The Big Squeeze: A Social and Political History of the Controversial Mammogram

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Overview

In 2009, an influential panel of medical experts ignited a controversy when they recommended that most women should not begin routine mammograms to screen for breast cancer until the age of fifty, reversing guidelines they had issued just seven years before when they recommended forty as the optimal age to start getting mammograms. While some praised the new recommendation as sensible given the smaller benefit women under fifty derive from mammography, many women's groups, health care advocates, and individual ...

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The Big Squeeze: a social and political history of the controversial mammogram

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Overview

In 2009, an influential panel of medical experts ignited a controversy when they recommended that most women should not begin routine mammograms to screen for breast cancer until the age of fifty, reversing guidelines they had issued just seven years before when they recommended forty as the optimal age to start getting mammograms. While some praised the new recommendation as sensible given the smaller benefit women under fifty derive from mammography, many women's groups, health care advocates, and individual women saw the guidelines as privileging financial considerations over women's health and a setback to decades-long efforts to reduce the mortality rate of breast cancer.

In The Big Squeeze, Dr. Handel Reynolds, a practicing radiologist, notes that this episode was only the most recent controversy in the turbulent history of mammography since its introduction in the early 1970s. In a book written for the millions of women who face the decision about whether to get a mammogram, health professionals interested in cancer screening, and public health policymakers, Reynolds shows how pivotal decisions made during mammography’s initial launch made it all but inevitable that the test would be contentious. He describes how, at several key points in its history, the emphasis on mammography screening as a fundamental aspect of women’s preventive health care coincided with social and political developments, from the women’s movement in the early 1970s to breast cancer activism in the 1980s and ’90s.

At the same time, aggressive promotion of mammography made the screening tool the cornerstone of a huge new industry. Taking a balanced approach to this much-disputed issue, Reynolds addresses both the benefits and risks of mammography, charting debates, for example, that have weighed the early detection of aggressively malignant tumors against unnecessary treatments resulting from the identification of slow-growing and non-life-threatening cancers. The Big Squeeze, ultimately, helps to evaluate the ongoing public health controversies surrounding mammography and provides a clear understanding of how mammography achieved its current primacy in cancer screening.

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Editorial Reviews

Publishers Weekly
Mammography has never been far from controversy, notes Reynolds, former chief of breast radiology at Indiana University. The cancer screening test has been lashed, he says, by political, social, and financial forces that have muddled the picture regarding its risks and benefits. This book is a quiet call for a more frank discussion of what an “indispensable tool” mammography is in the fight against breast cancer, without ignoring the test’s risks. Reynolds takes a critical look at the “breast cancer epidemic”; the ever-shifting guidelines regarding the age at which women should be screened ( 40? 50?); confusing interpretations of trial results; the role of breast cancer activists in promoting mammograms; and the profitable industry that has grown up around mammography. And after 40 years of screening, there still remains a stubborn silence about false readings and overdiagnosis. “Women... need complete and accurate information regarding the risks and benefits,” Reynolds asserts—and this brief, clear volume can be the first step in achieving that goal. (Aug.)
From the Publisher

"Does mammography reduce mortality from breast cancer,and if so, to what degree? . . . Do benefits of mammography exceed the potential harms? Why and how did the debate shift from a scientific to a political one? The Big Squeeze provides answers to these questions by taking readers on a fascinating and enlightening 50-year journey. . . . Providing a balanced, objective, in-depth discussion of all aspects of screening mammography, The Big Squeeze will not only be an educational asset for physicians but a book they can feel comfortable in recommending to their patients as well."—Leonard Berlin, MD, Journal of the American Medical Association (19 December 2012)

"The Big Squeeze gives a short and interesting view of the social and political history of mammography. . . . Reynolds . . . retells the so-called truth of mammography screening, and he gives a balanced view. He devotes a whole chapter to overdiagnosis, the major harm of mammography screening. . . . I enjoyed reading this book and would highly recommend it to everybody."—Mette Kalager, The Lancet Oncology (February 2013)

"Dr. Handel Reynolds has done a terrific job in telling the story of mammographic screening and putting it into context! Everyone who wants to understand why this has become a third rail needs to read this book."—Susan M. Love, MD, President of the Dr. Susan Love Research Foundation and author of Dr. Susan Love's Breast Book

"The Big Squeeze is a fascinating and thought-provoking review of the history, science, and politics of breast cancer screening. Despite my many years in this field, I learned a great deal, particularly about some of the earlier years of the development of screening mammography. The book is beautifully written and highly readable—it will be a great resource for health care professionals and the public."—Valerie P. Jackson, MD, FACR, Eugene C. Klatte Professor and Chair, Department of Radiology and Imaging Sciences, Indiana University School of Medicine

"This book is a quiet call for a more frank discussion of what an 'indispensable tool' mammography is in the fight against breast cancer . . . Reynolds takes a critical look at the 'breast cancer epidemic'; the ever-shifting guidelines regarding the age at which women should be screened; confusing interpretations of results; the role of breast cancer activists in promoting mammograms; and the profitable industry that has grown up around mammography. . . . 'Women need complete and accurate information regarding the risks and benefits,' Reynolds asserts—and this brief, clear volume can be the first step in achieving that goal."—Publishers Weekly (11 June 2012)

"The Big Squeeze is first class. Dr. Handel Reynolds describes the controversy over mammography in a careful, objective fashion. He avoids polemical descriptions and shares with readers the information currently available about the benefits and risks of mammography."—Jerome Kassirer, MD, Distinguished Professor, Tufts University School of Medicine, author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health

"The Big Squeeze is a terrific book: a history of screening mammography that is interesting, important, timely and controversial. The book is short, fast moving, and balanced (although, in this day of polarized opinions, balance is often perceived only through the eyes of the beholder). It will be of particular interest to women, physicians, and perhaps politicians. Dr. Handel Reynolds interweaves scientific, social, political, emotional and economic issues, many of which are peculiar to breast cancer. Much of the confusion and controversy regarding screening mammography resolves around age and timing: when to begin and how often. Physicians, statisticians, politicians, and patients from around the world, each using the same data, have come up with different recommendations for breast screening. Dr. Reynolds takes us on this roller-coaster ride and his conclusions are that annual screening mammography, starting at age 40, does save lives, but . . ."—Ferris M. Hall, MD, FACR, Beth Israel Deaconess Medical Center and Harvard Medical School

Library Journal
Many readers will remember the controversial decision in 2009 by a panel of medical experts (U.S. Preventative Services Task Force) that women should not undergo regular mammography screening until the age of 50, rather than beginning at 40. Here, breast radiologist Reynolds examines how this debate first started in 1976 and explains how the conversation about when to begin mammography screening has never been entirely about science, but is intermixed with political, social, and financial considerations. His work outlines the history, politics, and legal history of mammography and he explains how the AIDS activism of the early 1980s set the stage for the breast cancer activism of the early 1990s. In addition, Reynolds discusses benefits of screening and explains its most significant risk factor: overdiagnosis and overtreatment of breast cancer. VERDICT Though his target audience is the lay person, the reading level is high. Best suited for health-care professionals, students, and those with an interest in health-care policy and politics will find Reynold's book of interest.—Dana Ladd, Community Health Education Ctr., Virginia Commonwealth Univ. Libs., Richmond
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Product Details

Meet the Author

Handel Reynolds MD is a breast radiologist currently in private practice in Atlanta, Georgia. He was formerly Chief of Breast Radiology at Indiana University. He has lectured and published widely.

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Table of Contents

Introduction: The Mammography Story 1

1 Timing Is Everything 5

2 First Exposure 15

3 The Aftermath 28

4 A Tale of Two Epidemics 36

5 Age Is Nothing But a Number 50

6 Pulling the Plug on Granny 62

7 The House That Mammography Built 72

8 Overdiagnosis: Mammography's Burden 84

Notes 95

Index 113

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Customer Reviews

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Sort by: Showing 1 Customer Reviews
  • Anonymous

    Posted August 6, 2013

    This was a well researched, well documented and well written boo

    This was a well researched, well documented and well written book.

    Dr. Reynolds' accomplished what he set out to do. He sought to give women ages 40-49 the "need to know" information about doing a yearly mammogram.

    This is a MUST read. As a side note, within the first 6 months of publishing this book, Dr. Reynolds attained the prestigious Book of the Year Award  as granted by the American Nursing Association.

    It was recently brought to my attention that Dr. Handel Reynolds did not live to see the one year anniversary of his book's publication. He died on June 14, 2013. My family would like to take this time to extend their condolence to his mother, sister and children.

    Was this review helpful? Yes  No   Report this review
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