Refutation and conjecture around consensus breast cancer screening guidelines

Public health policy making sometimes goes beyond dispassionate scientific review of data and program analysis to reflect the attitudes and promote the interests of various health care constituencies, professional organizations, consumer groups, and governmental bodies. This article recounts events that precipitated the issuance of guidance about the advisability of periodic screening mammography for women 40 to 49 years of age. It illustrates how a pragmatic choice was born from equal parts of data, the community's underlying value system, and political exigencies. Examining the policy making process will provide public health practitioners greater capacity to find workable solutions in their advocacy of better health for all.