When George Papanicolaou developed the Pap test as a research method to understand the menstrual cycle, he realised its potential for finding cervical cancer early and thus presented his findings in 1923. Since then, a few other related findings emerged – with Raul Leborgne, a radiologist from Uruguay introducing a compression technique as a method to detect breast cancer in 1949, and Robert L. Egan’s technique of using a fine-grain intensifying screen and industrial film for clearer images of the mammogram scan.

It was only in the 1960s that Papanicolau’s method was widely implemented, declining the cervical cancer death rate in the United States by about 70% since it was first introduced. In the same year, the modern mammography methods were developed – and first officially recommended by the American Cancer Society (ACS) in 1976.

The exhausting war on cancer

When mammogram was first introduced, cancer was a taboo and the understanding about the disease was limited. The only understanding was that early detection gives the best chance at treating it and helps women live longer. Because of the stigma attached to the subject, doctors had a hard time getting the public to accept the disease and introduce the idea of getting tested as early as possible to control it.

Furthermore, the only treatment available was mastectomy, a surgery that involves removing both breasts, muscles and axillary lymph nodes even when tumour is only present in one breast. The treatment, claimed necessary to prevent cancer from recurring, left women with long-term pain and disability instead.

Mastectomy requires the removal of both breasts even when tumour is only present in one side
Mastectomy requires the removal of both breasts even when tumour is only present in one side

A more dynamic approach

It was only in the 19th century when improvements in sanitation and disease control increased the average lifespan of women that breast cancer demanded serious attention from the medical community. In the 1970s, researchers began to develop the lumpectomy, a less invasive surgical option that removes only the cancerous tumour and any surrounding tissue affected by the tumour. By 1985, research found that a lumpectomy followed by radiation treatment gave women a chance of survival equal to the considerably more invasive mastectomy.

In 1992, Congress enacted the Mammogram Quality Standards Act to ensure all women have access to mammogram for early detection. Ever since then, the FDA have been working to improve medical technology used in the early detection of breast cancer.

The effort proved to work; when in 2009, the ACS reported that breast cancer deaths were down 30% since their peak in 1991 – due to improved treatment and early detection.

Screening: How early is early?

Despite the massive reference on reduced breast cancer deaths to early detection, there are still debates around the topic of “when” women should go for a screening; or how often should it be done. Majority of groups agree that most women should get their first screening between age 45 and 50, and those with a history of breast cancer in the family should start earlier.

Two years ago, a study done by Charles Harding, Francesco Pompei and Dmitriy Burmistov on breast cancer screening, found that women who were screened regularly did not necessarily save women from breast cancer death, compared to women who weren’t screened.

Mammogram is important for early detection but researchers concluded that it might not always be the case.
Mammogram is important for early detection but researchers concluded that it might not always be the case.

The researchers studied 16 million women 40 years or older who resided in 547 counties, who reported to the Surveillance, Epidemiology, and End Results cancer registries during the year 2000. A total of 53,207 of them were diagnosed with breast cancer that year and were followed up for the next 10 years. The study chose women age 40 and older as younger women are not usually recommended to have mammography screening.

In addition to the lack of association between early detection and increased mortality, the study also concluded that mammogram screening may lead to overdiagnosis instead.

Overdiagnosis may lead to false positives, which in turn will result in women undergoing additional testing, biopsies and radical treatments, including mastectomy and even prophylactic mastectomy.

To prevent false positives from happening, the U.S. Preventive Services Task Force (USPSTF) recommended that most women start mammogram screening at age 50, and that they get screened once every two years rather than yearly.

Latest figure by the SEER cancer database showed that, despite the increase in number of women getting mammograms, deaths from breast cancer continued to decline at the same rate, by nearly 2% each year from 2005. Researchers say that, the fact suggests that early cases detected by mammograms among women in their 40s may not have been cancer, but lesions that were picked up by the test and then treated. MIMS

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