Symposium Mammographicum is a charitable organisation instigated in the 1970s to disseminate knowledge and education in breast imaging.
Prior to the 1970s, there were few health professionals specialising in breast imaging, and these were largely in symptomatic units associated with radiotherapy centres.
A drive to improve the quality of mammographic imaging at the Royal Marsden Hospital and an awareness of the lack of national mammography guidelines led to the founding of Symposium Mammographicum in 1979. Issues of concern were mammographic technique, radiation dose and image quality.
Founding members included Chair: Dr Huw Gravelle (University Hospital of Wales, Cardiff); Secretary: Mr Mike Fitzgerald (St Bartholomew’s); Treasurer: Professor David Dance; Professor Jack Boag (Institute of Cancer Research); and Mr Reg Davies, Dr Colin Parsons and Dr Audrey Tucker, from the Royal Marsden Hospital.
Dr Eric Roebuck (Queens Medical Centre, Nottingham) and Olivia Wilson (Royal Marsden) joined a year later, followed in the 1980s by Dr Jim Pemberton (St Thomas), Dr Jane Davey (Royal Marsden) and Mrs Maureen Yeowell (BUPA, London).
The first scientific conference and technical exhibition took place at University College London in 1980. Following concerns about the possibility of making a financial loss on the first meeting, the committee secured agreement from the British Institute of Radiology to underwrite the meeting, and to provide a secretariat.
The event was a resounding success with 120 delegates, scientific papers, technical exhibition, and posters.
Over the following years, the organisation grew in delegate numbers and reputation as an international breast symposium and, to mitigate potential risk for such a large conference, in 1984 sought charitable status and became a limited company.
Solicitor Sir John Stebbings offered to undertake all the legal work and documentation, and members of the group became Trustees. Sir John died in 1988. In honour and recognition of Sir John Stebbings’ huge contribution to setting up the charity, the opening eponymous lecture is named after him.
Mr Andrew Stebbings, son of Sir John, succeeded him and continued to provide essential legal and constitutional support for over twenty years, until 2014. We are very fortunate to have Ms Nicola Plant, Solicitor, currently undertaking this role.
The Forrest Report, leading to the establishment of the UK National Breast Screening Programme
Introduction of one-day training events at BUPA centres in London and around the country
Development and introduction of Digital Mammography
First talk at Symposium Mammographicum on Digital Mammography Prof Martin Yaffe (Toronto)
Appointment of Ms Caroline Roney as conference manager and Company Secretary.
Teaching faculties organised to Hong Kong, Kuala Lumpur, Singapore and Abu Dhabi
Emerging importance of breast MRI
Introduction of bursary and award schemes to fulfil Symposium Mammographicum educational commitments. So far recipients have benefitted from the following countries:
- Australia, Bosnia, Kenya, Jordan, Nepal, Nigeria, Rumania, Uzbekistan
NHS Plan for Reform – Introduction and establishment of consultant radiographer, advanced practitioner, assistant practitioner roles within screening and symptomatic breast imaging
Emergence of tomosynthesis, contrast enhanced mammography, ultrasound elastography
Introduction to the programme of workshops, seminars and poster tours
To reflect the full multidisciplinary approach to breast imaging, treatment, management and care, Symposium Mammographicum has formed close affiliations with The Association of Breast Clinicians, the Association of Breast Surgeons (ABC), and Mammography Physicists.
Symposium Mammographicum is recognised as one of the largest international breast conferences in the UK, attracting national and international delegates, world renowned international speakers, and leading commercial and industrial partners.
As recently as the 1960s, there were very few professionals, radiologists, radiographers or physicists with a particular interest in breast imaging, probably less than 25 in the whole country. Most of these were working in symptomatic units associated with radiotherapy centres. It was estimated in the early 1980s that throughout England, Scotland, Wales and Northern Ireland there were only 17 specialist teams with adequate expertise to undertake breast cancer screening.
During this decade, it became apparent that the quality of mammography imaging at the Royal Marsden Hospital (RMH), at that time, was inadequate, confirmed following a survey of screening centres in the UK. In addition to the work at the RMH, work was being conducted in the late 1970s / early 1980s, led by Mr Mike Fitzgerald (St Bartholomew’s Hospital) which demonstrated that there was a wide range of mammographic technique, radiation dose and image quality across 61 NHS centres. (Mammographic practice and dosimetry in Britain).
Mr Fitzgerald would later become one of the founding members of what is now Symposium Mammograhicum, along with Mr Reg Davis. One of his colleagues was Jack Boag, Professor of Physics at the Institute of Cancer Research and the Royal Marsden Hospital. Professor Boag was a leading figure in the science of cancer radiation therapy, and also played a part in the ending of the cold war through his involvement in the Pugwash group of scientists. Professor Boag had been a visiting scientist at the US National Bureau of Standards in the 1950s, and had worked with Sir Joseph Rotblat at St Bartholomew’s hospital. Following a further visit to the States in the early 1970s, Prof Boag returned to the UK with the recommendation to implement a newer type of radiography called ‘Xeroradiography’ to image breasts (an imaging technique based on the use of Xerox plates).
It appears that the inspiration to form an association dedicated to improvements in techniques and quality arose from a group of individuals at the Royal Marsden and Barts Hospitals. The Royal College of Radiologists was also noted at the time (in the 1970s) to be increasingly concerned with standards. The idea for Symposium Mammographicum (SM) arose from discussions at The Royal Marsden Hospital in Chelsea between Dr (now Professor) David Dance and fellow Marsden colleagues Mr Reg Davis, Dr Colin Parsons, and Mr Michael Fitzgerald from St Bartholomew’s Hospital. This group was meeting because two visitors from the USA, Dr Wende Logan (radiologist) and Professor Phil Muntz, an engineer from the University of Southern California, Los Angeles had come to the Marsden to visit Mr Reg Davis to discuss some of the work on mammography they had invited him to present in the USA but was unable to do. The visitors were also interested to discuss Mr Fitzgerald’s survey, the use of a breast test object which been developed with Dr Audrey Tucker (as co-author), and how to improve diagnostic accuracy. While efforts were being made to optimise radiographic technique, disparities between radiology and pathology were still apparent. The group concluded that ‘Xeroradiography’ could offer improved accuracy.
Following the discussion that the ‘Marsden’ group had with the visitors from the USA, it was apparent that there was a lack of academic meetings in the UK specifically focused on mammography. The group felt that this was an important and rapidly developing area where there was a strong need for discussion and education. They agreed that such a meeting should be organised. However, with a small group of three physicists and one radiologist, it was apparent that more radiological input was required. Mr Michael Fitzgerald suggested that Dr Audrey Tucker should be invited to join, which she did.
When the new group met, members felt that there was a need to recruit a ‘big name’ in mammography, and in due course Dr Huw Gravelle (University Hospital of Wales Cardiff) was pleased to join the group as first chairman. At that time, Mr Fitzgerald was the secretary and Professor Dance was the treasurer. Other key medical professionals in this specialised field were also invited to encourage the work: Dr Eric Roebuck (who joined the group a year later), a colleague of Dr Gravelle, and Olivia Wilson, a radiographer at the Marsden. The Group thus formed Symposium Mammographicum in 1979, and their first event took the form of a scientific conference and technical exhibition in September 1980 at University College London.
The Group was keen to promote itself to further its aims and Dr Tucker discussed options for a name with her husband, Dr Lewis Cannell (Radiologist and England rugby three-quarter). The suggestion ‘Symposium Mammographicum’ was adopted. For the organisation of the first meeting, the group was concerned about making a financial loss. The British Institute of Radiology agreed to underwrite the meeting, so the group was able to proceed. The BIR provided secretarial / registration support.
The form of the SM logo was conceived by Mr Davis who drew a basic design incorporating appropriately, the female breasts. He had close contacts with Farmitalia Carlo Erba and asked their graphic artist to apply to refine the basic idea. Farmitalia was a key early sponsor producing programmes for the first four conferences. Another early sponsor was Siemens.
The first meeting took place in the South Cloisters at University College, London, in September 1980. As well as scientific papers, there was a technical exhibition and posters. The technical exhibition was organised by Reg Davis. The event proved very successful with some 120 delegates attending. A second meeting was held at UCL, organised on similar lines, with the BIR again providing invaluable support. Subsequent meetings took place at Imperial College and UCL before moving away from the capital to other cities in the UK after the 1980s.
The membership of the organising group was gradually extended during the early 1980s, Dr Tucker being a driving force for recommending new members, who included Dr Eric Roebuck, (Queens Medical Centre, Nottingham), Dr Jim Pemberton (St Thomas’ Hospital) and Dr Jane Davey (RMH) and Mrs Maureen Yeowell, (BUPA Health Screening, London).
As the organisation grew, so did potential risk. It was Audrey who suggested to the group in 1984 that it needed to regularise itself by seeking charity registration and incorporate to become a limited company. Her friend, Solicitor Sir John Stebbings, offered to organise this for the group, by a drafting an application; articles and a memorandum of association were produced. Professor Dance and Dr Tucker met with Sir John in Fulham on a couple of occasions to review and agree final versions of the compliance documents. By early 1985, the group had become a charity and incorporated. In the early days, Audrey was the charity’s chair and David its company secretary. Other members of the existing group became Trustees. After the formation of the charity, the BIR gave SM the surplus funds from the previous meetings and the administration for the next few meetings was handled by the Royal College of Radiologists.
There was a great stimulus to SM with the beginning of Breast screening. Dr Roebuck was a member of the Forrest Committee (Chaired by Sir Patrick Forrest) which reported its findings in 1986 and led to the establishment of a national breast screening programme by the Department of Health. The recommendations of the report led to an intensive recruitment drive for office staff, radiographers, radiologists and breast clinicians, and an intensive programme of training was begun, with training centres in Nottingham, Guildford, Manchester and King’s College Hospital, London, and in Edinburgh, Cardiff and Belfast established. Eric was able to ensure that the quality objectives of SM were recognised and incorporated into the Forrest Report. SM was recognised as a valuable teaching and training resource. During the 1990s, SM held biennial conferences and exhibitions which grew with each passing event. In addition, trustees also organised and ran radiographers’ teaching courses.
Part of Dr Tucker’s private practice was at BUPA, and the National Mammography Trainer and Advisor to BUPA, Maureen Yeowell was a SM trustee. SM provided a series of one-day training courses (always on Saturdays) for BUPA and NHS radiographers at BUPA centres around the country. An average of 30 radiographers attended each of these courses. Kodak provided some financial support for this. The teachers included, Dr Audrey Tucker, Ms Jane Davey (breast physician, and trustee), Mrs Maureen Yeowell, Professor David Dance and Dr Stephen Evans.
Sir John Stebbings, who helped guide and form the charity in 1985, died in 1988. In recognition of his contribution to setting up the charity, successive conferences from 1992 have named the keynote opening lecture after him. SM has also been fortunate for having Sir John’s son, Andrew succeed as a trustee to provide the charity with the essential legal and constitutional guidance when required for over twenty years until September 2014.
By the early 1990s there was considerable interest in digital mammography. Although there was no commercially available equipment, films were being digitised and mathematical techniques were being developed to try to read the films. Professor Dance was heavily involved in the organisation of an independently organised International Workshop on Digital Mammography, and arranged for it to be held in York immediately preceding the 1994 SM, also held in York. Professor Dance invited Prof Martin Yaffe from Toronto, a world-leading expert on digital mammography at that time (and to this day), to give an invited lecture at SM. This was the first ever talk at SM on digital mammography.
As the conferences grew larger, it was apparent that the Trustees needed to seek additional resources to organise these events. SM was fortunate to appoint Miss Caroline Roney as its conference manager for the 1996 event and appointed as the Company Secretary in 1996 Miss Roney continued to organise the event until 2002. Miss Roney’s commitment to professionalising the charity led to it becoming internationally recognised with foreign experts accepting invitations to contribute to the symposia.
From the mid 1990’s teaching faculties were also organised, visiting South East Asia, and giving lectures, demonstrations and workshops in Hong Kong, Kuala Lumpur and Singapore and latterly, hospital based workshops in Abu Dhabi.
Following a period of review, the overseas teaching programme was superseded by the introduction and promotion of a bursary scheme for overseas applicants and an award scheme for UK clinicians and radiographers to conduct research or attend the conference. This shift in accent as to how the Charity fulfils its educational commitment witnessed specialised medical professionals successfully applying for clinical observation training courses at specialist centres in the UK from as far afield from Nepal, Jordan, Uzbekistan, Australia, Nigeria and Kenya. Applicants are invited to reflect on how their experience in the UK will benefit their relevant departments at home, sharing best practice and developments.
The Bursary scheme is also open to overseas applicants wishing to attend the Conference and scientific exhibition.
The Award scheme, for clinicians, radiographers and researchers resident in the UK, has been aimed at supporting innovative studies and research into diagnostics and treatments, which can support individuals undertaking post graduate work and groups of researchers.
The Conference and Exhibition is now a firmly established event in the calendar for radiographers, radiologists and associated clinicians from the wide variety of disciplines to attend and learn about the latest developments in diagnostic techniques and treatments.
The event has grown over the decades and the Trustees have been keen to develop a multi-disciplinary approach to the programme, running parallel programmes for physicists and more recently, forming a collaborative connection with the Association of Breast Clinicians. In 2016, the Charity established links with the Association of Breast Surgeons which led to Symposium Mammographicum being invited to present a dedicated session on new imaging techniques to surgeons at their conference in May 2017. Plans to reciprocate are being developed to invite the ABS to provide a surgical focus at SM2018.