Salomon Develops Mammography Summary

  • Last updated on November 10, 2022

Using a technique derived from X-ray photography, Albert Salomon developed the first procedure that used X rays to detect and diagnose breast cancer.

Summary of Event

Breast cancer has been the focus of medical research for more than a century, but at the end of the nineteenth century, techniques for detection were almost nonexistent. By the time breast cancer was detected, it was often too late for the radical surgical procedures prevalent at the time, and patients who underwent such surgery had a high mortality rate. As a result, cancer researchers were eager to experiment with X-ray technology after it appeared in 1896. Medicine;mammography Mammography Inventions;mammography Breast cancer screening Cancer;screening [kw]Salomon Develops Mammography (1913) [kw]Mammography, Salomon Develops (1913) Medicine;mammography Mammography Inventions;mammography Breast cancer screening Cancer;screening [g]Germany;1913: Salomon Develops Mammography[03300] [c]Science and technology;1913: Salomon Develops Mammography[03300] [c]Health and medicine;1913: Salomon Develops Mammography[03300] Salomon, Albert Vogel, W. Warren, Stafford L. Gershon-Cohen, Jacob Egan, Robert

The first scientist to use X-ray techniques in breast cancer experiments was Albert Salomon, a German surgeon. Salomon X-rayed more than three thousand breasts that had been excised in breast cancer operations in an effort to develop a biopsy technique that would reflect the cancerous and noncancerous nature of tumors without radical exploratory surgery. In 1913, he published the results of his experiments, demonstrating conclusively that X rays could detect breast cancer. His research predicted the presence of a number of different types of breast cancers based on the character of the X-ray image. Although he is the acknowledged inventor of breast radiology, Salomon never actually used the technique to diagnose breast cancer.

Breast cancer radiology, which came to be known as mammography, was not immediately embraced by the medical community. During the 1920’s, further research was conducted in Leipzig, Germany, and in South America. Eventually, the Leipzig group began to use mammography for diagnosis under the direction of Erwin Payr. Payr, Erwin One of the classic documents in breast cancer research emerged from the Leipzig experiments. Published in the 1930’s by W. Vogel, it accurately described differences between cancerous and benign tumors as they appeared on X-ray photographs. Included was information about the procedure that was useful to diagnosticians. The detailed descriptions included in the paper remain useful.

Mammography received little attention in the United States until 1926, when a Rochester, New York, physician discovered that a fluoroscope could be used to capture breast tissue images that were similar to Salomon’s. Stafford L. Warren developed a stereoscopic technique that he employed in preoperative examinations. Warren published his findings in 1930 in what was the first acknowledgment by the United States of the diagnostic potential of Salomon’s procedure. The article also described changes in the character of breast tissue caused by pregnancy, lactation, menstruation, and the onset of breast disease.

In the late 1930’s, Jacob Gershon-Cohen became the first clinician to advocate regular screening of all women to detect breast cancer before it became a major problem. He cited the high degree of accuracy achieved by using the technique for diagnosis and the relatively low cost. One of the milestones in breast cancer research came in 1956, when Gershon-Cohen and a number of colleagues began a five-year panel study of more than thirteen hundred women to test the accuracy of mammography in the detection of breast cancer. Each subject was screened once every six months. Of the 1,055 subjects who completed the study, 92 were diagnosed with benign tumors and 23 with malignant tumors. Only one malignant tumor was misdiagnosed as benign—an impressive record. At the same time, Robert Egan of Houston began tracking breast cancer X rays; during a three-year period, he used one thousand X-ray photographs to make diagnoses. When these diagnoses were compared to the results of surgical biopsies in the same period, accurate diagnoses were confirmed in 238 of 240 procedures using mammography. Egan joined the crusade for regular breast cancer screening, noting that most women sought help only after tumors had reached advanced states, which led to a poor recovery rate.

Once mammography was accepted by the medical community as a useful diagnostic tool in the late 1950’s and early 1960’s, attention turned to the need for a technique to teach mammography quickly and effectively to those who might employ it. Following the 1965 publication of the results of a major study, scholars determined that any radiologist could conduct the procedure with five days of training. In the early 1970’s, the American Cancer Society and the National Cancer Institute joined forces to coordinate a nationwide breast cancer screening program called the Breast Cancer Detection Demonstration Project. In 1971, its goal was to screen more than a quarter million women over the age of thirty-five. Although the accuracy of the detection method remained extremely high, controversy erupted over radiation’s potentially harmful effects on patients. In 1976, consumer advocate Ralph Nader issued a call for special consent forms that detailed the risks of breast cancer screening, citing the use of radiological techniques. During the ensuing years, the amount of radiation required to diagnose breast cancer has been reduced through refinement of mammography techniques.

Significance

The progress made in mammography during the twentieth century was a major improvement in the effort to decrease the mortality rate associated with breast cancer. The disease had long been one of the primary contributors to the number of female cancer deaths in the United States and around the world. This high figure stemmed from the fact that women had no way of detecting the disease until tumors were in an advanced state. Once Salomon’s procedure was utilized, physicians had a means by which they could look inside breast tissue without engaging in exploratory surgery, thus giving women a screening technique that was simple, painless, and inexpensive.

Unfortunately, most clinicians working with breast cancer during the first half of the twentieth century were not quick to adopt mammography. The complexity of radiology and the lack of standards for interpreting the images contained in an X-ray photograph of breast tissue led to confusion and skepticism by much of the medical community. In fact, despite efforts by Salomon and Vogel to publish useful information intended to be helpful to the practitioner, efforts by other researchers to duplicate the experiments on which their articles were based proved difficult, and the results were often inconclusive. Some clinicians cited the fact that Salomon never used the procedure in his own practice and was therefore unable to prove its success. It would be decades before work would begin in earnest to make mammography a practical, safe procedure.

Interestingly, the development that brought mammography back into the spotlight occurred by accident. While attempting to use the device to examine heart muscle in a patient, Warren discovered that breast tissue could be viewed through a fluoroscope placed 1.8 meters away from the patient. He became interested in mammography and published an article that detailed the results of experimentation conducted by him and his colleagues. Unfortunately, the technique he used was complex and required equipment unavailable to most clinicians at the time. Eventually, he lost interest in mammography and went on to other research, and the medical community missed its second chance to make significant advances in the field of radiology.

Gershon-Cohen refined mammography in the late 1930’s and began the first effort to get women to engage in preemptive screening for breast tumors. Gershon-Cohen was a controversial figure, however, and his experiments were the subject of much debate in the medical community. Some colleagues considered his methodology and reporting techniques inadequate at best and unacceptable at worst. Many refused to acknowledge his work. Gershon-Cohen was independently wealthy, and so he was able to purchase the latest equipment for his research without concern for whether the laboratory in which he was working could afford it. This irritated some colleagues, who questioned the practicality of mammography in the real world. Nevertheless, Gershon-Cohen was able to demonstrate that breast cancer screening represented a dependable technique for detecting breast cancer in its earliest stages, a development that would provide a significant challenge to the high rate of breast cancer mortality.

It is important to note that early experiments with mammography involved significant doses of radiation applied to the skin of the patient. During the 1940’s and 1950’s, concern began to mount over whether mammography was safe, and interest in the procedure slowed again as a result. In the 1960’s and 1970’s, public interest groups began to lobby against mammography, citing the purported negative effects of radiation exposure during screenings conducted over the long run. Efforts by some groups to require patients to sign consent forms detailing the risks associated with the procedure led to media attention that further diminished the number of women willing to submit to regular screenings. Still, even that problem was resolved relatively quickly, as the technique was further refined and less radiation was required. By 1971, 750,000 women over the age of thirty-five had been screened; thirty years later, about 20 million women a year underwent the procedure. Medicine;mammography Mammography Inventions;mammography Breast cancer screening Cancer;screening

Further Reading
  • citation-type="booksimple"

    xlink:type="simple">Gyllenskold, Karin. Breast Cancer: The Psychological Effects of the Disease and Its Treatment. Translated by Patricia Crampton. London: Tavistock, 1982. A good summary of some of the psychological factors that appear in many women who suffer from breast cancer. The approach is to separate the disease from its treatment in order to differentiate the effects caused by each. The intention is to offer information that might help breast cancer patients make decisions about treatment techniques.
  • citation-type="booksimple"

    xlink:type="simple">History of Cancer Control Project. A History of Cancer Control in the United States, 1946-1971. Book I in A History of Scientific and Technical Advances in Cancer Control. Washington, D.C.: Department of Health, Education, and Welfare, 1979. An excellent history of mammography that includes a lengthy and thorough discussion of the work of Salomon, Gershon-Cohen, Egan, and Warren. Contains sections on the history of detection techniques for other types of cancer.
  • citation-type="booksimple"

    xlink:type="simple">Kelly, Pat, and Mark Levine. Breast Cancer: The Facts You Need to Know About Diagnosis, Treatment and Beyond. Richmond Hill, Ont.: Firefly Books, 2003. Examines what is known about the causes and treatments for various kinds of breast cancers. Included is a discussion of some of the genetic factors that have been encountered in breast cancer research.
  • citation-type="booksimple"

    xlink:type="simple">Kushner, Rose. Alternatives: New Developments in the War on Breast Cancer. New York: Warner Books, 1985. Over the past two decades, the emphasis in the treatment of breast cancer has been on prevention and improved surgical techniques that can replace the radical mastectomy in some patients. This book looks at significant developments in the evolution of mammography and outlines methods in which the disease is being viewed and treated.
  • citation-type="booksimple"

    xlink:type="simple">Lerner, Barron H. Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America. New York: Oxford University Press, 2001. The author, a physician and historian at Columbia University, studies the social history and biology of breast cancer, technology related to it (including mammography and mastectomy), and the disease’s psychological effects.
  • citation-type="booksimple"

    xlink:type="simple">Watson, Rita Esposito, and Robert Wallach. New Choices, New Chances. New York: St. Martin’s Press, 1981. Unlike other books that describe the causes and treatments for breast cancer, this book gives advice on how to deal with the disease from a personal level. The upbeat treatment offers hope and encouragement to sufferers.

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