The debate rages on: Should we screen for breast cancer?  If so, who do we screen, and when? The U.S. Preventative Services Task Force (see the June/July issue of ADVANCE cover story, "Screening's Defenders and Doubters") has certainly left a trail of controversy in the wake of its recommendation.

"Too many false positives!" argue the opponents of current standards. "Too much scaring women with needless biopsies!" 

Should women really wait until age 50 to begin screening, and then be able to get additional mammograms only once every other year?

If you're reading this, you're most likely working in mammography or in another area of radiology or health care, so you probably know where I stand on this issue. Many women agree with me that screening mammography should start at age 40, and be done annually. However, in some states (including my state of Illinois) Medicaid is already changing its regulations to pay for screening mammograms only once every two years. Can Medicare be far behind?  Where Medicare goes, the private payers usually follow.

Ultimately this means that many women who would still want to have a screening mammogram might not be able to get one because their insurance won't cover it. Indeed, the cost can be prohibitive--even a basic screening mammogram costs about $500, once computer aided detection (CAD) charges and radiologist fees are figured into the equation.

The cover story mentions tennis pro Martina Navratilova's diagnosis of breast cancer in February, and that got me thinking about other celebrities that have been treated for breast cancer. When I looked them up on the Internet, the list of celebrity survivors under age 50 surprised me. It included people like actresses Christina Applegate, Cynthia Nixon, Edie Falco, Maura Tierney, Ann Jillian, Jill Eikenberry, Suzanne Somers and even two of the original cast members of "Charlie's Angels-" Kate Jackson and Jacklyn Smith. Singers were also represented--Melissa Etheridge, Olivia Newton-John,  Sheryl Crow, Kylie Minogue, Anastacia-as were newscasters like Linda Ellerbe and Robin Roberts.

And those are just the celebrity women I found by only half trying, so I'm probably missing many more. I'm sure these women would argue that their screening mammograms did not turn out to be a bad thing. But then again, they can afford to make their own decisions about it. Many of the rest of us can't.

So hear this, insurance companies and those who oppose screening mammography:  If you want to know whether a woman feels more anxiety from an unnecessary biopsy than from a missed breast cancer, just ask her. If she thinks a screening mammogram isn't necessary and she doesn't want the "needless anxiety" of a negative biopsy, then let her skip it.  

But if she believes she needs that screening mammogram, then pay for it.

Fair enough?   

Sandra Mueller is the technical manager of women's services at Adventist Hinsdale Hospital's Outpatient Centers in Chicago.