Like many young doctors, Dr. László Tabár wanted to make a lasting contribution in his field. In Hungary, where he trained and worked as a radiologist in the late 1960s, he realized that breast cancer detection—an area few knew much about—would make this possible.
Over the course of his 40 year career, Tabár has read more than 1,000,000 mammography X-ray screenings, trained nearly 25,000 mammographers and breast surgeons worldwide, and helped set up roughly 60 breast imaging centers in the U.S. alone. This may explain why he’s considered by some to be the father of mammography.
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DOTmed News spoke with Tabár, who’s currently medical director at the Department of Mammography at Falun Central Hospital in Sweden, to get a sense of how the field has progressed through the years.
Tabár explained that mammography started to develop as a technique after the breast’s unique vascularity became more well-known to radiologists like himself. While image quality may have been superb “it came at the expense of the dose, which was about 20 times what it is today,” said Tabár.
But that changed in 1975 with the introduction of the intensifying screen from DuPont. The technology reduced the number of X-ray photons that went through film, and consequently, reduced the amount of radiation. This led to more widespread use of mammography as a screening tool to detect breast cancer.
Tabár and his colleagues knew that dense breast tissue played a critical role in detecting cancer too. “Despite the enthusiasm for mammography, we found out early that there were limitations, like the cloud,” he said. “It was clear that breast density varied from woman to women, and it didn’t feel fair that one woman got the reliable mammography report while the other woman didn’t.”
According to Tabár, the next breakthrough along mammography’s path forward came with the development of ultrasound. “It really goes through the cloud, which is the dense breast tissue.”
But ultrasound had its drawbacks too. Many lesions that ultrasound can detect look like cancer, so doctors end up performing biopsies no matter if the cyst is benign or malignant.
Tabár said that introducing needles—from small to large—allowed the process of tissue extraction to become easier and more efficient, and overall, it reduced unnecessary biopsies.
Tabár credits breast MRI as the latest great milestone for mammography. “Ultrasound and mammography are static methods, but MR is a functional imaging method, which means that anything that has a metabolism lights up,” he said. And this can help specialists differentiate between benign and malignant calcifications.
Using a combination of all these modalities, Tabár believes that doctors today have the tools necessary to save more women from breast cancer than ever before. The next priority, he says, should be training specialists.
“It’s not for the general radiologist or surgeon. Just like we have neurosurgeons and vascular surgeons, this too requires specialists. That’s why since 1977 I haven’t done anything but the breast.”