Did an Ancient Persian Queen Suffer From Breast Cancer?

In Histories, written in the 5th century BC, the Greek historian Herodotus tells the story of Atossa, the queen of Persia, who was struck by an unusual illness. Atossa was the daughter of Cyrus the Great, and wife of Darius I, the legendary Achaemenid emperor who ruled over a vast stretch of land from Lydia on the Mediterranean Sea to Babylonia on the Persian Gulf. Atossa was troubled by a bleeding lump in her breast, “which broke and spread further.” Atossa was embarrassed of her ailment, and at first hid it from others. But when the swelling increased and with it the pain, she sent for Democedes of Croton, who was one of the most gifted physicians of the 6th century B.C.

Bust of Atossa at the National Museum of Iran. Photo: DanielTheGreat/Wikimedia

Democedes did cure her, although how, Herodotus doesn’t say. Modern interpretation suggest that Democedes operated upon her and removed the malignant tumor. In return, Democedes requested Atossa to assist him to return to Greece. Keeping her word, Atossa successfully pleaded with her husband to set Democedes free, to which Darius sent Democedes on a ship for a reconnaissance mission to Greece for a later military campaign. Democedes escaped at Tarentum and eventually returned to Croton.

Herodotus’s passage on Atossa’s affliction, although brief, is considered to be the first recoded case of mastitis, sometimes interpreted as a sign of an inflammatory breast cancer.

A.T. Sandison believes that Democedes treated Atossa “with the simple remedies available at that time”. “We may be sure that no major surgery was undertaken and that cure probably resulted from simple non-operative measures,” Sandison wrote. After her cure Atossa lived a fairly normal life, bore four sons to Darius including the next Achaemenid king, Xerxes I. Atossa lived long enough to see Xerxes invade Greece, and died at an advanced age. “It seems reasonable to assume that at the time of her illness she was still a young woman, possibly in the early years of the third decade of life,” Sandison continued.

According to Sandison, Atossa’s lesion of the breast was not carcinogenic. “In an analyses of surgical lesions of the breast I have shown (Sandison 1958) that in 72 specimens from patients in the third decade of life carcinoma was seen only 2 times,” he reasoned. Sandison wrote: “Carcinoma is uncommon in very young women, but it does occur and cannot be excluded solely on the grounds of the age of a patient. Nevertheless it is universally accepted that the prognosis in such young women, unless immediate radical treatment is undertaken at the earliest date, is hopeless: even with radical treatment the outlook is poor. It is also generally accepted that pregnancy and lactation have a marked effect in accelerating the course of the disease. It may therefore be accepted that Atossa's condition was not carcinoma; a carcinoma which burst and continued to spread (i.e. fungated) would rapidly have proved fatal; the fact that Atossa had multiple pregnancies and survived to an old age makes the possibility quite untenable.”

Sandison reasons that carcinoma could not have been cured with the simple remedies available at the time. “The only lesion likely to occur in a young woman which might burst, spread, yield to simple measures and leave no harmful after-effects is some form of infective mastitis. This might well proceed to superficial suppuration, discharge of pus and be complicated by a spreading cellulitis of skin and subcutaneous tissues. In the past such disease processes were not rare.”

“The commonest form of infective mastitis is puerperal infection but no indication is given that Atossa was at the relevant time either pregnant or lactating. Non-puerperal acute inflammations do, however, occur; these may follow rupture of small ('sebaceous') cysts of the areola. I have seen biopsies from three such cases in the past five years. Another important cause in trauma; this may be accidental or due to cosmetic measures, e.g. cutting or plucking hairs from the breast. It may also result from the use of a badly fitted or too tight brassiere. “

Sandison concludes: “Herodotus describes briefly a lesion of the breast of Queen Atossa which was successfully treated by the Greek physician Democedes of Croton. Although the case has been uncritically accepted by some authorities as an early report of mammary tumour, this interpretation is quite untenable. Almost certainly Atossa suffered from a superficial acute mastitis with suppuration and spreading cellulitis. Such a lesion might well have responded to simple medical measures. It would be unprofitable to speculate at length on possible aetiological factors but rupture of a simple cyst of an areolar gland or cosmetic trauma seem likely causes.”

References:
# Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer.
# A. T. Sandison,  "The First Recorded Case of Inflammatory Mastitis— Queen Atossa of Persia and the Physician Democêdes", Medical History