Three years ago, an independent task force of experts in preventive medicine caused a national outcry when it recommended that routine mammograms for women should begin at age 50 rather than the previous 40, and should be conducted every two years rather than annually.
The panel, the U.S. Preventative Services Task Force, had concluded that on average, screening women in their 40s resulted in a 15 percent reduction in the death rate, an outcome that did not justify the possible negative effects of screening, such as stress, anxiety and false positive diagnoses that could lead to more tests such as biopsies.
Across the country, doctors and cancer groups blasted the recommendation. For them, real people comprised that 15 percent figure, and the lives of the few outweighed the collective stress and anxiety of the many.
The recommendation was quickly rejected by President Barack Obama, whose health insurance overhaul bill was at the time under attack, accused of leading to health care rationing and "death panels."
In his new book, "The Big Squeeze: A Social and Political History of the Controversial Mammogram," breast radiologist Handel Reynolds argues that in the debate over mammography, politics has repeatedly trumped science. But he thinks the 2009 controversy over mammograms could be the country's last debate on the matter.
The smoke has cleared since then and today, it's almost business as usual, with some local doctors saying they tried to stay clear of the political pendulum.
"Right after those guidelines came out, I saw several women whose cancers were diagnosed by mammograms under 50," said Dr. Loie Sauer, a breast cancer surgeon who has worked for Kaiser Permanente.
Sauer, who was previously in private practice in Santa Rosa starting in 1990, said there has been no change in Kaiser's screening guidelines.
For women from 40 to 74, that routine mammogram is recommended every one to two years, she said.
"If a woman wants a mammogram every year from age 40, she books an appointment and Kaiser does a mammogram," Sauer said. "No one is turned away from an annual mammogram."