Following the recommendations, more than a dozen states including New York, California, Florida and Michigan made changes in their breast and cervical cancer early detection programs, according to a survey conducted by the Avon Foundation for Women. Respondents reported seeing declines in screening volumes of women under 50. Many women also used the guidelines as a justification to avoid or delay mammograms.

A provision in the newly passed health care law prohibits private insurers from denying breast cancer screening coverage on the basis of the USPSTF recommendations. According to the American College of Radiology, federal programs like Medicare and Medicaid must also adhere to this clause.





"It is our interpretation that by not specifically excluding the federal government, they are included as a group health plan," says Rebecca Spangler, director of congressional affairs for ACR.

Although screening coverage is protected from the influence of the recommendations, breast imaging specialists are still facing the challenge of explaining the new guidelines to their patients.

"The Task Force seems to have over weighted potential harms such as a recall for additional views or ultrasound or a core needle biopsy," says Dr. Berg. [It] "downplayed the proven benefits of early detection in not only saving women's lives but also reducing the need for more harmful treatments with more advanced disease. Women should be well-educated on the facts and consider the issues: mammography does save lives and is very effective," she says.

Breast Imaging on Verge of 3D
The next anticipated development in the mammography industry is the arrival of digital tomosynthesis and 3D technology. In tomosynthesis, an image of the breast is taken in varying angles and the slices are then reconstructed into a 3D volume model. Research suggests that 3D applications are superior to 2D mammography, as they address some of the modern system's drawbacks.

"Where mammography is limited is in those patients who have very dense breasts, in which case a cancer can be obscured by the dense breast tissue overlying it," says Dr. Levine. "The idea behind digital tomosynthesis is that by being able to essentially peel off the layers of overlying dense breast tissue as we slice through the breast, we can uncover a cancer within a dense breast," he says.

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