Mammography: Changing Role and Concepts

The first randomized trial to assess the potential benefits of screening mammography was conducted by the Health Insurance Plan of New York between 1963 and 1970. The initial results from two randomized screening trials begun in 1977 in Sweden have demonstrated a 40% reduction in deaths from breast cancer in women aged 50 to 74 years, although there was an insufficient number of women aged 40–49 with breast cancer to unequivocally prove screening benefit of mammography in that age group. Given the current knowledge of radiation risk, as well as the remarkable decrease in radiation dose, controversy over the risk/benefit ratio of screening mammography that raged in the 1970s should no longer be an issue in women of screening age. Mammography has its limitations, particularly in women with dense breasts. Multiple attempts have been made to find a nonionizing imaging technique as good as, or superior to, mammography for breast cancer screening and diagnosis.