DERRY – When Norma Jean Gecks started having routine mammograms at age 40, she thought she was doing the right thing. Nine years, several false positives, countless lumpectomies, two surgeries, and one mastectomy later, she still feels yearly mammograms are a must, and continues to advocate for early cancer screenings for women of all ages.

"If I'd waited until 50 for my first mammogram, I wouldn't be here," said Gecks, who has become a crusader against the devastation of the disease. She rejects the notion that women should be less vigilant about cancer screenings, despite the U.S. Preventive Services Task Force's recommendation Monday that routine cancer screenings should be less frequent and not begin until age 50.

"The problem is, with a recommendation like this, you can see what's going to happen. Insurance companies will stop paying for annual exams, even for women in higher-risk groups. Look at my situation -- I've already lost one breast, and there are calcifications in the other. But the insurance company won't pay for me to have a breast MRI. I want to make sure there's nothing growing behind my implant. I want to know if something's growing in my other breast, before it's too late. How do you get to be higher risk than that?" Gecks said.

Her first-person outrage was echoed yesterday by others, from medical professionals to those deep in the trenches of cancer research and prevention, who say they regard the USPSTF statement as scientifically baseless and anecdotal, at best.

"There is no doubt that mammograms and early diagnosis save lives. I see this USPSTF statement as more opinion and statistics than science," said Dr. Edward Dalton, director of Elliot Breast Health Center in Manchester.

"They are downplaying the role of digital mammography -- there's no recommendation for women over 75, who are at greatest risk for breast cancer. This is old information and old science. I hate to see this recommendation turn back the clock," Dalton said. "It flies in the face of advances with digital imaging and ultrasounds. It's going back to the stone age."

Strong stance

The USPSTF is a 13-member panel of experts, funded and appointed by the U.S. government. Among the current task force members are Allen Dietrich, professor of Community and Family Medicine with Dartmouth Medical School in Hanover, who could not be reached for comment yesterday.

Taking an equally strong stance against the revised mammography guidelines was Otis W. Brawley, chief medical officer for the American Cancer Society.

"As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: this is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member," Brawley said in a prepared statement.

"With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them," Brawley said.

ACS regional spokesman Peter Davies said his organization has no intention of changing its current recommendation, that women over 40 should continue having annual mammograms. When it comes to cancer diagnostics, it comes down to weighing risks against benefits.

"We recognize that there are limitations (to mammography). Some cancers will be missed. There will be some false positives," Davies said. "But we still believe the benefits outweigh the risks."

Conflicting recommendations

Davies and others said they are concerned that the public will be confused by conflicting recommendations.

Beth Beaudin is operations manager for the Women's Life Imaging Center in Somersworth.

Dr. Edward Dalton, director of the Elliot Breast Health Center in Manchester, examines a digital mammogram X-ray yesterday. A federal agency has issued new, lower recommendations on the use of film mammography. (BOB LAPREE)

The task force recommends...

Key recommendations from the U.S. Preventive Service Task Force regarding film mammography for breast cancer screening:

• Under age 50: The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one.


• Age 50-74: The USPSTF recommends screening mammography every two years for women aged 50 to 74 years.


• Age 75 and older: The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.


• Self-exams: The USPSTF recommends against teaching breast self-examination (BSE).

►Click here to view the USPSTF's recommendations on breast cancer screening.

"We certainly take issue with the report's recommendations to essentially just turn your back on any type of breast health preventive type screening," Beaudin said.

"I know these studies look at this from 10 miles up and they are looking at hundreds of thousands of groups," Beaudin said. "We are at a much closer level to the patients and we see things every day that say this makes perfect sense to keep screening starting at 40."

The panel made the point that invasive diagnostics are costly and sometimes dangerous remedies for cancers that are contained and may never spread.

But Beaudin had a different viewpoint.

"Maybe one of those small cancers turns into a really big cancer," Beaudin said.

Elaine Lavallee, director of the diNicola Breast Health Center at Southern New Hampshire Medical Center in Nashua, said that after 26 years in the trenches, she has seen and heard it all.

"I've seen this kind of thing come and go before, and it's concerning. If you are the one person who, in your 40s, found a lump because of a mammogram, then you certainly don't want them to say that you don't need one until you are 50," Lavallee said.

She said findings that run counter to long-standing guidelines of early detection are often based on tests done using older equipment and methods. As for self-exams, women don't need permission to continue to do them at home, and should always request follow-up testing if anything feels abnormal.

"From my point of view, I want them to find a cure. I'm a woman. I care about this. I could just as well go sell real estate. But I choose to spend my life doing this work. I want them to find a cure. While they're working on that, the best thing that we have is early detection."

A life-saver

Melody Becker-Cleary, of Derry, is a two-time breast cancer survivor.

"My best friend, Sue, died of breast cancer when she was 44. Just before she died, she made me promise I would have annual mammograms. I had my first when I was 40, for her. It was clear," Becker-Cleary said.

"The next year, at 41, I had breast cancer -- stage 2, triple-negative, aggressive form of cancer. I had no breast cancer in my family. Without that mammogram, my chances of survival were probably next to nothing. My three girls were 18, 22 and 25. My husband had one more year to go in the military. It was my youngest daughter's senior year of high school," Becker-Cleary said.

"I had a lot to live for. I went through 12 chemo treatments, 28 radiation treatments, 13 surgeries, a mastectomy and two breast reconstructions. I was glad when 2007 was over, but I'll tell you, I'd go through it all again to be here today, with my family," Becker-Cleary said. "That mammogram saved my life."

New Hampshire Union Leader Correspondents Gretyl MacAlaster and Melanie Plenda contributed to this story.