These past couple of days, there has been a firestorm of reaction to the new recommendations just released from the U.S. Preventive Services Task Force about mammography and breast health.

Briefly, the newest recommendations state that routine mammography is not necessary for women under age 50. There are other recommendations, but among those that surprised me the most is the recommendation that teaching breast self-examination should be brought to an end as well. Beginning as a teenager, I have had it pounded into my head that once a month we were supposed to examine our breasts in the shower.

Disclaimer:  NCFR is not a medical organization, and we do not disseminate any recommendations outside of our professional organization's areas of expertise. As a blogger, I have no medical credentials either. I will give no medical advice. However, I do have two breasts which entitles me to have an opinion...  and to be just as confused-and angry-as any other woman. 

Even though NCFR is not in the cancer screening business, cancer is a family matter. I thought that it might be helpful to collect some of the official sources of information as well as some of the commentary from other organizations-and from women themselves-for the convenience of our members, so that the information is accessible from one site.

Here is the actual information from the US Preventive Task Force (USPTF) that touched off the controversy:

http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm#summary

Here is a CNN story about it: http://www.cnn.com/2009/HEALTH/11/16/mammography.recommendation.changes/index.html

Here is how the American Cancer Society is weighing in-they are resisting the change:

http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Responds_to_Changes_to_USPSTF_Mammography_Guidelines.asp

Here is the official position of the American College of Obstetrics and Gynecology (ACOG), whose protocols will also remain unchanged:

http://www.acog.org/from_home/Misc/uspstfResponse.cfm

ACOG has a good summary of the rationale for the USPTF's change: that having routine mammography has its own risks... "the harms assessed by the USPTF were radiation exposure, false-positive and false-negative results, overdiagnosis, pain during procedures, and anxiety, distress, and other psychologic responses."  Even breast self examination has "risks": women feel what they perceive as a lump and it requires mammography-and then the resultant radiation, false results, biopsies and several days of fright.  However, ACOG's official position after the USPTF's news was that ACOG's recommendations will not be changing.

I understand the basics of statistical assessment of this issue, and that epidemiology is based on numbers from the aggregate of studying a huge number of women. That doesn't mean that each of us doesn't have a half dozen anecdotes of a friend, neighbor or coworker, under age 50, who found her own malignant lump or had it picked up on a mammogram. This "anecdotal evidence" is pretty emotionally-charged. Without mammography in her early 40s, I would not have one of my dearest friends today. One of my aunts found her lump herself. However, I am one who had the kind of results the USPTF is concerned about-I had a suspicious lump found by mammogram at age 45. I had a core biopsy (not painful), but I did have several days of official freak-out waiting for the results.

What is causing me more freak-out now is the confusion. Across all of these organizations that we are supposed to trust, there is no consensus. Surprisingly, I am reading very little about using a women's family history as a factor in the decision. Worse yet, I worry about the implications these new recommendations may have about insurance coverage for screening for those whose doctors recommend it.

ACOG notes that although heart disease is the highest risk for death in women, "surveys have shown that women are more concerned about their risk of breast cancer than heart disease, which is more common."  We are concerned.  In my opinion, trying to keep us from unnecessary worry is a moot point. We already worry. Women don't run races and sport pink ribbons for nothing. The website of the "pink ribbon" people-Susan Komen for the Cure-offers perhaps the most calm and compassionate assessment of the controversy. http://ww5.komen.org/KomenNewsArticle.aspx?id=6442451500 .

What am I going to do? I'm going to listen to my doctor.