Chronicles of Cancer

Chronicles of Cancer: A history of mammography, part 2


 

Well into its development, the technology still found itself under intense public scrutiny, and was enmeshed in a continual media circus, with ping-ponging discussions of risk/benefit in the scientific literature fueling complaints by many of the dominance of a patriarchal medical community over women’s bodies.

With guidelines for mammography still evolving, questions still remaining, and new technologies such as digital imaging falling short in their hoped-for promise, the story remains unfinished, and the future still uncertain. One thing remains clear, however: In the right circumstances, with the right patient population, and properly executed, mammography has saved lives when tied to effective, early treatment, whatever its flaws and failings. This truth goes hand in hand with another reality: It may have also contributed to considerable unanticipated harm through overdiagnosis and overtreatment.

Overall, the history of mammography is a cautionary tale for the entire medical community and for the development of new medical technologies. The push-pull of the demand for progress to save lives and the slowness and often inconclusiveness of scientific studies that validate new technologies create gray areas, where social determinants and professional interests vie in an information vacuum for control of the narrative of risks vs. benefits.

The story of mammography is not yet concluded, and may never be, especially given the unlikelihood of conducting the massive randomized clinical trials that would be needed to settle the issue. It is more likely to remain controversial, at least until the technology of mammography becomes obsolete, replaced by something new and different, which will likely start the push-pull cycle all over again.

And regardless of the risks and benefits of mammography screening, the issue of treatment once breast cancer is identified is perhaps one of more overwhelming import.

References

1. Berry, DA. The Breast. 2013;22[Supplement 2]:S73-S76.

2. Lerner, BH. “To See Today With the Eyes of Tomorrow: A History of Screening Mammography.” Background paper for the Institute of Medicine report Mammography and Beyond: Developing Technologies for the Early Detection of Breast Cancer. 2001.

3. NCI website. The National Cancer Act of 1971. www.cancer.gov/about-nci/overview/history/national-cancer-act-1971.

4. Lerner BH. The Huffington Post, Sep. 26, 2014.

5. Wu C. Cancer Today. 2012;2(3): Sep. 27.

6. “”The New York Times. Oct. 17, 1987.

7. Ford B. Remarks to the American Cancer Society. 1975.

8. The American Cancer Society website. History of ACS Recommendations for the Early Detection of Cancer in People Without Symptoms.

9. Nelson HD et al. Screening for Breast Cancer: A Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation. 2016; Evidence Syntheses, No. 124; pp.29-49.

10. Qasseem A et al. Annals of Internal Medicine. 2019;170(8):547-60.

11. Gotzsche PC et al. Cochrane Report 2013.

12. Lerner, BH. West J Med. May 2001;174(5):362-5.

13. Gotzsche PC. J R Soc Med. 2015;108(9): 341-5.

14. Susan G. Komen website. Weighing the Benefits and Risks of Mammography.

15. Biller-Andorno N et al. N Engl J Med 2014;370:1965-7.

16. Burton R et al. JAMA Netw Open. 2020;3(6):e208249.

17. Webb C et al. Plast Surg. 2019;27(1):49-53.

Mark Lesney is the editor of Hematology News and the managing editor of MDedge.com/IDPractioner. He has a PhD in plant virology and a PhD in the history of science, with a focus on the history of biotechnology and medicine. He has worked as a writer/editor for the American Chemical Society, and has served as an adjunct assistant professor in the department of biochemistry and molecular & cellular biology at Georgetown University, Washington.

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