Over the past century, mammography, or X-ray imaging of the breast, has become an accepted, although controversial, tool in the diagnosis of breast cancer. Breast cancer remains one of the deadliest diseases that strikes women; anestimated one out of every nine women will develop the disease in her lifetime. Mammography is considered an important screening and diagnostic tool because it can detect tumors while still small and most easily treated. In one study, women whose breast cancers were found early through mammograms had a five-year survival rate of 82 percent, while a group of women whose cancers werenot found by mammograms had a five-year survival rate of just 60 percent. TheAmerican Cancer Institute guidelines recommend women aged 40 to 49 be screened every one to two years, and that women aged 50 and older be screened annually because the incidence of breast cancer increases with age.

Researchers began experimenting with X-ray technology in detecting cancer inthe late nineteenth century. German surgeon, Albert Salomon, became the firstperson to use the X-ray to study breast cancer. Working with breast tissue that had been removed during surgery, he used the X-ray to determine the difference between cancerous and noncancerous tumors and found that the techniquecould successfully be used to detect breast cancer. He also discovered, basedupon the differing X-ray images he obtained, that a number of different types of breast cancer existed. Salomon, who published his findings in 1913, is considered the inventor of breast radiology. However, he never used the technique in his own practice. In the 1920s, other German scientists continued Salomon's research. Out of these experiments came a study written by Leipzig researcher W. Vogel that fully described how X-rays could detect the difference between cancerous and noncancerous tissues. The detailed information is stillconsidered useful to scientists who diagnose cancer.

Stafford L. Warren, a Rochester, New York, physician, became the first to experiment with the new technology in the United States. Using a fluoroscope, hediscovered images similar to those found by Salomon in breast tissue. Warrenused his technique for detailed examinations prior to breast cancer surgery.Using radiology, he also discovered changes in breast tissue as a result ofpregnancy, menstruation, lactation, and the beginning of breast disease. Hisfindings were published in 1930. The first physician to advocate the wide useof X-rays to screen women for breast cancer was Jacob Gershon-Cohen. In themid-1950s, he and his colleagues began a five-year study of more than 1,300 women, screening each woman every six months. As a result, 92 were diagnosed with nonmalignant tumors and 23 with malignant tumors. A similar study conducted in Houston, Texas, found that women diagnosed early through mammography had a better recovery rate than those whose disease was discovered at a later stage by breast biopsy. By the 1960s, mammography was becoming a widely used diagnostic tool, although some critics alleged that the procedure exposed women to unnecessary levels of X-radiation. Through the development of more sensitive film, the amount of radiation needed to produce clear pictures of breasttissue was reduced significantly. By 1971, a quarter-million women over agethirty-five had been screened for breast cancer with mammography. The National Cancer Institute conducted a four-year study (1973-1977) of some 270,000 women throughout the United States. Some women were found to have very small benign growths, yet large numbers of these women had surgery, which some researchers felt was unnecessary. As a result of the study, the National Cancer Institute issued a set of guidelines regarding which groups of women will benefit from regularly scheduled mammograms. For women under age forty, the procedure was recommended only to those at risk of developing the disease because offamily history other indicators such as palpable breast lumps.

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