 Selling cancer screening can be easy, starts in editorial in the Journal of the National Cancer Institute, induce fear by exaggerating risk, then offer hope by exaggerating the benefit of screening, and don't mention harms caused by the screening. This ploy is especially easy with cancer. No diagnosis is more dreaded. And we all know the mantra, early detection is the best protection. Doubt it, and someone may suggest you need your head examined, and they are not exaggerating. Screening can lead to important benefits, but it can also lead to important harms. And so that's the big challenge, conveying the counter-intuitive idea that screening doesn't always help, and can even be harmful. Yet, surveys have shown that most people believe that cancer screening is almost always a good idea, and few believe harm is even possible. Inpatient education materials passing references to potential harms may deceptively be buried under a euphoria of benefits. The cancer screening test that has been most carefully studied is mammograms. In the past 50 years, more than 600,000 women have participated in 10 randomized trials. Given this extraordinary research effort, it's ironic that mammograms continue to be one of the most contentious issues within the medical community. There are a few things in medicine that provoke more passion than mammograms, with both sides, ironically, accusing the media of being in the opposite camp. But this contentiousness is in itself instructive. I mean, it should tell us something for context. A single study involving fewer than 150 men who were followed for less than two years was sufficient to convince physicians of the value of treating severe high blood pressure, because the benefits were just so obvious, whereas after 10 trials, 600,000 women, the fact that we're still debating the merits of mammograms 50 years later suggests that it's a close call between the benefits and harms. But that's assuming people are weighing the pros and cons objectively. It may be worse than that, given the multi-billion-dollar industries involved in mammogram machine manufacturers to the radiologists that read them. Several organizations publish contradictory cancer screening recommendations. Some say mammograms starting at age 40, others say 50, some say every year, some say every other year, and some say women shouldn't get them routinely at all. There's increasing concern that these disagreements may be arising from both financial and emotional conflicts of interest. People can get so invested in their position that they've staked out that it kind of clouds their judgment. Reasonable experts agree that the body of evidence suggests that there is some benefit to mammography, although the benefits have almost certainly been exaggerated. This does not mean that mammograms don't save lives, or that women shouldn't get them. The question is, do the benefits outweigh the risks? That's the decision each woman has to make for themselves, but they can't do that without knowing all the facts. Women are so bombarded with information about mammograms, you'd think women would be fairly knowledgeable about it, yet nothing is farther from the truth. 9 out of 10 women surveyed vastly overestimated the benefits or had no idea. It's not the women's fault, though. They're obviously being misinformed by the system. Most American women didn't even appear to understand the concept of screening, thinking mammograms somehow help prevent you from getting breast cancer in the first place. This raises doubts about how well women are being informed. Sounds like women are just being told what they should do, but without being given the facts necessary to make informed decisions. As a result of this paternalism and pink ribbon culture, almost all women have a false impression of the benefit of mammography screening. Surprisingly, those who frequently consulted their physicians and health pamphlets were slightly worse informed, so they were like anti-educated by their doctors. And the problem is that these kinds of inaccurate and exaggerated perceptions prevent women from making an informed choice. Misleading women, whether intentionally or unintentionally, is a serious issue. All of those in the business of informing women about screening call that medical systems are for patients, not the other way around. We should not just blindly be selling screening. We should be giving people the numbers they need to decide for themselves. That's why I created this video series. The question of whether screening mammography does more harm than good has the potential to shake up the state of our medical knowledge, alter our views of ethical medical practice. The stakes are high in this discourse because women's lives hang in the balance.