Mammography is an imaging technique that uses low-dose X-rays to examine breast tissue. It plays a major role in public health by enabling the early detection of breast cancer, often years before a lump can be felt during a physical examination. The ability to detect disease at its earliest, most treatable stage significantly improves patient outcomes and helps reduce breast cancer mortality rates. The technique’s development, however, was not the work of a single inventor but a long, incremental process built upon anatomical study and technological refinement.
Early Photographic Evidence
The earliest conceptual work for mammography began with the application of newly discovered X-rays to surgical specimens. German surgeon Albert Salomon was the first to explore this connection, publishing his findings in 1913. Salomon examined over 3,000 surgically removed breast tissue samples (mastectomies) using X-ray photography to correlate imaging findings with the actual pathology of the tissue. His research provided the foundational evidence that X-rays could distinguish between cancerous and non-cancerous tumors. He was the first to associate tiny calcium deposits, or microcalcifications, with breast cancer, a finding that remains a cornerstone of detection today. This initial work was purely a pathological analysis of excised tissue and did not involve the screening or diagnosis of living patients.
Standardizing the Clinical Procedure
The transition from a pathological study to a usable clinical diagnostic tool for live patients required significant technical improvements and standardization. A major advancement came from Uruguayan radiologist Raul Leborgne in the late 1940s and early 1950s. He introduced a technique that used an apparatus to compress the breast during the X-ray exposure. This compression spread the tissue out, reducing its thickness and allowing for lower radiation doses while dramatically improving image clarity. Leborgne’s innovation made it possible to visualize small structures and subtle details, enhancing the detection of microcalcifications in living patients. His work set the stage for the modern mammogram.
In the United States, radiologist Robert Egan further refined and popularized the technique in the late 1950s and early 1960s. Working at the M.D. Anderson Hospital, Egan established a reproducible protocol using a high-milliamperage, low-voltage X-ray technique with specialized fine-grain film. This standardized approach significantly reduced radiation exposure compared to earlier attempts while producing consistently high-quality images. In 1960, Egan reported on a thousand cases, demonstrating that his method could detect unsuspected cancers, including some missed by physical examination. The ability to reproduce Egan’s results in national studies led to the widespread clinical adoption of mammography and the launch of the first successful mass screening programs.
Major Technological Shifts
Following the standardization of the clinical procedure, mammography continued to evolve with major shifts in imaging technology. The first significant change was the transition from conventional screen-film (analog) systems to Full-Field Digital Mammography (FFDM), approved by the FDA in January 2000. FFDM replaced X-ray film with solid-state detectors that capture the image and convert it into electrical signals. This change allowed for immediate image display, digital storage, and the ability to manipulate image contrast and brightness after the exposure. Digital mammography was particularly advantageous for women with dense breast tissue, where film mammography often struggled to achieve adequate clarity.
The next major advancement was the introduction of 3D mammography, known as Digital Breast Tomosynthesis (DBT), approved by the FDA starting in 2011. DBT involves the X-ray tube moving in an arc around the compressed breast, taking multiple low-dose images from different angles. These images are then reconstructed by a computer to create thin, parallel “slices” of the breast tissue. This slicing technique minimizes the problem of overlapping tissue, which can hide small cancers on a standard 2D image. DBT improves cancer detection rates and significantly reduces the need for patients to be called back for additional imaging.