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Knowledge circulation in breast cancer

detection. Techniques, methods and lexicon †

Article · January 2017

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Yolanda Eraso
London Metropolitan University
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Knowledge circulation in breast cancer detection.

Techniques, methods and lexicon†

YOLANDA ERASO

The circulation of knowledge in relation to science, technology, and medicine

has developed in the last years into a vast area of research helping us to
reconsider the role of knowledge production as a process of control, diffusion,
appropriation, and hybridization across national borders. I’ve been particularly
interested in analysing this process in the area of female cancer, its diagnosis,
treatment and management more broadly, and this paper focuses specifically on
one topic, the development of mammography as a diagnostic tool for breast
cancer.
I suggest that the developments in breast radiology and the interpretation
of what became visible in breast imaging between the 1950s and 1960s were
crucial in stabilizing old and new notions in cancer diagnosis, thus, radically
changing the paradigm of ‘early detection’. Here the circulation of knowledge
in the Americas provides a useful interpretative framework to elucidate how a
locally produced knowledge in the South was later adopted and adapted into the
North from where it emerged as a standardised and legitimated practice.
Concentration on these aspects can also shed light into how the perception of
pre-cancers changed in those years, not only, as it has been argued, from
pathologists’ histological observations, but from radiologists’ perspective, as
new radiological signs of cancer became available.
By 1948 the technique of mammography was considerably improved in
Uruguay (South America), paving the way for its clinical acceptance as a
diagnostic tool in breast cancer. The main actor in this process was radiologist
Dr Raúl Leborgne, from the Radiology and Radiotherapy service at the Pereira
Rosell Hospital in Montevideo. Leborgne designed new equipment alongside
the introduction of novel procedures to obtain higher-quality images of the
breast. Innovations included the use of a cone sufficiently large to cover the
whole breast, which he used to compress the breast within two plaques, and thus
reduce the interposing of tissue and minimize patient motion. He also
introduced an optimal X-ray beam collimation, that is, a device that filters a
stream of rays allowing only those travelling in parallel to a specific direction to
go through. The combination of collimation and, mainly, compression, which


Email: y.eraso@londonmet.ac.uk
†Cite this article as: Y. Eraso, ‘Knowledge circulation in breast cancer detection. Techniques,
methods and lexicon’, Medical Historian, 27 (2017), 43-5.

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normally produces considerable discomfort in women, is now a standard

procedure in mammography technique.

Poster campaign, Rio de Janeiro; INCA; 1997. Credits: Acervo INCA (Brazil)

In addition to these technical contributions, Leborgne also provided new

radiological notions to interpret the presence of abnormalities in mammographic
images. In particular, the identification of calcifications became a real
breakthrough, as Leborgne considered them ‘a roentgenographic sign ..[of]
singular diagnostic value’.1 Indeed, this will radically change the idea of cancer
diagnosis, from the idea of ‘cancer evidence’ provided by the visualisation of a
tumour, to the idea of a ‘sign’ (calcifications) that simply indicated a suspicion
of a cancerous process. Leborgne’s ground-breaking association of
calcifications to breast cancer had a very enduring existence in cancer detection,
as the presence of microcalcifications and their shape constitutes today ‘one the
most pertinent markers of both benign and malignant lesions of the breast’
especially for the diagnosis of early stages of the disease.2

1
R. Leborgne, ‘Diagnóstico de los tumores de la mama por radiografía simple’, Boletín de la
Sociedad de Cirugía del Uruguay, 20 (1949), 407-22 [at p. 416].
2
M. Morgan, M. Cooke, and G. McCarthy, ‘Microcalcifications associated with breast cancer: an
epiphenomenon or biologically significant feature of selected tumors?’, Journal of Mammary Gland
Biology and Neoplasia, 10(2) (2005), 181-7 [at p. 182].

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Arguably, one important feature for this new way of visualising cancer to
become an established practice was its capacity to disseminate. In this case,
from the periphery of South America, Montevideo, to the centre of specialised
institutes in North America. The paper argues that the circulation of this
knowledge through different forms of encounters facilitated a series of
processes of adaptation and adoption of mammography technique and
radiological notions that lead to a new paradigm of early detection.
In the US, Dr Gershon Cohen, was the first American radiologist to
advocate for the use of mammography as a screening tool in symptomless
women. During the 1950s and 1960s, his successful collaboration with a
pathologist, Dr Helen Ingleby, also contributed relevant aspects to understand
the natural history of breast cancer disease. The real breakthrough for the
acceptance of mammography came from its adaptation into the American
scientific culture, which post 1950s was grounded on a new epistemic order, the
clinical trial.
The paper argues that the transfer of mammography as a diagnostic tool
into the US reflected the process of adaptation, as mammography crossed the
Atlantic, in at least three distinctive features: the development of a new style of
work, the collaboration between radiology and pathology; its transformation
into a screening tool in the 1980s; and its universalisation via the
standardisation of mammographic terms in the 1990s. All these facets in the
circulation of knowledge can render visible certain aspects underpinning the
current controversy on mammography screening, a discussion that is widely
interlocked in an endless epidemiological debate.

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