In 1895, a German surgeon, Albert Salomon, started to take Xrays of mastectomy specimens (after removing the breast surgically) to see if he could visualize the difference between benign and malignant disease. Between 1895 and 1913, he did an extensive study, performing x-rays on 3000 mastectomy specimens. This showed that in fact, there did appear to be a difference between benign and malignant calcifications. Not much happened until…
In 1949, the idea of mammography was revitalized when in Uruguay, Raul Leborgne started to use a compression technique with breast imaging. In the 1950s, a female pathologist, Dr Helen Ingleby, did a very comprehensive study of the breast, incorporating a patient’s age, menstrual status, radiologic and macro and microscopic correlation with pathologic analysis.
In 1962, Robert Egan reported 53 cases of mammogram found cancers out of 2000 imaged breasts. It was in the 1960s that the American College of Radiology started to truly look at mammography as an important tool in breast cancer detection. In 1965, in France, Charles Gross developed the first dedicated mammography unit. In 1969, mammography became available worldwide. Through the 1970s, films of increasing quality were developed, including those by Kodak and Xerox.
In 1985, Dr Laszlo Tabár and his colleagues screened 134,867 women between the ages of 40 and 79 with a single image, and reduced their mortality from breast cancer by 31%. Dr Tabár, who is not only my colleague, but I am honored to call him a friend, is truly a pioneer and a giant in the development of breast imaging, and specifically mammography.
In the early 1990s, developing dedicated digital mammography machines took priority. In 1996, the FDA published guidelines on commercializing digital mammography equipment, and it was not until 2000 that the first digital mammography machine was approved by the FDA. This is also referred to as a 2D (two dimensional) mammogram. These images are 2 dimensional, but the breast is 3 dimensional. This is the reason that we take 2 views, so we can cross reference them to be able to reconstruct the idea of a 3 dimensional breast.
Can you believe that this was only 20 years ago?! As we continue to improve our mammography units, we decrease the amount of radiation used and improve the detail with which abnormalities are seen.
In 2011, the first 3D (or three dimensional) mammography unit was approved by the FDA. You may also hear this called tomosynthesis. 3D technology is especially helpful in dense breasts, as multiple pictures are taken in 1mm increments through the breast layers instead of a flat image. Overlapping breast tissue can hide lesions, so this layer by layer look identifies more lesions. There is also less chance that you would be called back for additional views. A 3D mammogram takes just a few seconds longer than a 2D mammogram, and no additional compression is needed.
Moving forward, there is a lot of development upcoming with AI, or artificial intelligence, to help interpret these studies. This is incredibly exciting and already starting to be implemented in clinical trials.