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A look back at the history of mammography

by Sean Ruck , Contributing Editor
Long before mammography became a topic of debate about guidelines and the benefits of tumor identification versus false-positives, it was just another technology that seemed to be a curiosity for some and a revelation for others.

The precursor to mammograms were the radiography studies performed in 1913 by Dr. Robert Salomon on breast tissue that had been collected through mastectomies. Through his research, Salomon discovered that there were different types of breast cancer. And while he was able to use radiography to show the role the axillary lymph nodes played in the dissemination of cancerous tumors, holding the claim to fame as the first to perform a mammogram was not to be his lot, possibly due to not realizing or caring about the benefits it could bring to women or possibly due, in part, to the disruption of his work caused by the rise of Hitler, which resulted in his being ousted from his faculty position at the University of Berlin. Salomon was later placed in a concentration camp for several months before ultimately landing in Holland by 1939, where he would spend the rest of his life.

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Regardless of the reasons Salomon didn’t pursue his work further, others picked up the baton. Another German researcher, Walter Vogel, detailed how X-rays could help medical professionals differentiate between healthy and cancerous breast tissue. His guidelines, created nearly a century ago, were so well-crafted, that they’re still used today. However, to get to the first mammogram with a patient, a leap of a few years to 1930 is required.

It was in 1930 that Stafford Warren became an associate professor of medicine at University of Rochester School of Medicine. It was also that year that he published his work, “A Roentgenologic Study of the Breast.” Like Salomon, Warren developed images of cancer tissue gathered via mastectomy – more than 3,000 images in all. Unlike Salomon, Warren continued his research and created methods to capture images of living breast tissue by repurposing available X-ray equipment. The mammograms performed by Warren required his patients to lie on their side with one arm raised. According to the book “Diagnosis of Diseases of the Breast,” by Lawrence Bassett and Valerie Jackson, out of a patient pool of 119 women who were set to undergo surgery, Warren accurately diagnosed cancer in 54 of the 58 cases he labeled as positives.

These findings were significant because they elevated radiography of breast tissue from a research pursuit to a method of improving patient health by reducing the need for invasive procedures. An ironic side note to Warren’s impressive career is the fact that he was part of the Manhattan Project, meaning he helped harnass the power of radiation to potentially save lives as well as to take them away.
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