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

Handel Reynolds

The word “controversial” in the title is redundant, as anyone familiar with breast-cancer screening knows. Studies differ on whether it’s of benefit to women under 50—and whether early detection improves mortality rates. Concerns surround the fact that one-quarter of cancers found are DCIS, ductal carcinoma in situ, a grade 0 tumour which may or may not spread yet is often treated as aggressive cancer, with the attendant risks.

Now an instructive 94-page study of the “culture” of mammography by an Atlanta-based breast radiologist traces the political and medical forces that lead to women viewing their breasts as “ticking time bombs.” It took root in the 1970s when the U.S. government, eager for diversion from Vietnam, endorsed the American Cancer Society and American Society of Radiologists’ call for widespread screening, contrary to science. AIDS activism spawned breast-cancer activism, and an “epidemic” mindset, despite a 1992 Canadian study that found screening more harmful for women 40 to 49. The issue resurfaced during the “Obamacare” debate, which enshrined coverage for women over 40.

Handel expresses frustration with the political hijacking of mammography and the concern women view it as “preventative.” He blasts the “meaningless” stat that one in nine women will get breast cancer and addresses DCIS “overtreatment,” including high-dose radiation and double mastectomies. And he expresses regret that “the little pink engine that could” has created a “secondary economy,” while admitting he enjoys “Pink Ribbon” bagels without asking how his purchase supports cancer research.

Yet, oddly, the book ends up as less exposé than status-quo endorsement, with the highly profitable screening industry unmentioned. Mammography is lauded as an “indispensable tool,” and contentious current guidelines are endorsed. Unanalyzed are perplexing U.S. breast-cancer death-rate stats: in 1970, it was 27 per 100,000, unchanged since 1930. In 1990, it was 33.0; by 2007, it had fallen to 22.91. So after four decades of divisive debate and science, deaths are down four points? Now that’s a topic begging for controversy.

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