The new breast cancer screening recommendations for women over 40 are surprisingly fraught.
On May 9, the US Preventive Services Task Force (USPSTF) released a draft of their new guidelines on who should be screened for breast cancer. The biggest change: recommending that women with average breast cancer risk start getting mammograms every two years beginning at 40, instead of starting at age 50.
According to the recommendation’s authors, the reasons for the change included a noticeable increase in breast cancer cases among women in their 40s between 2015 and 2019, as well as a higher likelihood of late cancer diagnoses — and of dying due to breast cancer — among Black women in particular.
“The most important thing for women to know is to begin screening at the age of 40, because it just might save your life,” said USPSTF chair Carol Mangione in a video on the USPSTF website.
But a number of experts say it’s not that simple. For a test so often touted as lifesaving, there’s a surprising lack of consensus about how much mammography actually prolongs lives, and whether the unnecessary medical care mammograms sometimes lead to is worth their benefits.
Breast cancer causes more than 42,000 deaths in the US each year, and about 40 percent more Black women die due to breast cancer than do white women. The causes of this disparity are complex — and recommending more mammograms to all Americans as the solution comes with increased physical, emotional, and economic costs.
Will they be worth it? Let’s get realistic about what these recommendations can and can’t do.
The new recommendations can increase rates of breast cancer diagnosis and treatment — which is both good and bad
The USPSTF’s recommendations offer guidance on how to use mammograms for screening average-risk people. That’s worth keeping in mind for a couple of reasons. First, higher-risk people — like those with family histories of breast cancer — may need to be screened differently.
Additionally, not every mammogram that gets done is for screening: These recommendations do not apply to, for example, someone who detects a lump in their breast. (In that scenario, because the person has a symptom before they get the test, the mammogram is a diagnostic test — and the procedure and what follows are a little different.)
When screening tests work, they find medical problems early, before people have any indication that they might have that problem. Mammograms can do this, flagging tiny changes associated with many types of breast cancer. Some breast cancers are slow-moving while others grow quickly; some are treatment-responsive and others are resistant to treatment; some readily invade other tissues and others resolve on their own. Mammograms can help spot them all.
But they can also detect lots of breast changes that aren’t actually abnormal, like benign texture differences in the breast tissue called fibrocystic changes. Trouble is, they’re not great at distinguishing what’s harmful from what’s benign. For that reason, abnormal mammograms are generally followed by a cascade of other evaluations to help determine what’s going on, depending on what they’ve found.
Increasing the number of mammograms people get can increase the number of abnormalities that get diagnosed and will lead to more follow-up ultrasounds, biopsies, and other procedures. It can also increase the number of people getting treated for conditions judged to be cancerous, with a range of surgeries, chemotherapies, and radiation treatments.
But how much more premature breast cancer death can all this added care prevent? That’s not a simple question to answer.
The thing about breast cancer is that most types are so slow-moving and so responsive to therapy that even if people don’t get breast cancer treatment until they first notice a lump, they’re still highly likely to survive the cancer.
Yes, diagnosis in early stages of these cancers leads to better outcomes than late-stage diagnoses — but those early stages last a while, with the median time around 10 years altogether.
(About one in 10 breast cancers diagnosed in the US are very aggressive and resistant to treatment, and they usually move too quickly to be caught by a mammogram done only once every two years.)
That means that for people who are vigilant about changes in their bodies and have decent access to health care, the value-add of mammograms over simply being aware of your body is actually pretty small.
“The better we get able to treat a disease, the less important it becomes to find it,” said Gilbert Welch, a senior researcher at Brigham and Women’s Hospital in Boston who studies cancer overdiagnosis. In other words, when we find treatments that work at many different stages of disease, the benefits of early diagnosis shrink dramatically. For breast cancer, that treatment is the anti-hormonal therapies that emerged in the 1990s and dramatically changed breast cancer survival rates.
A recent analysis by the Lown Institute, a nonprofit health care think tank, highlighted some key USPSTF figures, which show the limits of mammograms in a helpful way.
The analysis imagines a world without screening mammograms, in which women seek evaluation for breast cancer only when they notice a breast lump or other concerning symptoms. According to the USPSTF’s models, about 28 out of every 1,000 women in this world would die from breast cancer at some point in their lives.
Then, let’s look at what the previous guidelines — recommending regular mammograms starting at age 50 — can accomplish. If all women adhered to those guidelines, then seven of those breast cancer deaths would be prevented.
However, the USPSTF estimates those mammograms would also result in 1,021 false-positive mammograms and 148 biopsies that turn out to be benign. It would also lead to 10 cases of overdiagnosis — that is, treatment of a cancer that never would have harmed them to begin with.
That’s bad. False-positive mammograms are associated with psychological consequences, such as anxiety and sleep issues, that persist for years afterward. And the unnecessary surgeries, medications, and radiotherapies that follow breast cancer overdiagnosis cost the US an estimated $4 billion a year.
Now, what can we expect under the new guidelines, with the mammogram age starting at 40? The USPSTF projects that would save an additional two of those 1,000 women from a breast cancer death (technically, one and a half; the authors rounded up). But significant added harms would come with all of those extra positive mammograms: This scenario leads to an additional 62 benign biopsies and two additional overdiagnosed cases.
What all of this means is that the new recommendations can potentially lead to a lot of unnecessary, and potentially harmful, care. To some people, those trade-offs, even if they harm hundreds of people, are worth saving even one extra life.
What complicates things even further is that these are calculations set in the ideal world of a statistical model. The complexity of the real world leads to some changes in the math, especially for Black women.
The new recommendations can give Black women in particular an on-ramp to breast cancer care — but they can’t map the rest of the route
These models assume that every one of these 1,000 hypothetical women is equally watchful and attentive to changes in their bodies, and seek medical evaluation and care when they notice something’s off. They also assume that each has equal access to a medical system that provides the same quality of care to all of them.
But we know that latter part isn’t the American reality. Decades of economic and residential segregation mean Black Americans are more likely to be uninsured and to live in areas without readily available health care providers and facilities. Furthermore, the legacy of medical racism translates to high levels of distrust in medical providers among Black Americans. And Black women with breast cancer receive lower doses of breast cancer chemotherapy compared with white women.
As a result, even if Black women notice breast changes that may be associated with cancer, they may be less likely to seek and receive evaluation for those changes, and to get appropriate care when they do.
That delay means many Black women only start treatment in the later stages of disease, once the cancer is more likely to have spread beyond their breasts. These kinds of treatment differences explain, at least in part, why even Black women with treatable breast cancers have worse outcomes than do women of other racial and ethnic groups.
Black women also more often have the rarer, particularly aggressive triple-negative breast cancers, so named because their cells don’t carry any of the three targets at which the most effective treatments take aim. These cancers, which make up around 20 percent of all US breast cancers and have lower survival rates than other types, are at least twice as likely to be diagnosed in Black women than in white women, especially at younger ages.
The role of mammograms in improving these cancers’ outcomes is unclear: Triple-negative breast cancers are generally harder to see and progress far more quickly than other cancer types, making them hard to catch at early stages by a test done only every one or two years. Although magnetic resonance imaging (MRI) is better at diagnosing these cancers, its cost and resource demands are barriers to using it as a population-wide screening tool.
The more common and more treatable breast cancers are where the new recommendations could potentially help by giving Black women an on-ramp to earlier cancer care. In this sense, regularly scheduled mammograms — which are covered by all US insurance plans and are often available free for uninsured people — could make an end-run around some of the many reasons women might let a breast lump go unevaluated for years.
Because routine mammograms could help improve access to care among Black women with treatable cancers who’d otherwise lack a treatment entry point, this group could have more to gain than lose from getting more mammograms. In USPSTF’s models, the number of Black women’s lives saved by routine mammograms was slightly higher than in the general population, no matter at what age they started.
What the recommendations don’t (and can’t) do is plot out a route for after the on-ramp.
More mammograms aren’t the solution to the biggest problems in breast cancer
The USPSTF didn’t restrict its new recommendations to Black women alone: It recommended it for all women. That also means more mammograms for women who have already effectively maxed out the benefit they could get from the screening test. In that group, the recommendation will likely lead to more benign biopsies, more overdiagnoses, and more harm.
Some researchers have suggested starting screening mammograms at different ages in different racial and ethnic groups based on these considerations. However, the USPSTF opted not to do that.
USPSTF member and internist John Wong told Vox in an email that rising rates of breast cancer among younger women of all racial and ethnic backgrounds provoked the choice. Younger women stand to have more years of life saved when a mammogram diagnoses a breast cancer in them than in an older person, he said. “Fundamentally, with more women being diagnosed at younger ages, each life that is saved from dying of breast cancer means even more years that women have to live after a diagnosis,” he said.
That’s true — if the early diagnosis is what saved their life. But it’s possible these younger women would’ve survived the same duration even with a later diagnosis.
Shannon Brownlee, a special adviser to Lown’s president, said the new recommendations mean “exposing a large population of women to overdiagnosis and overtreatment — which is harmful, we know that — in order to fix the fact that poor women and Black women have poor access to health care.”
Furthermore, they don’t actually fix the health care access disparities at the root of the problem, she said, because they do nothing to address barriers to getting timely care for cancers identified during those screenings.
“Maybe it’ll help some women who really didn’t have access” to health care, she said, “but they still don’t have access: You can get your mammogram now for free, but then you can’t get treated because your insurance isn’t adequate.”
It “just seems like a really dumb way to fix that problem,” she said. “This is really a travesty. Frankly, I think it’s going to harm a lot of women.”
Instead of increasing the number of mammograms, it would be far more beneficial to research and identify the environmental, genetic, and other potential causes of triple-negative breast cancers that create added risk for Black women, said Brownlee.
Also critical, she said, is addressing racial inequities in health care access.
Many studies have documented how differences in environment, insurance coverage, and treatment likely contribute to breast cancer mortality inequities and also drive Black Americans’ dramatically worse mortality more broadly. Fixing these inequities is generationally important work that urgently demands the attention of American policymakers, scholars, and health care institutions.
But more mammograms won’t solve these problems, said Welch. “You can’t screen your way out of health disparities.”
What’s a person with breasts to do?
The new recommendations are still just in draft form and will be open for public comment through June 5. But things might not get much clearer even once they’re finalized. Meanwhile, what’s a woman with average breast-cancer risk to do?
Welch urges viewing the recommendations in a bigger context. “No one should think this is the most important thing they do for their health,” he said. Instead, people should do “what their grandmother would have told them 40 years ago: Eat your fruits and vegetables, go play outside, run around, find things that give your life meaning, exercise.” he said. “And don’t smoke. Whatever you do, don’t smoke.”
Even if you opt out of mammograms, being aware of your body and seeking care for early warning signs and for other general preventive care makes sense. (The USPSTF officially recommended against breast self-exams in 2009, but some research suggests the practice still has value, especially in high-risk groups, like those with personal or family breast cancer histories or who carry certain genetic mutations.)
It’s understandable if, even knowing all of this, some people still want regular screening mammograms. If he had to write the mammography guidelines, Welch would tell people that getting a mammogram is a choice. Although women who notice a breast lump should seek care immediately, viewing their breasts as ticking time bombs can itself create a sense of unwellness, he said.
“You develop a new problem, come see the doctor,” said Welch. “But this whole question of to what extent you should see your body as a laboratory, you need to be testing it every other day — I think that’s a recipe for a sick society.”
The showdown will cause a global crisis — and that has real implications for US influence.
In case you haven’t heard, the United States is in the middle of a perilous debt-ceiling showdown. Congress needs to expand the amount of money the US can legally borrow, but Republicans and the Biden White House can’t agree on the terms.
That is pushing America closer and closer to the date of default, which means America won’t be able to pay its bills. That would, as you’ve also probably heard, cause economic pandemonium in the United States, but also abroad, potentially triggering a global financial crisis and recession.
Sounds bad — because it is. The US political dysfunction will engulf the rest of the world because America anchors the global financial system. US Treasury bonds and the dollar have traditionally been seen as risk-free. If the US defaults, they won’t be that reliable any longer — but that readjustment can’t happen overnight, either.
The US is already starting to look like a much more chaotic bet. And if America defaults, that could accelerate and have profound implications for the United States’s global influence. US power and geopolitical leverage have very much to do with its financial dominance. It’s how the US can wield sanctions to punish Russia for its Ukraine invasion, or North Korea for its nuclear weapons program. Suddenly, the world looks very different if, say, central banks start buying up more reserves of euros or Chinese renminbi.
To be clear, the world is nowhere near that yet, but as Marcus Noland, executive vice president and director of studies at the Peterson Institute for International Economics said, a US default “gives that process a nice shove.”
Vox spoke with Noland about what we’re actually talking about when we talk about a US debt default causing a global crisis, and what some of the longer-term implications of that might be for America and the rest of the world.
The conversation, edited and condensed for length and clarity, is below.
Jen Kirby
When we talk about a possible US default, we often say some version of it could cause a “global financial crisis.” What does that mean?
Marcus Noland
US Treasury bonds act as a kind of risk-free benchmark on which many, many, many, many, many other financial transactions around the world are based, so that your mortgage, or commercial real estate — all sorts of transactions — are linked, ultimately, to the prices for US Treasury bonds, and the interest rates that are implied by those prices.
It can get way beyond just things like mortgages or commercial real estate interest rates, but other kinds of transactions as well. This could be in all kinds of financial markets, and it’s not limited to the United States. There are markets around the world that ultimately are benchmarked against this standard of a risk-free asset.
If that market freezes up and there are no longer transactions [around US Treasury bonds], and those prices are no longer observable, or the markets become so thin and fragmentary that the prices become highly unstable and erratic, that will cascade into other markets. Not only will the US Treasury market itself be affected, but all these other markets that are ultimately linked to it are affected as well.
Jen Kirby
So the value of other contracts is pinned to the value of the US Treasury bond?
Marcus Noland
There may be a contract in which the interest rate on this particular contract is some margin above a specific US Treasury issuance. If that US Treasury issuance essentially no longer exists, if there’s no price, then that [other] contract basically has no price.
Once the market for US Treasuries freezes up, then that will have a cascading effect, within the United States, but globally as well, as other financial contracts that are ultimately linked to that risk-free benchmark can no longer function, either.
Jen Kirby
Essentially, it takes this standard that everyone is using, and it just throws it completely out of whack because you don’t have a fixed point to compare it to — so you don’t even know what you’re supposed to be paying.
Marcus Noland
Exactly, exactly. You lose that fixed point. That’s a good way of putting it. It would be sort of like if Greenwich Mean Time disappeared. You wouldn’t even know what time it was because everything is measured against Greenwich Mean Time.
Jen Kirby
Outside of the United States, are there countries or markets or industries that are particularly vulnerable if that were to happen?
Marcus Noland
I’ve mentioned, obviously, things like housing, commercial real estate here in the United States, but essentially, anybody who holds US Treasuries would be at risk. And that includes foreign central banks, that includes foreign financial intermediaries or American intermediaries that sell services to foreigners based on US Treasuries, or securities that are benchmarked off of US Treasuries. Think of pension funds. Think of banks. I mean, it would be taking the cornerstone out of the entire modern finance global financial system.
Jen Kirby
It sounds like immediate chaos. What might happen next?
Marcus Noland
I honestly don’t know what large holders of US Treasuries would do. For example, foreign central banks. You can imagine an alternative system in which bonds issued by the European Central Bank, or bonds issued by the Bank of England, or other major central banks around the world, could start to form that new set of benchmarks. And you could essentially reconstruct contracts, linking them to those instruments as kind of the risk-free benchmark. But there’s a reason why the dollar is, and US Treasuries are, the benchmark, and not the euro and bonds issued by the European Central Bank or the Bank of England or something. In some long-run sense, they might play an equivalent role, but they don’t play that role today.
It’s not like there are no alternatives to the dollar-based system. But the dollar and US Treasuries are the dominant vehicles for this function in the international financial system.
Jen Kirby
Even if the US does not default, this showdown is coming closer to the edge — and may be a feature, not a bug, of our political system. How do you think that is influencing how the rest of the world thinks about US Treasury bonds and the dollar in the longer term?
Marcus Noland
The dollar can play a variety of roles, and US Treasuries play a variety of roles. The use of the dollar and US Treasury securities as central bank reserves has been declining over time, but it’s still by far the largest. It accounts for about 60 percent of global central bank reserves, and no other currency comes close. The euro is in second [at about 20 percent]. And then I think after that, everything else is in single digits. So there’s already a trend away from the dollar, but it’s a slow-moving trend.
Likewise, it’s hard to get data on trade invoicing. But the International Monetary Fund and other groups have tried to collect such data. It appears that the dollar is the predominant currency used in international trade. The Chinese are denominating a lot of their trade in renminbi. So that is already rising, and that process is further along. The use of non-dollar currencies for trade invoicing has moved along further than for central bank reserves.
And then you can look at things like: How is it used in portfolio investment around the world? In this situation, of course, people are going to be moving away from the dollar. The question is, how rapidly and to what other alternatives?
Periodically, there has been a thought that some other currency might challenge the US dollar for supremacy. Back in the late 1980s, people thought maybe it would be the Japanese yen. But the Japanese didn’t want to do the things that would be necessary to make the yen more widely used around the world. So that moment passed.
Then the euro was created in 1999. People thought the euro could be an alternative to the dollar. But this was an untested central bank that was governed by a whole group of countries. That’s not the same thing as the US Treasury and the US Federal Reserve. And so while the euro has gained use in all sorts of ways, it has not supplanted the dollar.
Now the interest is with the Chinese renminbi. Here, the story gets more interesting because China is a non-Western country with a set of diplomatic interests and political values that seem to be quite distinct from those held in the United States and the West more broadly. It is thought that the rise of China and the potential use of the renminbi could present a greater political challenge to the United States, which leads to your interest in sanctions and foreign policy.
Jen Kirby
Yep, let’s talk sanctions.
Marcus Noland
Because the dollar is the dominant currency, that has implications for United States foreign policy.
The US can use its control over dollar deposits in the United States as a direct lever for sanctions, as we have done in the case of Russia and its invasion of Ukraine.
[The US] can also use the vast and lucrative US financial market as a lever to gain compliance with economic sanctions. For example, in the 2000s, the United States sanctioned a small bank in Macao called Banco Delta Asia, which was a small, obscure bank, but it turned out it was one of only two banks that North Korea used. When the US put sanctions on Banco Delta Asia and got the Macanese authorities to freeze North Korean holdings in the bank, it crippled North Korean international exchange. Ultimately, the Macanese authorities and the People’s Bank of China were willing to go along with this because they took a look around and they said — obviously, I’m making these numbers up for illustrative purposes — “you know, we’re doing $10,000 worth of business with the North Koreans. We’re doing $10 billion worth of business with the United States. We’re going to do the commercially prudent thing and throw this troublesome small customer overboard to maintain access to the US market.” The centrality of the dollar and the size of the US financial markets gives leverage in that regard.
The final way is — and I’m going to use an example with respect to North Korea — when you’re doing dollar transactions, those dollar transactions pass through banks in the United States, and through the US Federal Reserve System. And so we can watch what you’re doing. We can block transactions. We can use all that data, we have to suss out what front companies may be operating to do illicit transactions that we don’t want to happen. When it comes to North Korea and, say, missile proliferation or their nuclear program, we can use our information on dollar transactions to figure out who the front companies are and how they’re linked, and then we can go after them in terms of trying to impede these transactions that we want to stop.
If you have a rise in the renminbi and have the development of alternative messaging systems to SWIFT and those transactions — especially if you have a central bank digital currency, the e-Chinese yuan, and those transactions are going through the People’s Bank of China, they’re not going through the New York Fed, then we can’t see them. And so now, if you’re the North Koreans, and you want to do some nuclear program work or missile proliferation, you can run your transactions through Chinese banks in Chinese currency and never use the dollar, it never enters the American radar system. And so if you’re in the United States, and you want to impede these activities, the rise of the renminbi as an alternative to the dollar can really impede the effectiveness of US sanctions activities.
For all three of those reasons, an erosion of the status of the US dollar and the centrality of the dollar or dominance of the dollar will lessen the ability of the United States to carry out certain forms of economic or financial diplomacy or sanctions policy.
Jen Kirby
How does the debt ceiling showdown tie into that, exactly?
Marcus Noland
There’s this massive loss of confidence in the dollar, and massive reappraisal of the riskiness of the United States, and you’re looking around for alternatives.
Now I want to make clear, the renminbi is not going to immediately replace the dollar. The Chinese have capital controls. Their internal financial markets are large, but they’re relatively unsophisticated. If you were a foreign investor, you cannot hedge and swap risk in China like you can in New York. Finally, the issue of lack of constraint on executive authority — maybe we don’t have enough executive authority here — but they have excessive amounts. You might be a little concerned about putting yourself at the whim of Xi Jinping.
So it’s not like the renminbi is immediately going to replace the dollar. But this is more like a self-inflicted thing by the United States, which then encourages people to start looking around for alternatives.
The most likely ones will be the euro and the renminbi. In the long run, we may end up in a situation, such as some people argue we existed in prior to the First World War, where you have multiple currencies all kind of existing together. There’s not a single dominant currency. You could imagine, eventually, in however many years, the dollar, the euro, and the renminbi kind of playing a similar role in the 21st century.
Jen Kirby
So it’s not like this will happen overnight, but these debt showdowns, and the possibility of default, may accelerate that decline of the dollar’s dominance.
Marcus Noland
Exactly. It gives that process a nice shove.
What it will do in China is — China, like I said, they have capital controls; their markets aren’t as well developed as ours are; they have an executive that doesn’t have a lot of constraints on his behavior. But China may say to themselves, “This is presenting us with an opportunity. If we start to get rid of the capital controls, if we develop more sophisticated markets, if we tie the executive’s hands more, we may make the renminbi more attractive to others.” So it might also elicit a kind of response within China that would help propel or facilitate the internationalization of the Chinese yuan.
Jen Kirby
But I wonder, is a global financial market where different currencies have more parity necessarily a bad thing?
Marcus Noland
No. That’s the world that existed, basically, at the end of the 19th century, in the first stage of globalization, and it seemed to work okay. But it means that the US would have less power and influence.
In a pure economic sense, no: You can have a multi-currency world. The fact that we have vast increases in electronic capabilities and development of digital currencies will reduce the transaction cost of moving from one currency to another. There might be some efficiency gain from having a single currency, but there’s not going to be huge efficiency loss from having several currencies operating in that way.
The big change would be the loss of US geopolitical influence.
Jen Kirby
Is there anything else about a potential US debt default that you wanted to flag?
Marcus Noland
I mean, everybody loses.
Low-income countries will be vulnerable because a lot of them borrow in dollars, but everybody will be vulnerable. If you want to bring it home to Americans, you could disrupt their pension systems and pension payments and their mortgage and everything else. And then the foreign policy aspect is the US is advantaged by the centrality of the dollar and our Federal Reserve System in global finance. If that starts to disappear, then our ability to use financial sanctions for things like dealing with North Korea start to erode as well.
The live-action Little Mermaid is a reminder of what movies like Encanto and Frozen II don’t have: a bad guy.
When Disney’s live-action remake of The Little Mermaid is released on May 26, audiences will finally get to see Melissa McCarthy’s take on one of the most iconic villains of all time: Ursula. The sea-witch octopus, originally voiced by Pat Carroll and modeled after drag queen Divine, is the epitome of a classic Disney baddie: unabashedly evil and self-serving, with a campy anthem to boot. But with a new version of this character back on our screens, you might realize that it’s been quite some time since Disney has produced an antagonist as brazenly wicked as Ursula. That kind of unbridled villainy has become a relic of sorts in the animation studio’s latest original storytelling, which might have you wondering: Where are all the bad guys?
Once a staple of Disney’s animated features, particularly musicals, villains have slowly been phased out in favor of stories like Frozen II or Encanto that focus more on our hero’s inner conflict with themselves. Rather than face off against an evil archetype working toward their downfall, our current generation of heroes are fighting their own demons, acting as their own foils, and having to overcome their own mistakes.
The change marks one of the starkest shifts in the history of Disney fairytales, perhaps second only to the switch from 2D animation to CGI. For over half a century, the villain had loomed large in these stories, beginning with the Evil Queen in the first-ever animated feature, Snow White and the Seven Dwarfs. Cinderella’s Stepmother, Captain Hook, and Maleficent soon followed during the Golden Age, and eventually, when the “Disney Renaissance” began in 1989, villains like Ursula, Jafar, and Scar continued the tradition.
It’s classic storytelling, with each playing a key role in driving the plot and furthering the character development of our hero. Whether it be locking them away in a tower, stealing their voice, or trying to kill them in a power grab, these characters set the ball in motion and serve as a tangible figure to defeat.
But as of late, those archetypes have gradually faded away. While The Princess and the Frog (2009) and Tangled (2010) gave us Dr. Facilier and Mother Gothel respectively, we haven’t seen a traditional villain since 2013. Even in that case — Hans from Frozen — the villain pales in comparison to the conflict that Elsa has with her own powers. That theme continued in the film’s sequel, where Elsa struggled to find where she and those powers belonged. Similarly, in 2016’s Moana, the title character sets out on an adventurous ocean quest of self-discovery. And most recently, in 2021’s Encanto, Mirabel’s main conflict is her desire for approval and purpose within her magical family as she fights to restore their fading powers.
/cdn.vox-cdn.com/uploads/chorus_asset/file/24642398/ENCANTO_ONLINE_USE_490.0_074.60_0104.jpg)
Disney
But why exactly did this change come about? Disney’s storytelling patterns have always evolved over time, but typically that evolution has been guided by (and can be traced back to) previous successes and failures.
For example, when The Little Mermaid revitalized the studio’s flailing animation department in 1989, the company doubled down on fairytales and the songwriting team of Howard Ashman and Alan Menken — resulting in Beauty and the Beast and Aladdin. It also began the still-active trope of an “I Want” song, in which the main character sings about their desires early in the film, with “Part of Your World.”
More recently, when disappointing box office numbers for The Princess and the Frog were blamed on the title deterring boys, Rapunzel’s title was changed to the more gender-neutral Tangled, and the successful adjective trend of course continued with Frozen.
So what was it that could have inspired this move away from the traditional hero vs. villain format?
If there’s anything in the world of animation that could have spurred such a seismic shift, it’s Pixar. From its origins producing the first ever CGI animated feature with 1995’s Toy Story, the studio (now a subsidiary of Disney) completely reimagined the genre — both in terms of its animation style, and the kinds of stories they were telling. Pixar’s themes, premises, and characters broke convention time after time, and the studio even veered into Disney’s lane by trying its hand at a princess movie with Brave.
The success of Pixar’s films likely gave filmmakers permission to draw outside the lines, and reimagine what a Disney animated feature could be. This new, broader path, which led Disney to acclaimed films like Moana and Encanto, proved commercially and critically successful, and resulted in groundbreaking new stories told in exciting new ways. And at times, that meant no villains.
But Frozen II, which had a more mixed reception in 2019, demonstrates some of the pitfalls that can come along with this new approach. In the film, Elsa is led by a mysterious voice on a journey of self-discovery to protect her kingdom from a curse. If it sounds a bit abstract, that’s because it is. The docuseries Into the Unknown: Making Frozen II follows the last year of the film’s production, and the challenges that the creative team faced in crafting a clear narrative. With only months to go until the film’s release date, they were still unsure of who the voice was that was calling Elsa, and feedback from repeated test screenings highlighted the story’s lack of clarity. In this case, fighting the abstract concept of “the elements” paired with the internal journey of finding one’s place proved very difficult to clearly depict on screen. It’s in an instance like this, where the story becomes muddled, that the value of having a villain is really seen.
While a traditional good guy vs. bad guy dynamic might seem simpler and less nuanced than complicated heroes facing complex internal battles, oftentimes both approaches are doing the same thing. A villain is at their best when their presence is facilitating our hero’s inner journey and eventual growth — and doing so in an active, cinematic way.
Take The Little Mermaid for example. Much like Moana or Frozen, that movie is about a character grappling with balancing their love of family with their desire to leave them behind for something more. The difference is the inclusion of Ursula, who facilitates that journey and thus helps depict it in a very linear and active way. With Ursula there to push Ariel in a certain direction, her grappling becomes a dialogue instead of a monologue. “Life’s full of tough choices, innit?” Ursula famously says, before kicking off the film’s plot by forcing Ariel to make that tough choice.
The role villains like Ursula play is invaluable, whether it be as surrogates for our hero’s own inner demons, foils to their big plans, or fun, campy fools that we love to see defeated. Not to mention that villains come with great accessories: a showstopper like “Poor Unfortunate Souls,” poisoned produce, or a comedic sidekick like Iago — all of which are more entertaining than a vague, mysterious curse.
For now, we can look to the slew of live-action remakes to remind us what we’re missing. Those films, along with the success of retellings like Cruella and Maleficent, should also garner hope that the studio hasn’t lost sight of the value villains can hold.
But until these live-action attempts inspire a return to form on the animation front, those classic villains continue to be missing in action. To borrow a phrase: “You’ll find that nowadays / I’ve mended all my ways / repented, seen the light, and made the switch.” But will that switch stick? When The Little Mermaid ushered in the return of fairy tales for the first time since 1959’s Sleeping Beauty, it proved that a return to form is always possible for the House of Mouse. And soon enough, an iconic animated villain might come our way again. Who knows? Maybe someone at Disney is sketching a pair of sinister, villainous eyebrows as we speak.