zed to add to their diagnostic procedures.

In

the i 950s, surgeons and primary-care physicians were only

vaguely aware that it was possible to perform a radiographic

examination of the breast. This article traces the evolution of

mammography through the scientific contributions of those

who developed, investigated, and improved it, emphasizing

their trenchant articles that appeared in the American Journal

of Roentgenology (AJR) over the last 50 years. This retrospective was undertaken to provide an
understanding not

only of the origins of state-of-the art mammography, but also

of the challenges facing mammography then and now. Pioneers In Mammography

In 1 9i 3, Salomon, a German surgeon, performed radiographs of 3000 excised breasts, correlating

radiographic,

gross, and microscopic anatomy [i ]. Not only did Salomon

show how highly infiltrating carcinoma could be radiologically

distinguished from circumscribed carcinoma, but he was also

the first to recognize nonpalpable breast cancer on a radiograph of a specimen and to report the finding.

In the United States, Stafford Warren pioneered the clinical use of breast radiography when, in i 930, he
reported a

stereoscopic technique for mammography (Fig. i). His article

[2] described and classified the appearances of normal

breasts, identifying fatty and glandular types, as well as

illustrating the changes of pregnancy, mastitis, and benign

and malignant tumors. Warren also emphasized the importance of comparing images of the right and
left breasts by

viewing them side by side. In i933, Lockwood [3] reviewed

the then-current diagnostic criteria for mammography, and, in

i938, Gershon-Cohen and Strickler [4] recognized that “a

comprehensive knowledge and familiarity of the roentgen

appearance of the normal breast under all conditions of

growth and physiologic activity must be acquired by the

roentgenologist before he can ever hope to make real progress in the development of the roentgen
method of diagnosis

in breast neoplasia.” They, therefore, published a report on

variations of the normal mammogram. Otherwise, the literature of the 1930s and 1 940s emphasized
only the technical

difficulties and limitations of mammography; in fact, from i 938

to i 950 the sole mammography article in the AJR was a case

report of extensive posttrauma calcification [5].

In the i950s, Leborgne in Uruguay revitalized interest in

mammography with the publication of a series of articles

reporting plain breast radiograp zed to add to their diagnostic procedures. In

the i 950s, surgeons and primary-care physicians were only

vaguely aware that it was possible to perform a radiographic

examination of the breast. This article traces the evolution of

mammography through the scientific contributions of those

who developed, investigated, and improved it, emphasizing

their trenchant articles that appeared in the American Journal

of Roentgenology (AJR) over the last 50 years. This retrospective was undertaken to provide an
understanding not

only of the origins of state-of-the art mammography, but also

of the challenges facing mammography then and now. Pioneers In Mammography

In 1 9i 3, Salomon, a German surgeon, performed radiographs of 3000 excised breasts, correlating

radiographic,

gross, and microscopic anatomy [i ]. Not only did Salomon

show how highly infiltrating carcinoma could be radiologically

distinguished from circumscribed carcinoma, but he was also

the first to recognize nonpalpable breast cancer on a radiograph of a specimen and to report the finding.

In the United States, Stafford Warren pioneered the clinical use of breast radiography when, in i 930, he
reported a

stereoscopic technique for mammography (Fig. i). His article

[2] described and classified the appearances of normal

breasts, identifying fatty and glandular types, as well as

illustrating the changes of pregnancy, mastitis, and benign

and malignant tumors. Warren also emphasized the importance of comparing images of the right and
left breasts by

viewing them side by side. In i933, Lockwood [3] reviewed

the then-current diagnostic criteria for mammography, and, in

i938, Gershon-Cohen and Strickler [4] recognized that “a

comprehensive knowledge and familiarity of the roentgen

appearance of the normal breast under all conditions of

growth and physiologic activity must be acquired by the

roentgenologist before he can ever hope to make real progress in the development of the roentgen
method of diagnosis

in breast neoplasia.” They, therefore, published a report on

variations of the normal mammogram. Otherwise, the literature of the 1930s and 1 940s emphasized
only the technical

difficulties and limitations of mammography; in fact, from i 938

to i 950 the sole mammography article in the AJR was a case

report of extensive posttrauma calcification [5].

In the i950s, Leborgne in Uruguay revitalized interest in

mammography with the publication of a series of articles

reporting plain breast radiography and duct injection. He used

nonscreen film and a focus-to-film distance of 60 cm, 20-30

kVp, 5 mAs for each centimeter of compressed breast thick- ness. Leborgne relied primarily on the
cephalocaudal view,

which he performed with the patient standing and with “slight

pressure with the cone on a small cotton pad placed between

the cone and the breast so that the least quantity of breast

tissue is interposed” (Fig. 2). A large cone was used for a whole-breast image, and a smaller one was
used for a second

image of the area of interest [6]. Most importantly, Leborgne

reported the occurrence of carcinomatous microcalcifications

that, he said, resembled “fine grains of salt”; he detected such

microcalcifications in about 30% of breast cancers. This sighy and duct injection. He used

nonscreen film and a focus-to-film distance of 60 cm, 20-30

kVp, 5 mAs for each centimeter of compressed breast thick- ness. Leborgne relied primarily on the
cephalocaudal view,

which he performed with the patient standing and with “slight

pressure with the cone on a small cotton pad placed between

the cone and the breast so that the least quantity of breast

tissue is interposed” (Fig. 2). A large cone was used for a whole-breast image, and a smaller one was
used for a second

image of the area of interest [6]. Most importantly, Leborgne

reported the occurrence of carcinomatous microcalcifications

that, he said, resembled “fine grains of salt”; he detected such

microcalcifications in about 30% of breast cancers. This sig