Cover

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Title Page, Copyright

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Contents

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p. vii

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Introduction

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pp. 12-15

The story cried out to be told. It cried out in the passion of the true believers, apologists for a beleaguered test. It cried out in the polemics of the skeptics, emphasizing possible risks and advising caution. It cried out in the posturing of political leaders who co-opted a scientific debate to satisfy the expediency of the moment. It cried out in the gratitude...

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1. Timing Is Everything

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pp. 16-25

Screening mammography burst onto the stage of national consciousness in 1973. When it did, it found an audience primed to receive it. Political, social, and health movements that had been occurring in the larger American society underwent a remarkable convergence in the late 1960s to mid-1970s. This was precisely the time when the results...

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2. First Exposure

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pp. 26-38

In medicine, the introduction of new imaging technology is typically a three-phase process.1 In the first phase, diffusion occurs slowly as early adopters—academics and other “technology leaders”— perform much of the initial clinical research that defines the capability of the new device. If these results are favorable, then as they are disseminated in medical journals...

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3. The Aftermath

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pp. 39-46

Screening in the BCDDP was concluded in 1981, and the first results were published the following year.1 Despite, or possibly because of, the controversy that had ensnared the program through much of its course, its sponsors proudly highlighted its accomplishments. Just over 280,000 participants had enrolled in the program, and about half...

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4. A Tale of Two Epidemics

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pp. 47-60

In June 1981 the U.S. Centers for Disease Control (CDC) published a brief report on fi ve previously healthy gay men in Los Angeles who had been diagnosed with a rare form of pneumonia. Two of them had died.1 At the time, no one could have anticipated the public health cataclysm that was...

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5. Age Is Nothing But a Number

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pp. 61-72

It has been frequently observed that the United States is virtually alone among developed countries in its support for screening mammography in women under fifty. This support has wavered little since the technology was introduced. This apparent American consensus on screening, however, is only an illusion. Just beneath the veneer of unanimity lies a dispute...

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6. Pulling the Plug on Granny

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pp. 73-82

The 1997 NIH-NCI episode had two far-reaching consequences. First, it established the primacy of politics over science in mammography disputes. No longer would science have the last word. If the conclusion based on scientific data was politically untenable, it would simply be overruled or circumvented by political leaders. This priority, evolving for about a decade,...

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7. The House That Mammography Built

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pp. 83-94

With a little help from its friends, screening mammography has not merely survived its myriad controversies, it has thrived. Eighty-one percent of women over fifty and 65 percent of women forty to forty-nine undergo regular screening.1 As mammography succeeded, a vast multifaceted collateral economy developed around it. In this screening-centric system, the various elements in the secondary...

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8. Overdiagnosis: Mammography’s Burden

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pp. 95-105

In this final chapter I expand on a subject that was previously mentioned in passing. Mammography-induced breast cancer overdiagnosis represents the most significant detriment of screening. Yet until recently it has received almost no mention in the public education messages of government, advocacy, or professional entities. This deafening silence...

NOTES

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pp. 106-123

INDEX

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pp. 124-133