Radiologist, at M. D. Anderson Hospital in Houston in 1959 of a mammogram showing a nonpalpable cancer led me to the concept of the possibility of earlier detection of breast cancer than was commonly the case and eventually to the initiation of the Health Insurance Plan (HIP) Study. An attempt to enlist presumably well women to follow through on the idea led me, most fortunately, to Sam Shapiro, then Vice-president in charge of statistics at the HIP. He was the superb architect who fashioned the concept in a most meticulous scientific manner with the foresight to create a potentially landmark study that, if successful, would stimulate the medical profession to follow through. The care and devotion of Wanda Venet in her collection of data over the years, the valued activities of Louis Venet in the clinical aspects of the study and especially, the support, sometimes against strong opposition, of Michael Shimkin of the National Cancer Institute, in addition to my radiological input eventually culminated in today's widely heralded Health Insurance Plan Study.
Why Should We Do Mass Screening?
The definitive diagnosis of breast cancer is made by the pathologist. The step before that involves the clinician, be he internist, gynecologist, or surgeon, who is faced with a more or less frightened woman who comes in with a lump, a localized pain, or a nipple discharge. A differential diagnosis is called for with the subsequent and sometimes difficult decision to explore the breast or do watchful waiting. The clinician uses all the resources available in the community in addition to inspection and palpation. All of these procedures are vital and most important to get as much information as possible to help make the decision to have the patient explored or not and to avoid delay in doing so.