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The first mammogram was performed in 1913 by Albert Salomon, a surgeon in Berlin, using a standard x-ray machine on an excised breast and axilla. Dr. Salomon wanted to show that the cancer spread to the axillary lymph nodes from the breast. Unfortunately, Dr. Salomon's work was cut short by political turmoil in Germany, and we do not hear of radiographs of breast specimens again until 1927 when another German surgeon, Otto Kleinschmidt, describes a technique for imaging the breast that he attributed to his mentor, the plastic surgeon Dr. Erwyn Payr.

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It was not until 1930 that a radiologist, Stafford L. Warren, from Rochester University, in New York, described an in vivo technique to image the breast preoperatively. He used a relatively sophisticated stereoscopic system with a grid mechanism to cut down on noise and intensifying screens to amplify the image. Little or no compression was used in these first mammograms. Still, Dr. Warren claimed to be correct 92% of the time when using this technique to predict malignancy.

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In 1931, Walter Vogel, and subsequently Paul Seabold, described methods to distinguish benign from malignant lesions with mammography. Shortly thereafter, in 1938, radiologists named Jacob Gershon-Cohen and Albert Strickland published an article describing the radiographic changes in a woman's breast throughout her menstrual cycle and life history. Dr. Gershon-Cohen tirelessly correlated mammographic images and pathologic specimens throughout his career, in an attempt to convince his colleagues of the utility of mammography. Dr. Gerson-Cohen emphasized the importance of compression and image contrast, using 2 films to collect data from both the thicker posterior breast tissue and the thinner peripheral breast. Despite his efforts, mammography was not used with any frequency until the 1950s.

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In 1949, Raul Leborgne, in Uruguay, reported seeing microcalcifications in 30% of breast cancers using mammography. This rekindled interest in mammograms. Leborgne was the father of modern mammography, emphasizing good compression and spot/magnification to better see small structures. His large cone-shaped compression devices and careful descriptions of positioning, as well as calibration for exposure times, set the stage for our current techniques.

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It was Robert Egan, however, who pulled all the technology together. By using high milliampere, low-kilovolt x-rays on industrial film with grids, he was able to effectively standardize screening mammography in the early 1960s.

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In May 1963, the Cancer Control Program of the US Department of Public Health held a conference on mammography at M.D. Anderson Hospital to report the results of an initial national mammography study involving 24 institutions. The results showed a 21% false-negative rate and a 79% true-positive rate for screening studies using Egan's technique.1 This was a milestone for women's imaging in the United States. Screening mammography was off to a tentative start.

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Standard screening views have evolved from the original positions of Leborgne, with the woman lying on her side, to Egan's technique, where the woman stands or sits ...

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