 Fueled by good intentions and economic conflicts of interest with the multi-billion dollar mammogram industry, many women are being given diagnoses of breast cancer unnecessarily, producing unwarranted fear and stress, and exposing them to treatment they don't need. This is the overdiagnosis problem I've been talking about, the detection of pseudo-disease. Mammogram-detected abnormalities that look like cancer under a microscope, and so you're diagnosed with cancer, you're treated for cancer. But it was just pseudo-disease and would never progress to actually cause symptoms. The human costs include mastectomies and even deaths. The chance that a woman will benefit from mammograms may be small, in fact, maybe 10 times smaller than the risk that she may experience serious harm in terms of this overdiagnosis. How many would elect to go in for a mammogram if they knew that for every one woman who was notionally saved by early detection, anywhere from 2 to 10 otherwise healthy women are being turned into breast cancer patients unnecessarily? Well, first of all, are patients even told about the possibility of overdiagnosis by their physicians? I mean, it is, after all, now recognized as the most serious downside of mammogram screening. Well, hundreds were asked, and less than one out of ten said that they'd been informed about it. And when they were told about it, a little more than half said they wouldn't agree to screening if it resulted in more than one over-treated person per life saved. Wow, that implies that millions of Americans might not choose to be screened if they knew the whole story, however, 90% do not. Most women are aware about false positives and tend to view them as an acceptable consequence of mammograms. But in contrast, most women were unaware that screening could detect cancers that may never progress. And what they don't know could potentially even kill them. So when considering the pros and cons of mammograms, it would be good to consider total mortality. It can actually help you live longer on average. And mammograms have not been shown to do that, as therefore misleading to claim that screening saves lives. Theoretically, routine mammograms should increase a 50-year-old, non-smoking woman's overall survival chance from around 96.3% to 97.1% over 10 years. But these statistics disregard deaths from over-diagnosis, deaths from the unnecessary radiation and chemo, and thus increased mortality from heart disease and other cancers that may entirely outweigh the benefit in terms of reduced breast cancer mortality. You can't irradiate the breast without exposing the rest of your chest to radiation, your heart, your lungs, meaning why breast cancer survivors can end up with significant and marked impairment in cardiopulmonary heart-long function. Radiation treatments increased deaths from heart disease by more than 25% and from lung cancer by nearly 80%. Now we would accept that risk if we were beating back some deadly cancer, but the main effect of screening is to produce patients with breast cancer for which treatment offers zero benefit, since they would have remained free of breast disease for the rest of their lives without it, since compelling data suggests that most over-diagnosed tumors would have regressed spontaneously without treatment. Still, women who have had a cancer detected and then removed are likely to feel their life was saved, but perhaps 10 times more likely their lives were actually seriously harmed and not saved. 10 times more likely you were told you had a cancer that could kill you, but you really didn't. Corraled into the operating room for surgery, you didn't need. Every doctor's appointment, every sleepless night, all completely unnecessary, yet you come out as mammogram's greatest advocate. It saved your life. That's the crazy thing about mammograms, about PSA testing for prostate cancer. The people who are the most harmed are the ones who claim the greatest benefit. So overdiagnosis creates this vicious cycle for more overdiagnosis, because more and more people know someone, a friend, family member, a celebrity, who owes their life to early cancer detection. So the worse the test is, the more overdiagnosis it causes, the more popular it becomes. The more mammograms harm women, the better they seem to work. The more breasts that are surgically removed completely unnecessarily, the more women swear by it. Yeah, it's maybe billions of dollars wasted for nothing that could be spent on doing more for women's health, but it's the human cause. The harms from breast cancer screening may outweigh the benefits if death caused by treatment is included. Based on some best and worst case scenario estimates, for every 10,000 women invited for 10 years of mammogram screening, three to four breast cancer deaths may be avoided at the cost of around two to nine deaths from the long-term toxicity of unnecessary radiation treatments. Yet only one in ten women undergoing mammography said they were ever told about overdiagnosis, even though 9 out of 10 thought they had the right to know. Now, overdiagnosis is not easy to talk about. It's a sensitive issue, but just because communicating with patients can be difficult doesn't mean that we shouldn't do it. Informed women deserve no less. We have an ethical responsibility to let them know.