Mammograms drive the cancer industry. Early detection is really a marketing strategy to procure oncology patients.
Fear drives the torturous treatment plans. No alternatives to cut/burn/poison are allowed to surface. The narrative is held fast via gatekeepers and funding.
Cancer research is steered to generate more of the same.
First do no harm is an intelligence test.
The premise our physiology is trying to kill us is plain wrong. Anyone who studies physiology comes away in amazement. Doctors play at pretend - pointing the bone or using nocebo to bring dire predictions into being.
Placebo has proved to be a powerful influence yet it remains largely unexplored by the pHARMa trainees.
Profit from sickness does not generate wellness. Fraud is rampant. The way through is due diligence.
You may find my articles of interest.
I’ve logically dismissed the gaseous exchange of oxygen and carbon dioxide as a fraud.
We breathe air not oxygen is the title.
We are not machines using gases of combustion and exhaust.
Hydration not oxygenation underpins our physiology.
Hydration equals SALT plus water.
The lungs require air reaching the alveoli to reach 100% humidity. That’s dew point or drop point.
Air is measured by its humidity or moisture.
Oxygen is calibrated by its dryness in parts per million of water contamination.
Can you see the mismatch?
Dehydration or dryness begins dis-ease.
Oxygen toxicity is due to its power to dehydrate. This is well known and mitigated by humidifiers. Even CPAP have humidifiers built in.
If an MRI is used as the initial procedure in screening, at what interval would we able to repeat the MRI to have the same sensitivity and specificity as annual mammography ? We would avoid the radiation risk and perhaps increase intervals. I also would like to see whether MRI is the proper second procedure if there is a question on an initial mammogram. Can the cost and efficiency and efficiency of MRI replace mammogram period ?
When it involves breast cancer screening, informed consent is virtually non-existent. The complexity in this area of medicine is significant and very few clinicians have a comprehensive understanding of pros and cons. With rapidly evolving treatment modalities a further shift away from screening recommendations is inevitable.
Wonderful read and fascinating perspective. The screening modality causing the very type of cancer it is meant to detect is indeed some irony. The only parallel that comes to mind is the lung cancer screening for smokers using low dose CT.
Important piece, thank you. It is tragic to contemplate the millions of false positives, hundreds of thousands of meaningless biopsies, and useless mastectomies (20% more in screened women in trials)—all when mammograms have never been shown to save lives. Once again, in medicine the cart is before the horse. Keep up your crucial work, Dr. Hardy, perhaps the needle will move.
I had an ultra sound. Nothing was found. That is an alternative. I understand it's not as thorough as the mammography but for me, I have no breast cancer in my family. Genetics plays a part. I was pressured by my OBGYN to have a mammography several times and I switched doctors. This obsession with screening is too much. The fear we keep putting in ppl has to be weighed against prevention of disease. Also WHY are so many women getting breast cancer now as opposed to when I was growing up? Perhaps more time and energy could be put into treating the cause and not the symptom. sabrinalabow.substack.com
One thing that must…MUST…now be a factor for ANY woman getting radiation to regions where cancer is common for them…whether they have been vac’d!! Since so SO many woked researchers desire not to mention any vac’d status into any equation of women cancer presence ..and now they desire radiation to the breast…imagine that. We know this vac causes decreased natural immunity even to cancer detection…now we do both to create such?! So before we advocate radiation instead of more refined magnetic MRI capability we must stop the vac…any mRNA…Women must be told to aggressively stay away from the COvID booster and most any vac for new borns until a new CDC is created to define total safety for all humans from vacs.
"metabolic syndrome, which currently affects 9 out of 10 adult women in the U.S.and is undoubtedly the common underlying factor behind the uncontrolled rise of cancer worldwide, despite improvements in diagnosis and treatment"
I've read 20% to 30% of US women are affected by metabolic syndrome, but it might be higher. Do you think the uncontrolled rise of cancer is caused by metabolic syndrome, or the increasing prevalence of chemicals in the environment?
Dear Robert, it is very easy to demonstrate that 9 out of 10 current leading conditions of morbidity and mortality are the bill that nature is presenting to us for having artificially intervened in the desires for ‘civilization,’ modernity, comfort, and the sybaritic idea of quality of life.
Specifically, there have been intense modifications, violating biological cycles, which have resulted in a very inadequate exposome of our microbiome and, therefore, our genome. This has led to the modern epidemic of ‘incurable’ chronic diseases. Are we curing coronary disease, or are we merely managing it by unblocking arteries with angioplasties and dozens of medications while the root cause remains?
We are investigating the factors that affect our genome in what we call the exposome, focusing on a series of fuese 12 aspects that are, in order of importance: careful management of real food and restrictive nutrition (80% all cause of burden disease, include cancer and dementia) , short and intense daily physical effort, adequate sleep, sun exposure, oxygenation, hydration, supplementation, study, sex, interpersonal relationships, and relationships with the environment or ecosystem.
We have spent several years studying how to establish the daily doses for each individual, with minimum and maximum ranges for these factors. Notably, the effects of these doses have a strange J-shaped curve: very small doses are insufficient, but excessive doses (like any ‘sport,’ even if not of high performance) are toxic and deleterious to health and longevity with vitality, which is the new paradigm that, in our opinion, is worth living for.
Pd: By the way, did you hear about the recent passing of the World Cup soccer player Johan Neeskens, who died ‘suddenly’ at the tender age of 73?
You can find this statistic in this citation: O’Hearn M, Lauren BN, Wong JB, Kim DD, Mozaffarian D. Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018. J Am Coll Cardiol. 2022 Jul 12;80(2):138-151. doi: 10.1016/j.jacc.2022.04.046. PMID: 35798448; PMCID: PMC10475326.
(1) As breast cancer treatments are improving, the marginal gains of early detection are becoming less important.
(2) There are real harms associated with mammograms, and those harms are increasing, if anything, as we extend screening programs to groups at lower risk of breast cancer.
(3) The harms affect a different group than the benefits. This is accepted as OK in public health settings, where the ethics say that decisions are about the “greater good”. It’s not OK when individual doctors advise individual patients, because the recommendation to screen may in fact be a recommendation to do something that has little or no benefit for the individual (no beneficence) and a significant possibility of harm (maleficence, the thing you are supposed to avoid).
(4) These days, it’s not clear that patients are truly making informed decisions about breast cancer screening. There’s a lot of messaging that it’s “the right thing to do”, and that messaging comes from biased/financially self-interested organizations and people.
(5) We should be looking either to target breast cancer screening to those at highest risk OR accept the fact that the earlier detection doesn't really make much difference. Screening programs are expensive!
Seeing as how I’m not on Twitter, and have no intention of going on Twitter, I can’t read your thread. I will assume that you have your opinion, backed by evidence you believe, and I have mine.
Breast cancer treatment has produced improved outcomes for all stages of breast cancer. The underlying theory of screening was that early detection meant the cancer was more easily treated and that therefore the treatment would be easier and more effective. In fact, over time, the earlier diagnosis has made much less difference than expected. Most of the improvement in breast cancer outcomes has to do with improved treatment, NOT earlier diagnosis.
Furthermore, screening has a big problem with over-diagnosis, turning up large numbers of small breast cancers that were inherently more benign, but still treated as if they were as serious as those which presented as lumps. So, it looks like the cancers detected by mammogram do better, but in fact they do better because they were less aggressive, not because they were detected earlier.
Overdiagnosis is a common,important issue not only in cancer medicine(eg kidney, prostate, melanoma, thyroid etc.) but in a larger sense, is a major driver of overutilization and health care waste in this country.
I agree that overdiagnosis can be an important issue. It is simply not a major issue in breast cancer screening and it does not explain the enormous excess of cancers observed.
The hallmark of overdiagnosis is the rapid and unequivocal divergence of disease incidence versus mortality over time. Breast cancer shares this with others I have previously named. The others, however, do not necessarily rely on radiation exposure as a diagnostic commonality. That’s why I have trouble understanding your reasoning.
Great article. The distinction between active and passive participation in untoward events is valid and never brought up, so thank you. Another risk beyond radiation exposure and not mentioned here is of course that of costly, stressful and risk laden treatment cascade for unknown benefit. I find that oversight especially presumptive by the screening messaging.
What an insightful article, that given the current state of affairs, cannot be more enlightening without arguments that would take a whole book to provide additional guidance.
Non-ionizing radiation diagnostics for imaging and genetic biomarkers for defining at risk populations to better demarcate the vulnerable population will be helpful.
We have all read several studies demonstrating the increased lives saved by different mammogram screening methods and their resulting increase in false positives. But I have never seen a study with good data, well analyzed that compared the health outcome of lives saved vs lives lost/injured by different screening methods. More importantly, I have never seen any study demonstrating the increased costs due to the more aggressive screening methods, such as the American College of Radiology’s practice guideline on mammography for patients with average risk of breast cancer. As we all know, Increased false positives of various screening methods require more procedures and treatments resulting in increased healthcare spending. Money is a valuable resource and is not infinite. Do we spend more money on the more aggressive mammogram screening or use that money to improve the social drivers of health? As everyone knows, social determinants of health affect health outcome more than what we do as healthcare professionals. I recommend to my patients that they follow the USPTSS, ACOG, and ACP’s practice guidelines, not ACR’s more aggressive screening recommendation. ACR does not even have a methodologist, such as a biostatistician, epidemiologist, or economist, on the practice guideline task force. I do not trust their recommendation.
It speaks volumes that the American Board of Radiology wants us to recommend earlier screening to women with a strong family history instead of getting them genetically tested, and cites the ACR.
Of course the earlier you start screening, the higher the lifetime cumulative dose.
DearDr. Hardy, I express my solidarity with your current battle and offer mycongratulations on the sensible essay you have written regarding the balancebetween utilitarianism and deontology in systematic and mass breast cancerscreening.For the past 50 years, the world has adhered to biennial mammographyscreening starting at age 40, despite high-quality systematic reviews andmeta-analyses of clinical trials published 15 years ago, showing that thebenefits of such a procedure have not materialized. The clinical benefits aremarginal and closely align with the organic and emotional side effects causedby false positives and overdiagnosis [i]. Moreover, surprisingly, despite parallel evidence from systematicreviews of experimental and observational studies, it is estimated that one ofthe main reasons for the lack of expected reduction in breast cancer incidencemay be due to ionizing radiation from medical sources — specifically, frommammography itself, accounting for up to three-quarters of the cases [ii].To make this situation even more concerning, there exists a widespreadpublic and health professional misconception — a chimera, so to speak — basedon an unfounded belief that routine screening mammography “prevents” breastcancer [iii].Another discouraging aspect is that, although a significant number of“risk factors” for breast cancer have been identified, they do not present ineven half of diagnosed cases.It is clear that the utilitarian perspective has ceased to be a validapproach to this issue, given the reality that our biomedical diagnostic modelstill has much to learn about cancer biology and its implications. How can weconvince the community that it may be more “useful” and deontological to focuson identifying future cases based on each person’s estimated baseline riskthrough a predictive model, similar to cardiovascular risk calculators [iv] , [v], incorporating sociodemographic, familial, genetic, dietary, lifestyle,sexual, and clinical data, along with the FIRST MAMMOGRAM? This could helpestimate the epigenetic risk of breast cancer and mammography-induced breastcancer over a five-year period, beyond a threshold that determines whetherbiennial mass screening or a more "personalized" approach iswarranted.Regardless of whether mammography is the right course of action, thismodel could also suggest to the screened individual lifestyle and dietarychanges that might effectively modulate the impact on her genome, therebyreducing not only the risk of breast cancer but also other cancers and themetabolic syndrome, which currently affects 9 out of 10 adult women in the U.S.and is undoubtedly the common underlying factor behind the uncontrolled rise ofcancer worldwide, despite improvements in diagnosis and treatment [vi].
Sharing something similar on the Trolley problem and the Covid 19 oxygen shortage in India!
https://www.bmj.com/content/376/bmj.o369.long
Mammograms drive the cancer industry. Early detection is really a marketing strategy to procure oncology patients.
Fear drives the torturous treatment plans. No alternatives to cut/burn/poison are allowed to surface. The narrative is held fast via gatekeepers and funding.
Cancer research is steered to generate more of the same.
First do no harm is an intelligence test.
The premise our physiology is trying to kill us is plain wrong. Anyone who studies physiology comes away in amazement. Doctors play at pretend - pointing the bone or using nocebo to bring dire predictions into being.
Placebo has proved to be a powerful influence yet it remains largely unexplored by the pHARMa trainees.
Profit from sickness does not generate wellness. Fraud is rampant. The way through is due diligence.
You may find my articles of interest.
I’ve logically dismissed the gaseous exchange of oxygen and carbon dioxide as a fraud.
We breathe air not oxygen is the title.
We are not machines using gases of combustion and exhaust.
Hydration not oxygenation underpins our physiology.
Hydration equals SALT plus water.
The lungs require air reaching the alveoli to reach 100% humidity. That’s dew point or drop point.
Air is measured by its humidity or moisture.
Oxygen is calibrated by its dryness in parts per million of water contamination.
Can you see the mismatch?
Dehydration or dryness begins dis-ease.
Oxygen toxicity is due to its power to dehydrate. This is well known and mitigated by humidifiers. Even CPAP have humidifiers built in.
Click on my blue icon to read.
If an MRI is used as the initial procedure in screening, at what interval would we able to repeat the MRI to have the same sensitivity and specificity as annual mammography ? We would avoid the radiation risk and perhaps increase intervals. I also would like to see whether MRI is the proper second procedure if there is a question on an initial mammogram. Can the cost and efficiency and efficiency of MRI replace mammogram period ?
Respectfully
Gerald M Casey MD
When it involves breast cancer screening, informed consent is virtually non-existent. The complexity in this area of medicine is significant and very few clinicians have a comprehensive understanding of pros and cons. With rapidly evolving treatment modalities a further shift away from screening recommendations is inevitable.
Wonderful read and fascinating perspective. The screening modality causing the very type of cancer it is meant to detect is indeed some irony. The only parallel that comes to mind is the lung cancer screening for smokers using low dose CT.
Important piece, thank you. It is tragic to contemplate the millions of false positives, hundreds of thousands of meaningless biopsies, and useless mastectomies (20% more in screened women in trials)—all when mammograms have never been shown to save lives. Once again, in medicine the cart is before the horse. Keep up your crucial work, Dr. Hardy, perhaps the needle will move.
Thank you for your essay
I had an ultra sound. Nothing was found. That is an alternative. I understand it's not as thorough as the mammography but for me, I have no breast cancer in my family. Genetics plays a part. I was pressured by my OBGYN to have a mammography several times and I switched doctors. This obsession with screening is too much. The fear we keep putting in ppl has to be weighed against prevention of disease. Also WHY are so many women getting breast cancer now as opposed to when I was growing up? Perhaps more time and energy could be put into treating the cause and not the symptom. sabrinalabow.substack.com
Thanks for your time. Great read. More please.
One thing that must…MUST…now be a factor for ANY woman getting radiation to regions where cancer is common for them…whether they have been vac’d!! Since so SO many woked researchers desire not to mention any vac’d status into any equation of women cancer presence ..and now they desire radiation to the breast…imagine that. We know this vac causes decreased natural immunity even to cancer detection…now we do both to create such?! So before we advocate radiation instead of more refined magnetic MRI capability we must stop the vac…any mRNA…Women must be told to aggressively stay away from the COvID booster and most any vac for new borns until a new CDC is created to define total safety for all humans from vacs.
"metabolic syndrome, which currently affects 9 out of 10 adult women in the U.S.and is undoubtedly the common underlying factor behind the uncontrolled rise of cancer worldwide, despite improvements in diagnosis and treatment"
I've read 20% to 30% of US women are affected by metabolic syndrome, but it might be higher. Do you think the uncontrolled rise of cancer is caused by metabolic syndrome, or the increasing prevalence of chemicals in the environment?
Dear Robert, it is very easy to demonstrate that 9 out of 10 current leading conditions of morbidity and mortality are the bill that nature is presenting to us for having artificially intervened in the desires for ‘civilization,’ modernity, comfort, and the sybaritic idea of quality of life.
Specifically, there have been intense modifications, violating biological cycles, which have resulted in a very inadequate exposome of our microbiome and, therefore, our genome. This has led to the modern epidemic of ‘incurable’ chronic diseases. Are we curing coronary disease, or are we merely managing it by unblocking arteries with angioplasties and dozens of medications while the root cause remains?
We are investigating the factors that affect our genome in what we call the exposome, focusing on a series of fuese 12 aspects that are, in order of importance: careful management of real food and restrictive nutrition (80% all cause of burden disease, include cancer and dementia) , short and intense daily physical effort, adequate sleep, sun exposure, oxygenation, hydration, supplementation, study, sex, interpersonal relationships, and relationships with the environment or ecosystem.
We have spent several years studying how to establish the daily doses for each individual, with minimum and maximum ranges for these factors. Notably, the effects of these doses have a strange J-shaped curve: very small doses are insufficient, but excessive doses (like any ‘sport,’ even if not of high performance) are toxic and deleterious to health and longevity with vitality, which is the new paradigm that, in our opinion, is worth living for.
Pd: By the way, did you hear about the recent passing of the World Cup soccer player Johan Neeskens, who died ‘suddenly’ at the tender age of 73?
What do you think?
Jairo
Dear Robert, I’m really sorry to discourage you.
Things are worse than that.
You can find this statistic in this citation: O’Hearn M, Lauren BN, Wong JB, Kim DD, Mozaffarian D. Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018. J Am Coll Cardiol. 2022 Jul 12;80(2):138-151. doi: 10.1016/j.jacc.2022.04.046. PMID: 35798448; PMCID: PMC10475326.
Or, in my integrated review of this here: https://bit.ly/Echeverry_2024_Falsehod_origin_diabesity_pandemic
Interesting post!
I agree that:
(1) As breast cancer treatments are improving, the marginal gains of early detection are becoming less important.
(2) There are real harms associated with mammograms, and those harms are increasing, if anything, as we extend screening programs to groups at lower risk of breast cancer.
(3) The harms affect a different group than the benefits. This is accepted as OK in public health settings, where the ethics say that decisions are about the “greater good”. It’s not OK when individual doctors advise individual patients, because the recommendation to screen may in fact be a recommendation to do something that has little or no benefit for the individual (no beneficence) and a significant possibility of harm (maleficence, the thing you are supposed to avoid).
(4) These days, it’s not clear that patients are truly making informed decisions about breast cancer screening. There’s a lot of messaging that it’s “the right thing to do”, and that messaging comes from biased/financially self-interested organizations and people.
(5) We should be looking either to target breast cancer screening to those at highest risk OR accept the fact that the earlier detection doesn't really make much difference. Screening programs are expensive!
I’ve been writing on the same topic lately!
See:
https://rickgibson.substack.com/p/screening-for-breast-cancer?r=udsb1
https://rickgibson.substack.com/p/medical-care-public-health-and-everything?r=udsb1
https://rickgibson.substack.com/p/screening-for-breast-cancer-part?r=udsb1
Seeing as how I’m not on Twitter, and have no intention of going on Twitter, I can’t read your thread. I will assume that you have your opinion, backed by evidence you believe, and I have mine.
(1) is not true : https://www.bmj.com/content/381/bmj-2022-074684.long
All stages have benefited from improved treatments.
I think that was my point.
Breast cancer treatment has produced improved outcomes for all stages of breast cancer. The underlying theory of screening was that early detection meant the cancer was more easily treated and that therefore the treatment would be easier and more effective. In fact, over time, the earlier diagnosis has made much less difference than expected. Most of the improvement in breast cancer outcomes has to do with improved treatment, NOT earlier diagnosis.
Furthermore, screening has a big problem with over-diagnosis, turning up large numbers of small breast cancers that were inherently more benign, but still treated as if they were as serious as those which presented as lumps. So, it looks like the cancers detected by mammogram do better, but in fact they do better because they were less aggressive, not because they were detected earlier.
https://danielcorcos.substack.com/p/the-fraud-of-breast-cancer-overdiagnosis
No. Cancers detected through screening have also benefited from improved treatments, making early detection useful.
Overdiagnosis is not as important as you are told.
https://x.com/daniel_corcos/status/1800826773174706325
Overdiagnosis is a common,important issue not only in cancer medicine(eg kidney, prostate, melanoma, thyroid etc.) but in a larger sense, is a major driver of overutilization and health care waste in this country.
I agree that overdiagnosis can be an important issue. It is simply not a major issue in breast cancer screening and it does not explain the enormous excess of cancers observed.
The hallmark of overdiagnosis is the rapid and unequivocal divergence of disease incidence versus mortality over time. Breast cancer shares this with others I have previously named. The others, however, do not necessarily rely on radiation exposure as a diagnostic commonality. That’s why I have trouble understanding your reasoning.
Great article. The distinction between active and passive participation in untoward events is valid and never brought up, so thank you. Another risk beyond radiation exposure and not mentioned here is of course that of costly, stressful and risk laden treatment cascade for unknown benefit. I find that oversight especially presumptive by the screening messaging.
PS my use of “oversight” is directed towards the screening industry and not your analysis, hopefully that was clear!
I agree and those facts have been covered by many others.
I have nothing to add in that space.
What an insightful article, that given the current state of affairs, cannot be more enlightening without arguments that would take a whole book to provide additional guidance.
Non-ionizing radiation diagnostics for imaging and genetic biomarkers for defining at risk populations to better demarcate the vulnerable population will be helpful.
We have all read several studies demonstrating the increased lives saved by different mammogram screening methods and their resulting increase in false positives. But I have never seen a study with good data, well analyzed that compared the health outcome of lives saved vs lives lost/injured by different screening methods. More importantly, I have never seen any study demonstrating the increased costs due to the more aggressive screening methods, such as the American College of Radiology’s practice guideline on mammography for patients with average risk of breast cancer. As we all know, Increased false positives of various screening methods require more procedures and treatments resulting in increased healthcare spending. Money is a valuable resource and is not infinite. Do we spend more money on the more aggressive mammogram screening or use that money to improve the social drivers of health? As everyone knows, social determinants of health affect health outcome more than what we do as healthcare professionals. I recommend to my patients that they follow the USPTSS, ACOG, and ACP’s practice guidelines, not ACR’s more aggressive screening recommendation. ACR does not even have a methodologist, such as a biostatistician, epidemiologist, or economist, on the practice guideline task force. I do not trust their recommendation.
It speaks volumes that the American Board of Radiology wants us to recommend earlier screening to women with a strong family history instead of getting them genetically tested, and cites the ACR.
Of course the earlier you start screening, the higher the lifetime cumulative dose.
DearDr. Hardy, I express my solidarity with your current battle and offer mycongratulations on the sensible essay you have written regarding the balancebetween utilitarianism and deontology in systematic and mass breast cancerscreening.For the past 50 years, the world has adhered to biennial mammographyscreening starting at age 40, despite high-quality systematic reviews andmeta-analyses of clinical trials published 15 years ago, showing that thebenefits of such a procedure have not materialized. The clinical benefits aremarginal and closely align with the organic and emotional side effects causedby false positives and overdiagnosis [i]. Moreover, surprisingly, despite parallel evidence from systematicreviews of experimental and observational studies, it is estimated that one ofthe main reasons for the lack of expected reduction in breast cancer incidencemay be due to ionizing radiation from medical sources — specifically, frommammography itself, accounting for up to three-quarters of the cases [ii].To make this situation even more concerning, there exists a widespreadpublic and health professional misconception — a chimera, so to speak — basedon an unfounded belief that routine screening mammography “prevents” breastcancer [iii].Another discouraging aspect is that, although a significant number of“risk factors” for breast cancer have been identified, they do not present ineven half of diagnosed cases.It is clear that the utilitarian perspective has ceased to be a validapproach to this issue, given the reality that our biomedical diagnostic modelstill has much to learn about cancer biology and its implications. How can weconvince the community that it may be more “useful” and deontological to focuson identifying future cases based on each person’s estimated baseline riskthrough a predictive model, similar to cardiovascular risk calculators [iv] , [v], incorporating sociodemographic, familial, genetic, dietary, lifestyle,sexual, and clinical data, along with the FIRST MAMMOGRAM? This could helpestimate the epigenetic risk of breast cancer and mammography-induced breastcancer over a five-year period, beyond a threshold that determines whetherbiennial mass screening or a more "personalized" approach iswarranted.Regardless of whether mammography is the right course of action, thismodel could also suggest to the screened individual lifestyle and dietarychanges that might effectively modulate the impact on her genome, therebyreducing not only the risk of breast cancer but also other cancers and themetabolic syndrome, which currently affects 9 out of 10 adult women in the U.S.and is undoubtedly the common underlying factor behind the uncontrolled rise ofcancer worldwide, despite improvements in diagnosis and treatment [vi].
[i] Gøtzsche, P. C., & Nielsen, M. (2011).Screening for breast cancer with mammography. Cochrane Database of SystematicReviews, (1), CD001877. https://doi.org/10.1002/14651858.CD001877.pub4[ii] Godman, J. W. (1996). Preventing Cancer (2nded.). C.N.R Book Division.[iii] Feldstein, S. M. (2018). Public perceptions ofroutine mammography: A qualitative study. Health Communication, 33(7), 856-864[iv] PREVENT TM Online Calculator. (2024) AHA.Disponible en: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator?utm_source=substack&utm_medium=email[v]ASCVD Risk Calculator. Disponible en: https://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx?utm_source=substack&utm_medium=email[vi] Echeverry-Raad J. (2024)A falsehood that has been repeated many timesbecomes true, the origin of the diabesity pandemic, the most lethal of the 21stcentury? J Diab Metab Disorder;11(1):39‒50. DOI:10.15406/jdmdc.2024.11.00276