Just when I thought it was safe to go back in the water. The great mammogram controversy of 2009--regarding federal taskforce guidelines recommending no screening mammography under age 50, and only biannually after that--died down, and I thought we'd go back to normal. Not so fast! Earlier this month, MSNBC posted an article, "Mammogram row heats up: To screen or not?"

In Europe, two studies on mammography have been recently released, completely contradicting each other. There have even been accusations that bias affected outcomes. The issue is ductal carcinoma in-situ (DCIS). The pesky cancer cells that are contained within a breast duct haven't ventured outward. Research suggests that if left untreated, many of these groups of cells would never turn into invasive breast cancer. The problem is, it's hard to differentiate between the cells. So, we treat them all aggressively--which sounds reasonable to me!

Yet one side of the controversy says that we shouldn't do this; that tremendous resources are used to screen for and treat "something that might be nothing." Biopsies, surgeries and treatment--not to mention the mental anguish--may be unnecessary.   

As a mammographer, I disagree. The stress of an unnecessary biopsy is nothing compared to the stress of walking around wondering when the time bomb in my breast is going to go off. Just a personal opinion.

 But the hard truth remains: there isn't enough money for everything. More and more, the health care industry will start to play the odds. I mean, we have to cut somewhere, right?

Well, now there's a third consideration. Professor Michael Baum, who first introduced breast screening to Great Britain, suggests a "triage" system that divides women into high-, middle- and low-risk groups. High-risk women would get genetic testing. Low-risk women would get advice on minimizing risk factors. Screening would be reserved for the middle group, those with moderate risk of breast cancer.

I'm getting a visual of a breast emergency department--with a triage mammographer who sees patients immediately to assess need, to assign a path. Young, healthy, no family history? Here's a handout, see ya later. Strong family history, dense breasts? Step right up to our genetic testing bay. If you're middle-aged with a mild family history, overweight and don't exercise: lucky you, you get a mammogram!

Sandra Mueller, BA, RT(R)(M)RDMS, is the technical manager of women's services at Adventist Hinsdale Hospital's Outpatient Centers in Chicago.