While Warren holds the honor of performing the first mammograms, that historical note may require an asterisk. Warren performed his procedures on women who were already seeking medical treatment for some type of breast disease, so while there was value in the work, it didn’t ultimately change the fact that those women would be operated on. That’s where Dr. Jacob Gershon Cohen comes into the story.

During the 1950s, Cohen built on the work of his predecessors to act on the logical next step – the imaging and screening of women who were deemed healthy in order to head off instances where cancer had gone unnoticed. That early warning gave doctors the ability to head it off before it spread, thereby improving outlooks for women diagnosed with breast cancer. It was during Cohen’s time that some of the early controversy regarding mammography emerged. At the time of his early work, X-rays delivered relatively high radiation doses, creating a concern among some medical professionals that regular use of X-ray for screening could actually exacerbate the occurrences of breast cancer. The introduction of better film, which needed lower dosage, eased much of the concern and by 1969, the first X-ray equipment specifically manufactured for breast imaging was on the market.

Another challenge arose in the 1970s after the National Cancer Institute released findings based on a four-year study they conducted from 1973 to 1977. The study, which included the review of more than a quarter of a million U.S. women, concluded that a significant number had undergone surgical procedures after a mammogram turned up small, benign growths. The report’s findings led to the NCI issuing its first set of guidelines surrounding breast screening, and those guidelines are still being updated and debated today.

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