Surgery without anaesthesia, mammograms, AI. The evolution of breast cancer screening.

October 8, 2026

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By Helfie Population Health Lead, Christelle Kelley BSc (hons), MSc, RN

“A terror that surpasses all description”

There’s a courageous and searing book on women’s health called Unwell Women, by Elinor Cleghorn. In amongst its well-thumbed pages, I found the story of the novelist Fanny Burney.

Let’s set the scene. The year is 1812. Burney sat down to write a letter to her sister Esther that would become a significant document in medical history. In a visceral account, she describes undergoing a mastectomy before the widespread use of anaesthetic, the mammogram, or even the stethoscope.

For months she had been troubled by a pain in her right breast, which grew and hardened. Several doctors failed to cure it, and eventually, she writes, she was “formally condemned to an operation”.

It took place in her home in Paris, attended by a team of male doctors dressed in black, among them Antoine Dubois, obstetrician to the Empress herself. Given a wine cordial and a cambric handkerchief over her face, Burney endured a twenty-minute operation she described as “a terror that surpasses all description.” She recalled the moment “the dreadful steel was plunged into the breast,” and later, the knife “scraping against the breast bone.” By her own account, she fainted twice, perhaps mercifully so.

I am so grateful to Burney for giving us one of the earliest accounts of a woman’s own experience of breast disease, in her own words, rather than a clinical entry, at a time when so few women’s accounts survived at all. And to Cleghorn, for setting out to highlight women’s experiences of sickness and health.

My own experience

Just over two centuries later, I was sitting in a very different waiting room, with a breast lump of my own. I saw a specialist breast consultant, had a mammogram and an ultrasound. When I left, I walked past that same waiting room full of relief and gratitude, not only that my own lump was benign, but that for the women who don’t get that same reassuring news, we can now offer so much more than Burney ever had.

But how did we get here?

From x-rays to mammograms

There are too many incredible people to fit into this story, but a few milestones stand out.

Around 1913, in Berlin, Albert Salomon x-rayed roughly 3,000 excised breast specimens and compared the images against the tissue itself, showing how cancerous and non-cancerous tissue looked different and identifying what we now call microcalcifications. From 1930, x-raying breasts before removal began to take hold, with Stafford Warren’s US study of 119 women correctly diagnosing 54 of 58 confirmed cancers.

Improvements kept coming, including, for those of us who’ve experienced the extraordinary sensation of having our breasts squashed flat for a mammogram, the compression technique Raúl Leborgne developed in Uruguay between 1949 and 1951, which gave clearer pictures by separating overlapping tissue. Robert Egan standardised it in the US around 1959–60, showing it could find cancers in women whose physical exams were entirely normal. The first randomised trial of screening itself (the HIP trial) followed in 1963, and by 1966, Charles Gros had led the manufacture of the Senographe, the first commercially available mammography machine.

The impact of prevention

With a standardised technique in hand, Sweden took prevention to the front line and ran the Two-County Trial between 1977 and 1985. Screened women saw their risk of dying from breast cancer fall by 31%, and the evidence was compelling enough that Sweden became the first country to recommend screening nationally. Citing Sweden’s findings, the UK’s 1986 Forrest Report recommended national screening, and the NHS Breast Screening Programme launched in 1988. Australia followed with BreastScreen Australia in 1991.

And how has this changed the stories of women?

In the UK, screening is credited with averting around 9 deaths for every 1,000 women screened. Picture Wembley Stadium, sold out: 90,000 women, and around 810 lives saved in that crowd alone. In Australia, breast cancer claimed around 74 lives for every 100,000 women aged 50 to 74 in 1991. By 2023, that had roughly halved to 37. In the US, where screening runs through routine doctor’s visits rather than one national programme, modelling suggests around 1.3 deaths averted per 1,000 women screened.

Still more work to be done

As a Population Health Lead, I’m often reminded, and constantly navigating, the fact that even after so much progress, screening doesn’t reach everyone. The reasons are complex and vast: economic and political barriers, persistent health inequalities nationally and internationally, not enough radiologists, living too far from a mammogram machine, or simply not having the transport to get there. These are the human-sized, practical challenges, population-level and individual, of trying to reach millions of people reliably, in all the complexity of their lives. In my work each day, I strive to make preventative healthcare and wellbeing something every woman and man can access. I truly hope for that.

The difference AI is making

Interestingly, some of the most exciting work on those barriers is happening back where national screening really took off: Sweden!

The MASAI trial, a randomised controlled trial of around 106,000 women, used an AI risk-stratification tool to categorise mammograms by risk before they were allocated to radiologists. Higher-risk mammograms went to two or more radiologists, lower-risk to one. The study showed that AI-assisted screening was safe and reduced screen-reading workload by 44%, meaning it has the potential to expand reach and make the best use of those incredible radiologists who form the backbone of the screening pathway. Technology like this is a new, emerging part of the answer, but none of the breakthroughs of the last 200 years is the answer on its own. Together, with what comes next, they are greater than the sum of their parts at closing the gap between what screening can do, and who it actually reaches.

What Fanny Burney could only hope for

It’s a long way from a bedroom in Paris in the early 1800s, where Fanny underwent a mastectomy with no anaesthetic. She survived her ordeal, and lived for nearly thirty more years, long enough perhaps to hope for a world where her ordeal would be an account in history. Today, I don’t have to hope for that world. I get to live in it.

But that world still isn’t evenly shared, and it isn’t only women living in it: around 420 men are diagnosed with breast cancer in the UK each year, less than 1% of all cases, but no less real for how rarely it’s spoken about.

The work Fanny Burney’s letter began isn’t finished. It continues in the work still needed to make breast screening and diagnosis a reality for every woman, and every man, wherever they are in the world.

Sources

https://anthologydev.lib.virginia.edu/work/Burney/burney-letter-march-22-1812
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00298-X/abstract
https://www.thelancet.com/journals/landig/article/PIIS2589-7500(24)00267-X/fulltext
https://pubs.rsna.org/radiology/doi/10.1148/radiol.11110469
https://cdas.cancer.gov/learn/hipb/home/

By Helfie Population Health Lead, Christelle Kelley BSc (hons), MSc, RN

“A terror that surpasses all description”

There’s a courageous and searing book on women’s health called Unwell Women, by Elinor Cleghorn. In amongst its well-thumbed pages, I found the story of the novelist Fanny Burney.

Let’s set the scene. The year is 1812. Burney sat down to write a letter to her sister Esther that would become a significant document in medical history. In a visceral account, she describes undergoing a mastectomy before the widespread use of anaesthetic, the mammogram, or even the stethoscope.

For months she had been troubled by a pain in her right breast, which grew and hardened. Several doctors failed to cure it, and eventually, she writes, she was “formally condemned to an operation”.

It took place in her home in Paris, attended by a team of male doctors dressed in black, among them Antoine Dubois, obstetrician to the Empress herself. Given a wine cordial and a cambric handkerchief over her face, Burney endured a twenty-minute operation she described as “a terror that surpasses all description.” She recalled the moment “the dreadful steel was plunged into the breast,” and later, the knife “scraping against the breast bone.” By her own account, she fainted twice, perhaps mercifully so.

I am so grateful to Burney for giving us one of the earliest accounts of a woman’s own experience of breast disease, in her own words, rather than a clinical entry, at a time when so few women’s accounts survived at all. And to Cleghorn, for setting out to highlight women’s experiences of sickness and health.

My own experience

Just over two centuries later, I was sitting in a very different waiting room, with a breast lump of my own. I saw a specialist breast consultant, had a mammogram and an ultrasound. When I left, I walked past that same waiting room full of relief and gratitude, not only that my own lump was benign, but that for the women who don’t get that same reassuring news, we can now offer so much more than Burney ever had.

But how did we get here?

From x-rays to mammograms

There are too many incredible people to fit into this story, but a few milestones stand out.

Around 1913, in Berlin, Albert Salomon x-rayed roughly 3,000 excised breast specimens and compared the images against the tissue itself, showing how cancerous and non-cancerous tissue looked different and identifying what we now call microcalcifications. From 1930, x-raying breasts before removal began to take hold, with Stafford Warren’s US study of 119 women correctly diagnosing 54 of 58 confirmed cancers.

Improvements kept coming, including, for those of us who’ve experienced the extraordinary sensation of having our breasts squashed flat for a mammogram, the compression technique Raúl Leborgne developed in Uruguay between 1949 and 1951, which gave clearer pictures by separating overlapping tissue. Robert Egan standardised it in the US around 1959–60, showing it could find cancers in women whose physical exams were entirely normal. The first randomised trial of screening itself (the HIP trial) followed in 1963, and by 1966, Charles Gros had led the manufacture of the Senographe, the first commercially available mammography machine.

The impact of prevention

With a standardised technique in hand, Sweden took prevention to the front line and ran the Two-County Trial between 1977 and 1985. Screened women saw their risk of dying from breast cancer fall by 31%, and the evidence was compelling enough that Sweden became the first country to recommend screening nationally. Citing Sweden’s findings, the UK’s 1986 Forrest Report recommended national screening, and the NHS Breast Screening Programme launched in 1988. Australia followed with BreastScreen Australia in 1991.

And how has this changed the stories of women?

In the UK, screening is credited with averting around 9 deaths for every 1,000 women screened. Picture Wembley Stadium, sold out: 90,000 women, and around 810 lives saved in that crowd alone. In Australia, breast cancer claimed around 74 lives for every 100,000 women aged 50 to 74 in 1991. By 2023, that had roughly halved to 37. In the US, where screening runs through routine doctor’s visits rather than one national programme, modelling suggests around 1.3 deaths averted per 1,000 women screened.

Still more work to be done

As a Population Health Lead, I’m often reminded, and constantly navigating, the fact that even after so much progress, screening doesn’t reach everyone. The reasons are complex and vast: economic and political barriers, persistent health inequalities nationally and internationally, not enough radiologists, living too far from a mammogram machine, or simply not having the transport to get there. These are the human-sized, practical challenges, population-level and individual, of trying to reach millions of people reliably, in all the complexity of their lives. In my work each day, I strive to make preventative healthcare and wellbeing something every woman and man can access. I truly hope for that.

The difference AI is making

Interestingly, some of the most exciting work on those barriers is happening back where national screening really took off: Sweden!

The MASAI trial, a randomised controlled trial of around 106,000 women, used an AI risk-stratification tool to categorise mammograms by risk before they were allocated to radiologists. Higher-risk mammograms went to two or more radiologists, lower-risk to one. The study showed that AI-assisted screening was safe and reduced screen-reading workload by 44%, meaning it has the potential to expand reach and make the best use of those incredible radiologists who form the backbone of the screening pathway. Technology like this is a new, emerging part of the answer, but none of the breakthroughs of the last 200 years is the answer on its own. Together, with what comes next, they are greater than the sum of their parts at closing the gap between what screening can do, and who it actually reaches.

What Fanny Burney could only hope for

It’s a long way from a bedroom in Paris in the early 1800s, where Fanny underwent a mastectomy with no anaesthetic. She survived her ordeal, and lived for nearly thirty more years, long enough perhaps to hope for a world where her ordeal would be an account in history. Today, I don’t have to hope for that world. I get to live in it.

But that world still isn’t evenly shared, and it isn’t only women living in it: around 420 men are diagnosed with breast cancer in the UK each year, less than 1% of all cases, but no less real for how rarely it’s spoken about.

The work Fanny Burney’s letter began isn’t finished. It continues in the work still needed to make breast screening and diagnosis a reality for every woman, and every man, wherever they are in the world.

Sources

https://anthologydev.lib.virginia.edu/work/Burney/burney-letter-march-22-1812
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00298-X/abstract
https://www.thelancet.com/journals/landig/article/PIIS2589-7500(24)00267-X/fulltext
https://pubs.rsna.org/radiology/doi/10.1148/radiol.11110469
https://cdas.cancer.gov/learn/hipb/home/

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