Breast Health: Are Mammograms as Necessary as We’ve Been Taught?

The means and methods of detecting cancer have changed multiple times throughout history. In 1913, a German surgeon named Dr. Albert Salomon started using radiology to try and diagnose cancerous tumors in breast tissue. At the time, X-ray was only used for dense body parts like bone. Soft tissue is hard to examine using this method because it’s difficult to tell different tissue masses apart. He performed about 3,000 mastectomies (surgical removal of breasts) and studied the specimens with X-rays in order to differentiate healthy tissue from unhealthy tissue. Although he never used X-rays (radiology) as a diagnostic tool on presumably healthy women, he later became known as the “Father of modern mammography.”

In 1930, Dr. Stafford Leak Warren transitioned from studying the effects of radiography on dogs to female breasts. This is how he quickly developed the mammogram, which is essentially an X-ray image of the breast taken from different angles in order to compare the density of the sample to healthy breast tissue. The denser the image looks, the more likely it is a cancerous mass. He developed what is called the Stereoscopic method. Dr. Warren studied 119 women and published a paper on his accurate diagnoses of 54 out of the 58 patients who actually had cancer, which is how we came to implement mammography as the most accurate tool to diagnose breast cancer at the time. It doesn’t take a degree in research to know that 119 people hardly makes for accurate outcomes in data, but research studies were still in their infancy at the time. Compared to the only other option we had, which was performing a surgical biopsy (removal of some of the tissue), this “non-invasive” method seemed like the obvious next step.

But it wasn’t until 1940 that Dr. Warren even started testing the safety of exposure to radiation (according to embryo.asu.edu), a whole decade after implementing the mammogram as a diagnostic tool. In the end, it took working for The Manhattan Project in 1945, studying and implementing nuclear atomic bombs, for Dr. Warren and fellow scientists to realize how many safety risks come with radiation. The disastrous health effects of radiation that came out of Hiroshima were eye-opening. The Manhattan Project lost many lives doing this work, and thousands of workers were disabled. The main issue with radiation is that it doesn’t metabolize over time, like certain medications we take that have half-lives. It not only stays in the body forever but accumulates, like mercury. In fact, the accumulation of radiation over time can actually cause cancer. It is interesting to note that the means to diagnose breast cancer and the recommendations of frequency didn’t change, even with this additional knowledge. After all, we didn’t exactly have much better methods to diagnose at the time.

During Nixon‘s presidency in 1971, he began the war against cancer, and breast cancer was part of that fight. At that time, mammography was still relatively new. In fact, the most current research we had (done by Philip Strax, whose wife had died of cancer) took a pretty moderate tone on the recommendations for screening. The National Cancer Institute had set up four committees and their stance said that the data did not show any evidence that screening women under 50 saved lives. This was a big realization, and yet breast cancer screenings flourished for all ages. According to cancer.org, in 1976 the recommendations were to do a

screening if you had a history of breast cancer personally or in your family (for ages 35-49) and women could opt to have a screening after age 50 if they chose to do so. In 1983, that changed to a baseline mammogram for ages 35-39, every 1-2 years for women ages 40-49, and yearly for ages 50 and over. The numbers were rising rapidly as the United States attempted to quash cancer early. It’s believed that this was because so much money was being invested by Nixon’s cabinet into cancer research. 

The 5-year program began with The National Cancer Act of 1971. Implemented by President Nixon, it had a goal to get 250,000 women screened for cancer. It started with pap smears (another contentious topic) and the next logical step became mammographies. The thought process expressed in the book “Conspiracy of Hope: The Truth about Breast Cancer Screening” written by journalist Renee Pellerin and published in 2018, is that the number of screenings increased because the fight against cancer wasn’t just about science—it was an emotional battle. The average population was just now starting to learn about the link between the environment and our health. Since education often eliminates fear, women want to be informed about the health status of their bodies, especially if the screening is free.

Until recently, the most accurate study on screening (started in 1980) came from Canada. 90,000 women under 50 were screened 5 times in 4 years and the conclusion was that absolutely no lives were saved in the under-50 or the over-50 group. By this time (1992), mammography had become such a profitable industry, that the research outcomes were not received well by radiologists and others in the medical field who had invested their entire careers in cancer screenings. The study was continued for 25 years, and the results of impact on mortality still haven’t changed. There was even a forensic audit done on the study because so many medical professionals and researchers were baffled by how unhelpful the screenings were shown to be, but the audit showed that there were no issues with the randomized trial, and the results still stand.

So what are the risks of doing this screening, knowing that no lives are saved by it? Well, according to Komen.org, a non-profit cancer-awareness organization, we have an incredibly high incidence of false negatives (people who do have breast cancer and test results show they don’t) and false positives (you test positive and you don’t actually have breast cancer). We have different estimates of how many of these results aren’t accurate, but some data shows that up to 50-60% of women who are repetitively screened get some inaccurate results after 10 years. The experience of your radiologist also makes a difference in ranges of error. Overdiagnosis of cancer is an issue because once something is found in your mammogram, the treatments provided (chemotherapy, mastectomy, exposure to radiation, etc.) could cause more risk to your body than if you had left a benign (not dangerous) tumor undisturbed. There’s the recent story of UK resident Sarah Boyle, who was thought to have a very advanced form of breast cancer after a lump was found. Even with chemotherapy, the tumor did not get any smaller, and after many tests, a double mastectomy was recommended. One week after her surgery, the tumor was biopsied and it was found to be totally benign. She never had cancer. She recently shared her story on the This