144: The Overdiagnosis Epidemic Hiding Inside Every Annual Mammogram

In this solo episode of Keeping Abreast, Dr. Jenn Simmons takes on one of the most accepted messages in women's health and dismantles it with decades of evidence. Routine yearly mammography screening does not hold up when you actually read the trials. Dr. Jenn walks through the WISDOM trial, the Cochrane Review, the Canadian Breast Cancer Screening Study, and the brand new 2026 American College of Physicians guidelines to make the case that one-size-fits-all screening is not just outdated, it is causing real harm. She also takes on the estrogen myth that has left millions of women suffering through hot flashes, bone loss, brain fog, and lost quality of life for decades. A 1.8 million woman study and the Women's Health Initiative say estrogen is not the villain. The real culprit may be something millions of women are still being prescribed today. If you have ever been told to just get your mammogram every year without a single conversation about the risks or what the data actually shows, this is the episode you have been waiting for. What You'll Learn What the 2026 American College of Physicians guidelines say about annual mammography and why radiology groups do not want you to hear it What the WISDOM trial found when women received fewer mammograms and why the results challenge everything we have been told What the Cochrane Review and Canadian Breast Cancer Screening Study concluded after studying hundreds of thousands of women over decades Why up to 50 percent of screen-detected cancers may have never grown, spread, or threatened a woman's life and what that means for how we treat them Why estrogen alone has never been shown to cause breast cancer and what the data actually implicates instead The difference between synthetic progestins and bioidentical progesterone and why that distinction could change every conversation about hormones and breast cancer What BRCA mutation carriers need to know about hormone replacement therapy after risk-reducing surgery What smarter, safer, individualized breast cancer screening actually looks like Episode Timeline 00:00 Introduction 01:08 This Is an Informed Consent Episode 04:00 The WISDOM Trial and the End of One-Size-Fits-All Screening 08:30 Fewer Mammograms, No More Advanced Cancers 11:41 Why Adding MRI Led to More Biopsies and Zero Benefit 15:00 The Only Endpoint That Actually Matters 17:30 What the Cochrane Review Actually Found 19:30 The Number Every Woman Deserves to Hear 23:00 The Canadian Breast Cancer Screening Study 27:00 What Overdiagnosis Really Means 31:00 The 2026 American College of Physicians Guidelines 36:03 The Estrogen Myth 41:00 The Women's Health Initiative Unpacked 49:00 Birth Control, Progestins, and Breast Cancer Risk 53:00 Progestins Are Not Progesterone 57:00 BRCA Mutation Carriers and HRT: What the 2026 JAMA Data Shows 01:03:00 The Future of Breast Cancer Screening Studies Mentioned in This Episode The WISDOM Trial — JAMA The Cochrane Mammography Review — Cochrane The Canadian National Breast Screening Study: 25 Year Follow-up — BMJ 2014 ACP Breast Cancer Screening Guidance Statement — Annals of Internal Medicine 2026 Cracks in the Estrogen Carcinogenesis of Breast Cancer — Journal of Clinical Oncology 2026 Hormonal Contraception and Breast Cancer Risk — NEJM 2017 Me