Starting with the mammogram issue: The USPSTF does not base its decisions on monetary costs. It does look at the costs to women of unnecessary biopsies, treatment, and even the chemo and surgery some women undergo unnecessarily. Upon reviewing the evidence, the panel concluded that the evidence screening women under age 50 is far from persuasive, and recommends that decision be kept between a woman and her doctor based on her personal history and values. They also concluded that we can safely screen every 2 years rather than every year. This is not as radical a shift as some are claiming. The evidence has been iffy for years, the move to recommend screening for women under 50 was political rather than scientific, and in other countries such as Canada and UK they start screening at 50. I know that we’ve been taught for years that early detection = early cure. It seems to make sense. Unfortunately, it’s just not generally true. Rather than try to make the science something that it’s not, let’s focus on advocating for finding ways that we truly can pick up cancer at an early enough stage that we can make a real difference in treating it. Mammograms have been oversold, and as a result women have missed out on the opportunity to advocate for the development of better technologies.

In terms of cervical cancer screening, the new recommendations are not to start until age 21 (which is great because it’s one less barrier for young women to get the contraception they need!) and to space out screening to every 2 years in women . The reason this is fine is that the vast majority of pre-cancerous lesions resolve on their own. Even those that don’t resolve grow extremely slowly, leaving plenty of time to treat them. By decreasing the number of screenings we’re decreasing the number of biopsies, and therefore decreasing the number of more extensive procedures done. This is good because some of the surgeries to remove the abnormal cells can put a woman at risk of pre-term labor in the future.

And believe it or not, the USPSTF has also recommended against the routine screening we had been doing for prostate cancer, so we can’t blame this entirely on sexism!

I agree that we do hear about the “anxiety” factor of these tests a whole lot more when they’re for women’s health issues than men’s health issues, and that’s clearly a product of our societal norms. And I totally understand that hearing a man saying that the anxiety is the biggest problem is demeaning. But the bottom line is that these new recommendations are made with the best interests of women in mind. What we need to do is ensure that the decision to screen or not to screen remains between a woman and her doctor, and that further future efforts be made to give us access to better screening methods for breast cancer. (The screening for cervical cancer is actually a very good test; the mammogram is not so great).

As to the case you cite above, your friend, these recommendations would have had no effect on her whatsoever. Remember that they apply to *screening* tests, which look for something that hasn’t made itself apparent. Your friend had an abnormality that her doctor noticed, and her doctor did a *diagnostic* mammogram. All bets are off if there are symptoms or other concerning findings, a very strong family history (in terms of breast cancer, a mother or a sister), or other individual reasons.

Let’s try to look at these guidelines as a step forward. It charts a clear course for our advocacy for the future: better treatments for breast cancer and better screening tests.