A winner of the
American Journal of Nursing
2012 Book Awards in the category of Consumer Health
The Big Squeeze, The History of the Mammogram

Cornell University Press
ISBN: 978-0-8014-5093-8

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The Big Squeeze

A Social and Political History of the Controversial Mammogram

An influential panel of medical experts ignited a controversy in 2009 when they recommended that most women should not begin routine mammograms to screen for breast cancer until the age of 50, reversing guidelines they had issued just seven years before when they recommended 40 as the optimal age to start getting mammograms.

While some praised the new recommendation as sensible given the smaller benefit women under 50 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.

Pivotal decisions made during mammography's initial launch made it all but inevitable that
the test would be contentious.

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 establishment of mammography screening as a fundamental aspect of women’s preventative 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.

Click to print a PDF of the press release

Read a conversation with Dr. Handel Reynolds regarding the controversies surrounding the use of mammography.

To request an interview, or arrange a speaking engagement,
please click here.

Media & Reviews

The NY Journal of Books

“. . . a good case study of what happens . . . when politics and science use each other and the media to advance their own agendas rather than public policy.”  http://tinyurl.com/mammogramdilemma


The Lancet

The Big Squeeze: A Social and Political History of the Controversial Mammogram gives a short and interesting view of the social and political history of mammography. The author, Handel Reynolds, is a breast radiologist in private practice in Atlanta, GA, USA. In his book, he describes the history of the mammogram, from the idea of early detection of breast cancer at the beginning of the 20th century, to screening with mammography in the USA today. He tells the story of how a simple message was communicated to the public, and the pitfalls that have come about as a result of this unbalanced message. Click here to read the full review.


JAMA

No other medical test comes close to evoking the degree of passion and controversy that mammography does. Indeed, it is rare today to pick up a newspaper or magazine without being confronted with a controversial article about screening mammography. Does mammography reduce mortality from breast cancer, and if so, to what degree? Is mammography harmful to patients because of overdiagnosis or the radiation to which patients are exposed during the procedure? 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: A Social and Political History of the Controversial Mammogram by radiologist-mammographer Handel Reynolds provides answers to these questions by taking readers on a fascinating and enlightening 50-year journey, beginning with the introduction of mammography in the early 1960s.
Click here to read the full review.


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.


Feminist Peace Network

Dr. Reynolds analysis of how mammography became widely accepted is quite enlightening. He points to the blatant use of fear as a tool to convince women to get screened in the late 1980s with the American Cancer Society leading the way in telling us that breast cancer rates were rapidly rising despite the fact that the increased numbers of cases were attributable in part to increased use of screening (as well as by women’s longer life expectancy–you are more likely to die of breast cancer if something else hasn’t killed you at an earlier age). It wasn’t that the cancer wasn’t there before, it was that we weren’t aware of it or died of something else first.

ACS mounted a huge campaign around the use of the statistic that one in nine women would get breast cancer. Yet an ACS spokesperson was quoted in the New York Times as saying that it was, “meant to be a jolt…It’s meant to be more of a metaphor more than a hard figure.” (emphasis mine).

As Dr. Reynolds notes, that sort of messaging led to women overestimating their own risk of getting breast cancer as well as overestimating the benefits of mammography and the all too common mis-perception that regular screening can keep you from getting breast cancer.
Click here to read the full review.


Macleans.ca

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.
Click here to read the full review.


GoodReads

. . . 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. Click here to read the full review.


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