 For nearly a century, public health organizations, professional associations, patient advocacy groups, academics, and clinicians largely viewed cancer screening as a simple, safe way to save lives. But these days, even though we're all looking at the same body of evidence, differing interpretations about the benefits and harms of mammograms has led to conflicting recommendations that range from intensive annual screening, starting at age 40, to no routine screening at all ever. Currently, the four main groups in the US charged with making mammogram recommendations each set contradictory guidelines. So what's a woman to do? Well, the guidelines are based on systematic reviews of the evidence. In the last 15 years, 50 such reviews have been published, but they don't all reach the same conclusions. The question is why? It turns out the conclusions of systematic reviews may have been influenced by competing conflicts of interest of the authors. Only in healthcare does the same group that provides a service also tell us how valuable that service is and how much of it we need. We must sadly acknowledge that just as in any other professional industry, self-interest is unavoidably at work. An analysis more than 100 papers, the imbalance in those that tended to emphasize the major benefits of mammography over its major harms, was related to the author's affiliation. It may be no coincidence that all the expert panels that have come out against routine mammograms excluded radiologists, figuring those who depend on mammograms for their paycheck might be more likely to recommend them. To which mammogram proponents respond, if you don't have a conflict of interest, you're probably not doing it right. Accusing the breast cancer screening panels of injecting their own biases. In this debate, there are armies of the faithful and only a disappointing scattering of moderators and peacemakers. Some have even suggested that we shouldn't even be talking about this in public. But such paternalism assumes that women cannot decide for themselves whether the available evidence supports or refutes the case for mammography. Discouraging a discussion with women about the evidence, foreign against, could be considered more harmful for women's health, not less, if doctors truly believe that patients should be active partners in making decisions about their own bodies. Yeah, if you read the actual studies, you can see if the investigators declare any conflicts of interest. But if you just hear about the study secondhand, you may have no idea. Until the developers of screening guidelines emphasize evidence over commercial or financial interests, we all have to take personal responsibility to become informed consumers. It'd be nice to be able to just trust like cancer charities, but it's virtually impossible for such organizations to remain strictly evidence-based when they must rely on keeping donors happy for their very existence. To his credit, the Chief Medical Officer of the American Cancer Society said that we need to be true to the science. But note, this was him talking about prostate cancer screening. See the American Cancer Society just straight up tells women to get mammograms, but for men, it leaves them to decide for themselves. They're open about the prostate cancer screening harms, but very little transparent information about the harms of mammograms is provided. So there's this double standard. Women are encouraged to just do it, while men are advised to weigh the pros and cons. Although the fundamental issues to consider are actually very similar between the two tests, the dissimilarity in how organizations like the American Cancer Society view the patient's role in decision-making couldn't be clear. Do they believe that men can handle uncertainties regarding screening tests, but that women might just get all confused? Men get to make informed decisions about their bodies, but women are merely summoned. The bottom line is that there is more than one right answer to the question, should I be screened for breast cancer? My goal I have for this video series is to enable you to make the decision that is right for you or your loved ones. One survey suggested that if women were fully informed at how small the benefit actually was, 70% wouldn't do it, but you may be in that 30% and have a right to decide for yourself.