History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century

Abstract

Breast cancer is the most common forms of cancer and a leading cause of mortality in women. Early and correct diagnosis is, therefore, essential to save lives. The development of diagnostic imaging applied to the breast has been impressive in recent years and the most used diagnostic test in the world is mammography, a low-dose X-ray technique used for imaging the breast. In the first half of the 20th century, the diagnosis was in practice only clinical, with consequent diagnostic delay and an unfavorable prognosis in the short term. The rise of organized mammography screening has led to a remarkable reduction in mortality through the early detection of breast malignancies. This historical review aims to offer a complete panorama of the development of mammography and breast imaging during the last century. Through this study, we want to understand the foundations of the pillar of radiology applied to the breast through to the most modern applications such as contrast-enhanced mammography (CEM), artificial intelligence, and radiomics. Understanding the history of the development of diagnostic imaging applied to the breast can help us understand how to better direct our efforts toward an increasingly personalized and effective diagnostic approach. The ultimate goal of imaging applied to the detection of breast malignancies should be to reduce mortality from this type of disease as much as possible. With this paper, we want to provide detailed documentation of the main steps in the evolution of breast imaging for the diagnosis of breast neoplasms; we also want to open up new scenarios where the possible current and future applications of imaging are aimed at being more precise and personalized.

Review on Present-day Breast Cancer Detection Techniques

“…"Mammography" is the term that is used for X-ray scanning of breasts, as acknowledged by communities of medical practice [24]. For clearer contrast against other screening methods in the text of this article, it will be referred to as "X-ray screening".…”

Breast Imaging Physics in Mammography (Part II)

“…The patient is in an anatomical position (standing with hands against the tube), parallel to the tube, and the breast is perpendicular to the generated beam. The breast is compressed to ensure even distribution and to prevent motion during image acquisition, which could generate artifacts [28][29][30].…”

Breast Imaging Physics in Mammography (Part I)

“…Generally, additional filters used in mammography for Molybdenum targets are made of Molybdenum with a thickness of 0.03 mm, or for Rhodium targets are made of Rhodium with a thickness of 0.025 mm. They contribute to the removal of those photons in the beam whose energies contribute to the dose to the patient but not to the image quality [11,18,26,27]. Combinations of the above target/filter systems are also used, such as the Mo/Rh combination, but the Rh/Mo combination cannot be used as an additional Molybdenum filter would completely attenuate the discrete spectrum (XRF) of the Rhodium target [70][71][72].…”

“…Clinical experience is the discriminating factor in a reliable diagnosis of breast disease [30][31][32][33][34][35][36][37][38] (Figure 1). The development of mammography began in the 1930s, but the evolution of detection techniques and the use of new materials have made it possible in recent years to achieve high levels of sensitivity and specificity for the diagnosis of breast cancer [18][19][20]. In particular, with the support of new techniques such as radiomics, [21] tools from artificial intelligence [22] have been implemented for staging or tumour diagnostics to achieve more accurate diagnoses [23,24].…”