Embryo Project Encyclopedia

Screening for Breast Cancer with Mammography is a Cochrane systematic review originally published by Peter Gøtzsche and Karsten Jørgensen in 2001 and updated multiple times by 2013. In the 2013 article, the authors discuss the reliability of the results from different clinical trials involving mammography and provide their conclusions about whether mammography screening is useful in preventing deaths from breast cancer. Mammography is an X-ray technique used to detect abnormalities in breast tissue, such as breast cancer, which affects about twelve percent of women in the world and has a significant risk of mortality. The authors concluded that mammography screenings reduced breast cancer mortality, but resulted in problems such as overdiagnosis and overtreatment of screened women. The article Screening for Breast Cancer with Mammography contributed to the then ongoing controversy about the usefulness of mammography and provided accessible information about mammograms in seven languages.

Diethylstilbestrol (DES) is an artificially created hormone first synthesized in the late 1930s. Doctors widely prescribed DES first to pregnant women to prevent miscarriages, and later as an emergency contraceptive pill and to treat breast cancer. However, in 1971, physicians showed a link between DES and vaginal cancer during puberty in the children of women who had taken DES while pregnant. Consequently, the US Food and Drug Administration (FDA) banned its use during pregnancy. In the late 2000s, several studies showed that the grandchildren of women who had consumed DES also suffered medical issues. By the early decades of the twenty-first century, roughly ten million people in the US had been exposed to DES, and three generations of individuals had suffered medical issues due to DES exposure. Researchers class DES as an endocrine disruptor, which affects the form and function of the hormone (endocrine) system.

Published in 1971, Adenocarcinoma of the Vagina: Association of Maternal Stilbestrol Therapy with Tumor Appearance in Young Women, by Arthurs L. Herbst and colleagues, was the first piece of literature connecting maternal use of the drug diethylstilbestrol (DES), also called stilbestrol, with the development of a rare and severe form of vaginal cancer in young women. Diethylstilbestrol was later classified as an endocrine disruptor, a substance that disrupts the hormonal function of the body in those exposed to it during development or later in life. After Herbst and his team established the connection between DES and the occurrence of breast cancer, cervical cancer, infertility, and reproductive abnormalities, the US federal government banned use the drug for pregnant women. The article was published in the New England Journal of Medicine.

"Casti Connubii," a papal encyclical given by Pope Pius XI on 31 December 1930, served primarily as a reaffirmation and expansion of the issues discussed in Arcanum, an encyclical written by Pope Leo XIII. It was released to address new threats to marriage and conjugal unity, and indeed is translated "On Christian Marriage" or "On Chastity in Marriage." The document explores the meaning of Christian marriage and emphasizes its threefold purpose as borrowed from St. Augustine: to produce offspring, to grow in conjugal faith, and to show benefit from the sacrament. It begins by exploring the nature of marriage, followed by a discussion of its advantages for individuals and societies, erroneous but common beliefs about marriage, threats to pure marriage, and finally how to address them. Included in the threats to pure marriage is that of the growing popularity of contraception and abortive procedures, at which point Pope Pius XI elaborates on the Church' s statement that life begins at conception.

From 1963 to 1982, researchers in New York City, New York, carried out a randomized trial of mammography screening. Mammography is the use of X-ray technology to find breast cancer at early stages. The private insurance company Health Insurance Plan of Greater New York, or HIP, collaborated with researchers Sam Shapiro, Philip Strax, and Louis Venet on the trial. The researchers’ goal was to determine whether mammography screening reduced breast cancer mortality in women. The study included sixty thousand women aged forty to sixty-four. Half of the women received two annual breast examinations that involved mammography, a breast exam, and an interview. The rest of the women were not invited for annual examinations. After follow up, the researchers found that of the women who received the examinations, thirty percent fewer died from breast cancer than the women who did not receive any examinations. The HIP trial was one of the first large-scale clinical trials to provide evidence that mammography screenings helped prevent breast cancer deaths in women.

Sindell v. Abbott Laboratories was a 1980 California case that established the doctrine of market share liability for personal injury cases. For such liability, when a drug causes personal injury and the manufacturer of the drug cannot be identified, each producer is responsible for paying the settlement in proportion to the percentage of the market they supplied. Judith Sindell and Maureen Rogers brought the case against the producers of diethylstilbestrol (DES), which their mothers had taken during pregnancy to prevent miscarriage and other complications. Sindell and Rogers alleged that their mothers' ingestions of DES during pregnancy later caused Sindell and Rogers to develop cancers at the onset of puberty, but they could not identify the specific manufacturer of the drug. The market share liability ruling in Sindell allowed millions of DES-affected individuals to seek restitution for reproductive cancers caused by prenatal exposure to DES.

In 1894, William Stewart Halsted published The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins Hospital from June, 1889, to January, 1894, in the medical journal Annals of Surgery. In the article, Halsted describes the results from fifty of his operations on women with breast cancer, performed at Johns Hopkins Hospital in Baltimore, Maryland. Those operations involved a surgical procedure Halsted called radical mastectomy, which consists in removing all of the patient’s breast tissue, chest muscle, and underarm lymph nodes. Halsted’s surgery effectively cured breast cancer in a time period when no other effective treatment options were available. The radical mastectomy remained the standard of care from the 1890s to the 1970s as a means of treating a type of reproductive cancer common to women.

Emmett McLoughlin wrote People's Padre: An Autobiography, based on his experiences as a Roman Catholic priest advocating for the health of people in Arizona. The Beacon Press in Boston, Massachusetts, published the autobiography in 1954. McLoughlin was a Franciscan Order Roman Catholic priest who advocated for public housing and healthcare for the poor and for minority groups in Phoenix, Arizona, during the mid twentieth century. The autobiography recounts McLoughlin's efforts in founding several community initiatives throughout Phoenix, including the St. Monica's Community Center, later renamed St. Pius X Catholic Church, the Phoenix housing projects, and St. Monica's Hospital, later renamed Phoenix Memorial Hospital. McLoughlin's autobiography discusses his advocacy for people to have greater access to maternity and prenatal healthcare, to testing and treatment for sexually transmitted infections, and to birth control in the Phoenix area.

This thesis answers the following question: How does the history of cervical cancer show that prevention helps reduce rates of cancer-related deaths among women? By studying the history of cervical cancer, people can understand how a cancer that was once one of the top killers of women in the US has declined to become one of the lowest through the establishment of and effective communication of early prevention and diagnostics, both among the general public and within the medical community itself. This thesis is organized based on key episodes which were pertinent to the history of cervical cancer, primarily within the United States and Europe.