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."
Trained in medicine at both Stanford University and UC San Francisco, Sauer said the data on which the 2009 guidelines were based was "somewhat skewed" because it was compiled at a time when mammography was transitioning from analog to digital technology.
The precision of mammography imaging and the precision of interpretation are much better now, she said.
"Right now, the number of women who get biopsies is very appropriate and not too high," she said.
Francesca Manfredi, a family practice physician with Sutter Medical Group of the Redwoods, said most of her patients want to err on the side of safety and she tries not to confuse her patients with statistics from the most recent randomized, controlled trials.
"It's enough to make your head spin. What patients want is everything to be laid out for them," she said, adding that her patients usually will err on the side of getting a mammogram just to be on the safe side.
Dr. Dennis McDonald, the director of the Sutter Women's Health Center in Santa Rosa, said the negative effects of over-screening will be lessened as medical technology becomes more advanced. He said advances in genomics and genetics could allow screening guidelines to become more individualized.
But for now, the value of screening women under 50 is unmistakable, he said. At Sutter Women's Health Center, 30 percent of breast cancer patients are in that age category.
"My opinions are different, obviously, than that of the task force," he said. "I see a lot of young women with breast cancer. These are the women that have families; they've got jobs. These are the ones that you could affect the most by early detection."
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