15:281e4. [4] Karpozilos A, Pavlidis N. The treatment of cancer in Greek antiquity. Eur J Canc 2004;40(14):2033e40. [5] Zarshenas MM, Zargaran A. A review on the Avicenna's contribution to the field of cardiology. Int J Cardiol 2015;182:237e41. [6] Zarshenas MM, Petramfar P, Firoozabadi A, Moein MR, Mohagheghzadeh A. Types of headache and those remedies in traditional persian medicine. Pharmacogn Rev 2013;7(13):17e26. Ibn. (Avicenna). Kit n fı al-Tibb (Canon of medicine); in Hameed [7] Sına ab al-Q anu HA. New Delhi: Jamia Hamdard Printing Press; 1988. [8] Avicenna. Canon of medicine. Dar-ol-Behar, Beirut [book in Arabic. 2009. [9] Zohalinezhad ME, Zarshenas MM. Cardiovascular aspects of erectile dysfunction as outlined by Avicenna. Int J Cardiol 2014;175:33e4.
Contents lists available at ScienceDirect
The Breast journal homepage: www.elsevier.com/brst
Viewpoints and debate
A medieval description of metastatic breast cancer; from Avicenna's view point Mohammad M. Zarshenas a, b, Afshin Mohammadi-Bardbori c, * a
Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran c Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 15 September 2016 Received in revised form 13 October 2016 Accepted 22 October 2016
Historically, one of the earliest breast cancer case descriptions comes from an Egyptian manuscript so called “the Edwin Smith Papyrus” dating back to the Pyramid Age. However, apart from all respective documents remained from the antiquity, concepts and standpoints of Avicenna (Ibn Sina; a famous Persian physician) in regard of the cancer are interesting. A case of breast cancer and metastatic condition has been reported by Avicenna in the Canon of Medicine. This report can be considered as a very early report of metastatic or stage IV breast cancer. He underlined that cancer should be diagnosed and cured in the early stages. With views of Avicenna, cancer is an atrabilious (black bile) swelling (tumor) which sometimes may be accompanied by pain or swelling. He also mentioned that some vessels may be appeared around the cancerous part. Avicenna extrapolated the cancer with legs of cancer crab which can to grow around the other organs and tissues. © 2016 Elsevier Ltd. All rights reserved.
Keywords: Metastatic breast cancer Avicenna's view point
Introduction Cancer is a cohort of diseases (over 100 various types of cancer are known so far) in which abnormal cells start to divide without any control. The cancerous cell obtains a potential ability to grow beyond their usual boundaries, to invade neighboring parts of the body and to spread to other organs [1]. As a leading cause of death, cancer strikes more than one third of the population (more than 20% of all deaths). The most common cancer worldwide among female is breast cancer (521000 deaths in 2012) [2]. This cancer is also the most commonly diagnosed types (25.2% of total). Worldwide age-standardized incidence and mortality rate of breast cancer among female was reported at least 43.3 and 12.9 per 100,000 women respectively in 2012 [2]. Historically, one of the earliest breast cancer case descriptions comes from an Egyptian manuscript so called “the Edwin Smith Papyrus” dating back to the Pyramid Age [3]. Another similar case was reported by Herodotus (Book 3; 133; Greene's 1987 translation). He remarked a possible breast cancer of Queen
* Corresponding author. Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, P.O Box: 71345-1583, Iran. E-mail address: [email protected] (A. Mohammadi-Bardbori). http://dx.doi.org/10.1016/j.breast.2016.10.019 0960-9776/© 2016 Elsevier Ltd. All rights reserved.
Atossa, the daughter of Cyrus and spouse of Darius, who had a swelling on her breast, cured by Democedes, the most skillful physician of his time [Chapter 134]. Actually, the clinical explanation of the lesion brings doubt to the mind that her lesion could not be a breast cancer (it might be an abscess). However, it is not clear that how long Atossa was alive after being operated and thus, drawing a conclusion from that report might not reflect the reality [4]. In this regard, we tried to filter the medieval description of cancer and metastatic conditions which may have been mentioned by outstanding Persian scholars to report their findings evidently. Methods The medieval medical encyclopedia, Canon of Medicine is one of the almost 450 treatises authored by Ibn-Sina (Known as Avicenna in the western world) in the golden ages of the Islamic era (9e11th centuries A.D.). For more than a half of a millennium, this textbook was a standard medical compendium and the largest medieval encyclopedia through the medical history. The book composes of five separated volumes, containing medical and pharmaceutical knowledge [5,6]. We studied the third and fourth volumes focused on the medical information.
M.M. Zarshenas, A. Mohammadi-Bardbori / The Breast 31 (2017) 20e21
Results and discussion
confirmed the final draft.
Apart from all respective documents remained from the antiquity, concepts and standpoints of Avicenna (Ibn Sina; a famous Persian physician) in regard of the cancer are interesting [7]. A case of breast cancer and metastatic condition has been reported by Avicenna in the Canon of Medicine. In the eighth chapter of the second section in the fourth volume of his Canon; he has reported a patient with breast cancer who had been undergone to mastectomy before. He illustrates the condition: “The patient had been cured by surgery. Later, the other breast was affected by the tumor. Regarding, I say that the other breast was also affected as well or cancerous matters were in the way from the first breast or other organs to the second, before cutting [mastectomy]. In my opinion the recent theory is more likely”. This report can be considered as a very early report of metastatic or stage IV breast cancer. On the previous page, Avicenna meticulously has mentioned that hardly a physician can eradicate the cancer. In these conditions, he underlined that cancer should be diagnosed and cured in the early stages. With views of Avicenna, cancer is an atrabilious (black bile) swelling (tumor) which sometimes may be accompanied by pain or swelling. He also mentioned that some vessels may be appeared around the cancerous part. Avicenna extrapolated the cancer with legs of cancer crab which can to grow around the other organs and tissues [7,8]. It is significant that over 1000 years ago, an early physician and scholar simply but admirably defined and discussed the metastatic condition in breast cancer. Avicenna has undoubtedly been a pioneer in medical sciences in his era. However, many of his medical concepts are still remained undiscovered [9]. Therefore, comprehensive investigations of such medieval documents, other than the historical elucidation, may lead to many fruitful medical and pharmaceutical approaches to progress and promote development in medical sciences.
Declaration of conflicting interests
Author contributions AMB designed the structure of the paper. AMB and MMZ studied the medieval manuscripts and collected the data. MMZ and AMB wrote the draft of the article. Both authors have reviewed and
21
Authors of this manuscript have no competing financial, professional or personal interests. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Ethical approval Since this work was a book chapter review, no ethical approval was needed. Acknowledgement Authors of this manuscript wish to express their appreciation to Shiraz University of Medical Sciences, Shiraz, Iran. References [1] Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011;144:646e74. [2] Stewart Bernard W, Wild Christopher P, editors. World Cancer report. IARC. Wild BWSaCP; 2014. [3] Feldman RP, Goodrich JT. The Edwin Smith surgical Papyrus. Child's Nerv Sys 1999;15:281e4. [4] Karpozilos A, Pavlidis N. The treatment of cancer in Greek antiquity. Eur J Canc 2004;40(14):2033e40. [5] Zarshenas MM, Zargaran A. A review on the Avicenna's contribution to the field of cardiology. Int J Cardiol 2015;182:237e41. [6] Zarshenas MM, Petramfar P, Firoozabadi A, Moein MR, Mohagheghzadeh A. Types of headache and those remedies in traditional persian medicine. Pharmacogn Rev 2013;7(13):17e26. Ibn. (Avicenna). Kit n fı al-Tibb (Canon of medicine); in Hameed [7] Sına ab al-Q anu HA. New Delhi: Jamia Hamdard Printing Press; 1988. [8] Avicenna. Canon of medicine. Dar-ol-Behar, Beirut [book in Arabic. 2009. [9] Zohalinezhad ME, Zarshenas MM. Cardiovascular aspects of erectile dysfunction as outlined by Avicenna. Int J Cardiol 2014;175:33e4.