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 b 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 article info Article history: Received 15 September 2016 Received in revised form 13 October 2016 Accepted 22 October 2016 Keywords: Metastatic breast cancer Avicenna's view point abstract 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. 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). World- wide age-standardized incidence and mortality rate of breast can- cer 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 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 expla- nation 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. * 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: toxicology@sums.ac.ir (A. Mohammadi-Bardbori). Contents lists available at ScienceDirect The Breast journal homepage: www.elsevier.com/brst http://dx.doi.org/10.1016/j.breast.2016.10.019 0960-9776/© 2016 Elsevier Ltd. All rights reserved. The Breast 31 (2017) 20e21