Are We Screening Ourselves Into Cancer?

Written by John O'Sullivan CEO Principia Scientific International on December 14, 2025. Posted in Current News

A Critical Look at the Unintended Consequences of Routine Breast Cancer Screening – For decades, mammography has been promoted as an unquestioned public-health triumph. But increasing evidence suggests we may have missed an important unintended consequence.

1. Introduction

Since the late 20th century, mammography has been institutionalized as a public-health intervention aimed at reducing breast cancer mortality through early detection. While randomized trials initially suggested modest mortality reductions, subsequent analyses have raised concerns about overdiagnosis, overtreatment, and cumulative harms that may offset or exceed benefits at the population level.

Critics such as Dr. Jay Goodbinder argue that the prevailing narrative oversimplifies complex risk–benefit trade-offs and underrepresents uncertainty.

“Early detection saves lives” has become medical dogma. But a growing group of physicians and researchers argue that the story is more complicated—and that mass screening may be causing real harm alongside its benefits.

Dr. Goodbinder is among those asking an uncomfortable question: What if routine screening is not merely imperfect, but actively contributing to disease and overtreatment?

2. False Positives and Downstream Harm

Multiple longitudinal studies demonstrate that false-positive mammography results are common, particularly with repeated annual screening.

A landmark analysis by Elmore et al. found that after 10 years of annual mammography, the cumulative probability of at least one false-positive result exceeded 50–60%, with 7–9% of women undergoing biopsy despite not having cancer [1].

False positives are not benign. They are associated with:

• Additional imaging and radiation exposure

• Invasive diagnostic procedures

• Long-term psychological distress lasting months to years [2]

From a population-health perspective, critics argue that these harms are routinely framed as acceptable collateral damage rather than outcomes requiring explicit patient consent.

3. Radiation Exposure and Induced Malignancy

Mammography employs low-dose ionizing radiation. While individual risk is small, repeated exposure across millions of women over decades raises population-level concerns.

The U.S. National Research Council’s BEIR VII report confirms that there is no known safe threshold for ionizing radiation, with cancer risk increasing linearly with dose [3].

Modeling studies estimate that radiation-induced breast cancers may offset a fraction of screening-related mortality benefits, particularly when screening begins at younger ages or is performed annually [4].

4. Overdiagnosis and Overtreatment

Overdiagnosis refers to the detection of cancers that would not have become clinically significant during a patient’s lifetime.

The Cochrane Collaboration—using randomized controlled trials—estimated that for every 2,000 women screened for 10 years:

• 1 woman avoids death from breast cancer

• ~10 women are overdiagnosed and overtreated

• Hundreds experience false-positive results [5]

Overdiagnosed patients may undergo lumpectomy, mastectomy, radiation, or chemotherapy without survival benefit—interventions that carry their own morbidity and mortality risks.

5. Mechanical Compression: A Hypothesized Risk

Mammography requires substantial breast compression to improve image quality and reduce radiation dose. While compression forces of up to ~40 pounds are routinely reported, the biological implications remain underexplored.

Some critics hypothesize that mechanical stress could:

• Rupture fragile tumors or cysts

• Promote cellular dissemination

At present, direct causal evidence is limited, and major guidelines do not recognize compression as a documented risk. However, the absence of evidence is not equivalent to evidence of absence, and critics argue this area remains insufficiently studied.

6. Mortality Outcomes: Mammography vs. Clinical Examination

A large randomized trial published in the Journal of the National Cancer Institute found that careful clinical breast examination (CBE) produced mortality outcomes comparable to mammography in women aged 50 and older, despite detecting fewer cancers [6].

This finding challenges the assumption that greater detection necessarily translates into greater survival, and suggests that some screen-detected cancers may not be biologically lethal.

7. Alternative and Adjunctive Modalities

Critics often cite alternative imaging approaches as potentially lower-harm options:

• Ultrasound-based modalities (particularly for dense breasts)

• MRI for high-risk populations (with ongoing debate about gadolinium retention)

• Thermography, which remains controversial and currently lacks evidence sufficient for replacement of mammography according to major regulatory agencies

While none of these modalities is universally endorsed as a standalone screening replacement, critics argue that innovation has been constrained by entrenched screening paradigms rather than comparative outcomes research.

8. Ethical and Policy Implications

At the core of the debate is informed consent. Surveys consistently show that women overestimate the life-saving benefit of mammography and underestimate the likelihood of harm [7].

Ethically, population screening programs must justify:

• Net benefit

• Transparency of trade-offs

• Respect for patient autonomy

Critics argue that current messaging fails on all three counts.

9. Conclusion

The evidence does not support the claim that mammography is useless—but it does support the conclusion that its benefits are modest and its harms nontrivial. As medicine moves toward personalization, blanket screening mandates may be scientifically and ethically outdated.

A rigorous re-evaluation of breast cancer screening should prioritize mortality reduction per harm incurred, rather than detection rates alone.

References

1. Elmore JG et al. N Engl J Med. 1998;338:1089–1096.

2. Brewer NT et al. Ann Intern Med. 2007;146:502–510.

3. National Research Council. BEIR VII Phase 2. National Academies Press; 2006.

4. Miglioretti DL et al. Ann Intern Med. 2016;164:205–214.

5. Gøtzsche PC, Jørgensen KJ. Cochrane Database Syst Rev. 2013.

6. Miller AB et al. J Natl Cancer Inst. 2014;106:dju261.

7. Gigerenzer G et al. BMJ. 2010;340:c246.

About the author John O’Sullivan is CEO and co-founder (with Dr Tim Ball) of Principia Scientific International (PSI).  He is a seasoned science writer, retired teacher and legal analyst who assisted skeptic climatologist Dr Ball in defeating UN climate expert, Michael ‘hockey stick’ Mann in the multi-million-dollar ‘science trial of the century‘. From 2010 O’Sullivan led the original ‘Slayers’ group of scientists who compiled the book ‘Slaying the Sky Dragon: Death of the Greenhouse Gas Theory’ debunking alarmist lies about carbon dioxide plus their follow-up climate book. His most recent publication, ‘Slaying the Virus and Vaccine Dragon’ broadens PSI’s critiques of mainstream medical group think and junk science.

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