For years, health care providers have drilled the message into women's heads: Get a mammogram at age 40 and about once a year after that.

Now, a sharp reversal, even a potentially seismic shift in breast care.

WHAT'S HAPPENING?

The U.S. Preventive Services Task Force, established by the federal government to set standards on disease prevention, says mammography saves relatively few lives in women ages 40 to 49. It says the benefit of the test is eclipsed by the risks, including tests that may erroneously detect tumors when none exist.

The task force recommends mammograms for women up to age 74, but not yearly. And skip the self-exams, the task force says. They don't work.

The panel's new recommendations are more in line with international guidelines, which call for screening to start at age 50. The World Health Organization recommends the test every two years.

U.S. recommendations have shifted in recent years, but most groups have settled on age 40.

The task force recommendations don't require women or their health providers to change, and the recommendations are not about rationing health care, task force officials have said.

MAMMOGRAMS IN THE TREASURE VALLEY

Women here have more than a dozen places to get mammograms. St. Luke's medical centers and Saint Alphonsus Regional Medical Center alone have 12 between them.

And women in their 40s are using them.

At St. Luke's, women ages 40 to 49 made up 27 percent of the total number of women who had mammograms in 2008, said Dr. James Maxwell, medical director of breast care services for St. Luke's hospitals in Boise, Meridian and Ketchum.

He is opposed to a more conservative approach to testing. "I am convinced that we are going to see increased mortality from breast cancer as a result."

Other Treasure Valley views:

SUSAN G. KOMEN RACE FOR THE CURE

Much of the mission of this organization is to boost education and mammography screening for women ages 40 and up. The new recommendations are likely to create confusion, executive director Hilarie Engle said.

"We are going to stick for now with the age 40," she said.

BSU CENTER FOR THE STUDY OF AGING

As the health care industry gets better at collecting information and scientifically analyzing outcomes, we can expect more recommendations like this one, said Sarah Toevs, director of the Boise State University center.

Some tests and procedures that have become the standard may not make the cut as evidence-based medicine grows.

"I think this is going to be key to our whole health care management strategy, to make sure we are delivering care and screenings when it's appropriate," she said.

Even so, Toevs said the mammogram is a useful screening tool for women who fall into high risk populations or who know their bodies and know when something isn't right.

A PATIENT'S VIEW

Cheryl Imlach of Boise was diagnosed with breast cancer a year ago when she was 41. She is well now, but cancer patients aren't declared "cancer-free" until five years after their diagnosis.

"It doesn't make sense to me personally," she said of the recommendations.

Imlach worries that women will put off seeing a doctor, even if they have worrisome symptoms, because they will see age 50 as a magic number.

She and Toevs may disagree about the recommendation, but they share this philosophy: "Be in tune with your own body and take care of it," Imlach said.

BLUE CROSS OF IDAHO

Many people wondered whether insurers would continue to cover yearly exams, but the biggest single insurer in Idaho said it had not yet decided what to do. These decisions take time, spokeswoman Karen Early said.

Colleen LaMay: 377-6448