You've no doubt been hearing about how an influential U.S. public health group has recommended that women aged 40-49 no longer be given yearly mammography screenings.

These proposed changes by the U.S. Preventive Services Task Force (PSTF) are upsetting to me because, if you remember, screening mammograms saved my life not once, but twice. I was diagnosed twice, first on my baseline mammogram at age 38 and then again on a screening mammogram of the other breast at age 40.

I know that a lot of you are also concerned. I've been getting batches of emails and phone calls at my home and at work from breast-cancer survivors who like me had their cancers diagnosed--and their lives saved--by routine screening mammograms when in their forties.

The PSTF also argues that women 50 and older should only get mammograms every other year, and that doctors no longer need to teach women to do breast self-exams.

Why are they suggesting these cutbacks on screenings? The PSTF claims that the data just do not demonstrate that screening mammography saves the lives of "enough" women in their forties to justify the risks of yearly screening.

Their concerns have to do with false-positive mammograms, for example, which can trigger unnecessary further tests like biopsies, thus creating "extreme anxiety" in women. Or, a mammogram might find a genuine tumor but one that's growing so slowly it would never be her actual cause of death.

There are, however, several problems with this logic. We have no scientific way today of knowing for certain if a specific cancer within a woman's breast--slow growing or not--won't eventually progress and kill her. And we obviously can't do a clinical trial that randomizes women with breast tumors and then watches to see what happens.

I'm not so sure, either, whether women are as distressed by the whole process as the PSTF implies. I spoke to patients this week who said, "I'd rather have a biopsy when in doubt, even if it's nerve-wracking, and confirm that there's either no tumor there or else there's an easily treated early one, than walk around with a tumor in my breast and get a delayed diagnosis sometime later on." Excellent point.  

My concern is that the PSTF's new recommendations can't be squared with the following facts:

• National statistics show that about 18 percent of the women diagnosed with breast cancer in the U.S. are ages 40-49.
• Here at the Johns Hopkins Avon Foundation Breast Center, that figure is more like 25 percent, due to patients choosing to come to us from a large regional area rather than seeking treatment at their community hospitals.
• The PSTF's proposals completely ignore all the women who are diagnosed when under age 40.

I'm concerned too that the PSTF has based its exclusory recommendations on analog mammography. Well--good grief!--it's common knowledge that, while regular analog mammograms do a fairly good job of finding early-stage cancers in most kinds of breast tissue, analog mammograms too often fail women whose breast tissue is more dense. And just whose breasts are most likely to be made up of dense tissue? Younger women in their forties.

The new digital MRI mammography, on the other hand (which doesn't even enter into PSTF's review), was designed specifically to find tumors in denser breast tissues. Studies published in the last 2 years have confirmed that MRIs are 28 percent more likely to find cancers than is the old analog film method. Previously published studies have also confirmed that dedicated breast-imaging radiologists should ideally read mammogram studies, since a non-specialist radiologist is much more apt to miss a cancer that is present.

The decision to exclude women under age 50 from getting breast-cancer screening also ignores the fact that breast cancers in younger women tend to grow faster and more aggressively than do those in older women, making early detection doubly important.

At the other end of PSTF's spectrum of recommendations was to no longer provide mammograms to women over age 75. This is a strange suggestion, given that the risk of breast cancer increases with age. My own mother was distressed by this one. (She's of course also upset with the "no mammograms for young women" part, since she's thoroughly familiar with her own daughter's history.)

Deciding not to do mammograms on young women because the current technology is imperfect shouldn't result in the decision to use no technology at all. Let's not throw the baby out with the bathwater.

Many advocacy organizations like breastcancer.org, the Young Survival Coalition, Breast Cancer Network of Strength, and the Avon Foundation have posted their position statements on their websites too, discouraging the adoption of the new recommendations. Read the Johns Hopkins Breast Center's official position.

What the PSTF could have said instead is that all these younger women should have, at a minimum, a digital mammogram that is read by a radiologist who specializes in images of the breast, and supplemented with monthly breast self-exams (BSEs) and annual clinical breast exams performed by their gynecologist or family practitioner.  

And, ideally, research dollars should be directed toward developing screening methods that can detect cancers more accurately and earlier, especially in dense breast tissue.

So here are Lillie Shockney's (same old) recommendations:

• please continue to schedule your mammograms annually
• have your primary care physician perform yearly clinical exams of your breasts
• learn how to examine your breasts yourself and let your physician know when you feel any change
• if you're in your forties, ask for a digital (MRI) mammogram
• ask to have your images evaluated by a dedicated breast-imaging radiologist, one who does nothing all day but pour over mammogram images--because it won't do you much good to get a mammogram if it's not then read accurately!

What do you think about all this, readers? Would you be upset if your insurance company decided not to fund annual mammogram screenings for persons your age?

When you think about it, with a delayed diagnosis of breast cancer being the No. 1 reason for medical malpractice lawsuits in the U.S. today, I'd personally be really surprised if doctors started trying to discourage women from getting their annual mammograms, or if insurance companies said no to covering their cost.