Below are a few problems with mammography: I. Detection Is Not Prevention When the USPSTF issues an “A” or “B” grade for mammography, it is grading a screening procedure — the capacity to detect abnormal cells in breast tissue before they produce symptoms. What it is emphatically not grading is any intervention that reduces the biological conditions in which breast cancer arises. This is the foundational category error of modern oncological prevention: it conflates early detection with prevention, and treats the two as equivalent. They are not equivalent. A mammogram cannot reduce systemic inflammation. It cannot reverse intestinal hyperpermeability — the “leaky gut” phenomenon through which microbial products translocate into systemic circulation and drive the chronic immune dysregulation that provides fertile terrain for cancer proliferation. It cannot alter the epigenetic expression of tumor-suppressor genes. It cannot change the microRNA profile of a woman’s cells, which determines whether oncogenic pathways are silenced or amplified. What a mammogram can do is find something — and in finding it, set in motion a cascade of interventions whose benefits, when examined rigorously, are far more modest than their cultural mythology suggests. II. The Overdiagnosis Problem Overdiagnosis in breast cancer screening refers to a specific, clinically documented phenomenon: the detection by mammography of a cancer — a real cluster of abnormal cells — that would never, in the lifetime of that woman, have caused symptoms, spread, or killed her. Her body’s immune surveillance was managing it. Her epigenetic terrain contained it. Once detected, however, it becomes a diagnosis. A breast cancer diagnosis. And the institutional logic of oncology treats that diagnosis with the full arsenal: biopsy, surgery, radiation, and often years of hormone suppression therapy. 1.3 million women! This is thee stimated number of American women overdiagnosed by mammography screening over a 30-year period — treated for cancers that would never have caused symptoms or death — according to a landmark 2012 analysis in the New England Journal of Medicine.