The Mammogram: The History And
Advances In Breast Screening

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

“Early detection saves lives. Please schedule your screening mammogram today,” was the message printed on a postcard that I received in the mail. This year I’ll have my first screening mammogram.

I’m not looking forward to the procedure. I had a mammogram when I was 33 to evaluate I lump. The technician was a witch who wanted me, a practicing physician assistant, to “experience what I subjected my patients to”. Thankfully, most radiology technicians are not so callous. Yet my memories make me apprehensive.

Mammograms today can be more comfortable. Gail Lebovic, MD, a female breast surgeon, invented the MammoPads, cushions designed to make the procedure more bearable. According to Biolucent, the manufacturer, MammoPads significantly reduce the pain of having a mammogram without sacrificing the quality of the exam. MammoPads are used at North Austin Hospital, St. David’s Hospital and South Austin Hospital.

Forty years ago if I had found a breast lump I would have undergone a radical, and very disfiguring, mastectomy, and still would have probably died within a few months to a few years of treatment. The benefits of mammography far outweigh the discomforts and mammography, as we know it today, is a far cry from its start at the end of the nineteenth century.

According to BookRags.com, Albert Salomon, a German surgeon, first used x-rays to study breast cancer. He studied tissue removed during surgery, noting that x-rays detected differences between cancerous and non-cancerous tumors. He also found the technique successfully detected breast cancer in women. The different x-rays showed that many different types of breast cancer exist. He published his work in 1913, but never used breast x-rays in his own practice to diagnose breast cancer.

Jacob Gershon-Cohen, MD, D.Sc., first advocated regular breast examinations with x-rays in the nineteen fifties, following a five year study at Albert Einstein Medical Center which screened thirteen hundred women every six months. In the study, ninety-two women were diagnosed with non-malignant tumors while twenty-three were diagnosed with malignant tumors. As a result of his work, screening mammography became routine by the nineteen sixties. In France in the mid nineteen sixties, Charles M. Gros, MD introduced molybdenum targets and advocated forceful compression of the breast during exposures, which improved image quality.

Few people dispute that mammography saves lives. But what research is going on today? The American Cancer Society and the National Cancer Institute are funding research in new breast imaging methods. Ladies, this is what’s on the horizon:

Breast Ultrasound- This is currently an additional diagnostic tool used to distinguish between fluid filled cysts and solid masses, and between benign and cancerous tumors. Ultrasound uses high frequency sound waves to outline a part of the body. Sound wave echoes are picked up and translated by a computer into an image on a computer screen. There is no radiation exposure during this test. It is of limited value, however, because calcium deposits-one of the earliest signs of breast cancer-are not detected by ultrasound.

Magnetic Resonance Imaging-MRI uses a magnet connected to a computer to create detailed images of the inside of the body without using radiation. For breast exams, the patient lies on her stomach on the scanning table while her breasts hang into holes in a table containing coils that detect the magnetic signal. As the table moves through the tube-like machine that contains the magnet, cross-sectional images are taken. Sometimes non-radioactive contrast dye is injected into the patient to improve the clarity of images. MRI can detect some conditions but overall is less accurate than mammography in detecting cancers.

Computed Tomography Laser Mammograms- Laser technology is used to examine different planes of breast tissue and create a three dimensional image of the breast. There is no radiation or breast compression involved. The technique is not yet approved for general use, but is promising.

Positron Emission Tomography- A tiny amount of radioactive substance is injected into an arm vein that travels to the breast. The substance gives off a small amount of radiation that is picked up by the PET scanner to create an image. Typically the substance goes to cells that are the most active, like cancer cells. While this is an excellent method for detecting the spread of cancer, it does not currently detect tumors smaller than one centimeter, so it can’t be used for breast cancer screening.

Thermal Imaging-This technique uses a special camera to measure the heat from the breast. The computer looks for “hot spots” and analyzes the images. The theory is that an area of increased heat may indicate an increase in blood flow due to cancerous cells. Thermal imaging is an approved method of breast screening, but has not proven to be a reliable screening tool since it often misses cancers and has a high false positive rate.

Electrical Impedance Scanning-EIS measures the rate at which electricity moves through tissues. In breast tissue, electricity moves faster through cancerous tissue than through normal breast tissue. The test is not used alone as a screening test. EIS helps radiologists outline localize tumors and may reduce the number of biopsies done.