I'm not sure what to think. I'm well over 50 now, but would still be in a high risk group were I 40 or younger , as my sister died from breast cancer age 41 that was diagnosed when she was 36.

I haven't been able to make much sense of the medical reasons behind the revision from what I have heard from MD's interviewed on NPR, don't have time right now to read much of the news and "news" coming out through the various media outlets, so I think I will hold off for a bit and let the dust settle before I make a deliberate effort to learn enough to have an opinion.

Having said that, here are my very initial concerns:

I understand that when a screening tool is used, the number of false positives has to be considered in determining the over-all benefit of the broad use of the screening tool to the potential screening population. But the arguement I heard from an MD interview on NPR did not make much sense to me, and it was not clear to me that the potential harm to a women from a false positive outweighed the benefit to the number of women who get what turns out to be a true positive. What the MD mainly emphasized was the worry and anxiety women with false positives experience, some concern about women going through biopsies that end up being negative, and then went on to talk about women with false positives undergoing surgery, chemo, radiation, etc.

Mammograms, I have always understood, do not detect breast cancer. I assume(d) they detect suspicious lumps or changes in breast tissue that could prove cancerous upon further exploration, and can detect these lumps or changes that might be cancerous while they are still so small that a physical breast exam would not detect them. I have never heard of or known any one who was told they have breast cancer based on a mammogram.   I have also never heard of anyone having chemo, radiation or a lumpectomy or mastectomy based on a mammogram. I think, (perhaps incorrectly), that a biopsy is necessary to determine if tissue is cancerous, and assume that a woman would undergo any of those further significant procedures only if a biopsy confirmed cancer.

Any person told they may have cancer is going to experience worry and anxiety. That is part of life. I had a lesion a number of years ago that turned out to be squamous cell carcinoma, and I well remember the intense anxiety I experienced waiting to find out if it was in situ or had spread, and what the prognosis and treatment regimen was going to be. I had the lesion for a number of years, and several MD's said it was nothing to be concerned about. Then a PA, not so certain of herself, decided to remove it and it send off for biopsy.    Blessing on her forever. Since then, and because of that history, I have had MD's decide to biopsy other lesions because they "might be suspicious." I'm very anxious every time, and so grateful to endure that anxiety for the sake of an accurate evaluation. So far, no more cancerous lesions after 20 years.

Based on all the above, the cost/benefit analysis he presented didn't seem to make much sense to me, and I found myself wondering if the medical cost/benefit analysis was an attempt at spin to obscure the main cost/benefit analysis is really related to dollars spent by insurance companies, Medicare and Medicaid.

I do understand that the dollar cost does have to be factored in when considering a widely used medical screening procedure.

I would like to know more specifically what they mean when they say there is no drop in mortality for women who discover suspicious lumps through self breast exam. 1 year mortality? 5 year mortality? Over-all mortality from breast cancer? I didn't hear enough information for it to have any meaning. (Maybe news media have reported that and I just haven't come across it.) My sister's breast cancer was diagnosed after she felt a small lump while showering one morning and had a thorough medical evaluation of the lump. She had a radical mastectomy and then radiation and chemotherapy. After a 3 year remission, she went to the doctor because of back and hip pain, and tests indicated the cancer had metastatized (sp). She underwent more chemo, more radiation, and finally, an experimental bone marrow transplant (since that time, proven ineffective for the treatment of metastic breast cancer.) The hope was that better treatments or even a cure for metastic breast cancer might be found, the longer she lived. She lived 5 1/2 years after the original diagnosis. The last year of her life was pretty brutal, a combination of the pain from the metastic disease, and the brutality of the treatments.   If the statistics indicate that she would have likely died at 5 years, most of them with a pretty decent quality of life, even if the cancer had not been detected when it was and she had not gone through all of that torturous treatment, then there may be a good argument for not bothering with breast self-exams. If, however, her life would have been significantly extended, and that quality of life would have been pretty good, had she conducted breast exams and noticed that lump when it was smaller, even if she ultimately died from metastic breast cancer 7, 10 or 12 years after diagnosis, it seems to me the breast self-exam would be well worth the effort.

Since she was 36 when she detected the lump, she had never had a mammogram prior to detecting that little pea-sized knot.   I think it is pretty well established whether one is looking at medical or fiscal issues, that routine mammography screening is not warranted before age 40.

I know I'm wordy and redundant, and that my posts are way too long. Knowing that, and mastering the art of pithiness are separate skills. I am better at awareness than I am at change. Sorry.