New mammogram guidelines warrant more study

There's an old joke about mammograms that goes something like this:

"What's it like?" a man asks, and his wife tells him to grab his upper lip and squeeze it as hard as he can.

"That's not so bad," he says, after doing just that.

"Now pull it up over your head and all the way back so you can stand on it."

A mammogram is not a test that a woman would opt to get if she didn't need it. It's a fairly unpleasant (I can hear a thousand female voices laughing at my choice of words) procedure.

But it's also tremendously important, as anyone knows who has watched a friend struggle with and perhaps even die of breast cancer.

I lost a very good friend to the disease about a decade ago. She was 48. And I have seen a number of other friends go through biopsies and lumpectomies and mastectomies, chemotherapy and radiation. Several of them are alive, I am convinced, because a mammogram found their cancer before it had spread irreparably.

So I find myself a little confused about the recommendation that came down from the U.S. Preventive Services Task Force this week regarding the need for the diagnostic test that has widely been credited with reducing deaths from the disease by about one-third. That's a pretty significant drop.

The committee of primary care physicians now says that women need get the exam only if they are between the ages of 50 and 74, and then only every other year. That every-other-year thing has been debated before. But current guidelines say the testing should begin at age 40 and be done consistently.

To arrive at their conclusion, the panel ran computer models with different scenarios. What would happen if the women were screened every few years vs. annually? What would happen if the first screening was at 45? At 50?

There's no question, the panel said, that women who have mammograms on a regular basis are less apt to die of breast cancer. But those in their 40s don't really benefit quite enough when you add in the stress they feel when they are told they might have cancer and it turns out to be a false positive, or the cost of the further screening in those cases. At 50, the benefits do outweigh those concerns.

Many women in their 40s are likely to welcome the news and the assessment that they don't need the test right now.

Unless, that is, it turns out later that they are among the one-fifth of breast cancer cases that occur in women younger than 50.