In April 2007, the American College of Physicians—the largest medical specialty society in the United States—issued new guidelines on screening mammography for women aged 40-49. Rather than calling for universal screening, the guidelines recommend that women make an informed decision after learning about the benefits and harms of mammography.1

The last time a major US policy organisation made such a recommendation all hell broke loose. In 1997, a consensus panel of the National Institutes of Health concluded “that the data currently available do not warrant a universal recommendation for mammography for all women in their forties. Each woman should decide for herself whether to undergo mammography.” This recommendation generated intense reactions in the press, public, and government.2 Most stories in the press suggested that women should be screened and others directed anger at the panel for “failing” to recommend screening. The panel's chair was summoned before congress, and a US senate resolution in favour of screening was unanimously passed—a rare act of bipartisanship. After a few months of intense political pressure, the National Cancer Institute contravened the panel's conclusions and recommended that women in their 40s should be screened.

In contrast, the reaction to the recent guidelines was muted. The press carried a few stories—a few of which were critical—but there were no senate …