The argument over the right age for women to begin mammograms was pushed to the center of the healthcare reform and technology debate with Monday's release of new guidelines from the U.S. Preventive Services Task Force.

New advice from the task force, a government panel of scientists and physicians, calls for skipping screenings for women between the ages of 40 and 49 and beginning routine scans at 50.

The task force said mammograms for younger women have a higher rate of false-positive results, causing significant anxiety and unnecessary biopsies. Officials noted that breast cancer deaths have declined since 1990 by 2.3 percent per year overall and by 3.3 percent for women aged 40-50, and credited the decrease to the combination of mammography with improved treatment.

Critics – including the American Cancer Society and American College of Radiology, physicians and lawmakers, talk show hosts and their guests, bloggers and editorial writers - are weighing in loud and strong.

Republican lawmakers point to the new guidelines as evidence of the rationing of healthcare that they say will occur after healthcare reform is enacted. At issue is whether the guidelines would make it possible for insurance companies to deny coverage. How this might impact the healthcare reform bill (with its attendant healthcare IT provisions) now before Congress is unclear.

The American College of Radiology, which has 34,000 members, also raised the specter of rationing.

"If cost-cutting U.S. Preventive Services Task Force mammography recommendations are adopted as policy, two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year," the ACR said in a statement. "These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives – including in women aged 40-49. These new recommendations seem to reflect a conscious decision to ration care."

"If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women," said Carol H. Lee, MD, chairwoman of the ACR Breast Imaging Commission.

The American Cancer Society is standing by its advice for annual mammograms beginning at 40, as is the Society of Breast Imaging.

"The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40," said Otis W. Brawley, MD, chief medical officer of the society. "Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider."

"The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group," Brawley said. "Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. ... With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them."

"It is the opinion of your SBI leadership that adopting these guidelines would result in a major step backward in women's healthcare and increased deaths from breast cancer," the SBI said in a statement on its Web site.

The Radiological Society of North America (RSNA) will be holding a press conference at its annual meeting - Nov. 30-Dec.4 –  to address the recent reports, said spokeswoman Maureen Morley.

The vice chair of RSNA's Public Information Committee, Mary C. Maloney, MD, director of breast imaging at the University of Cincinnati College of Medicine, said, "Despite the limitations, screening mammography is a very effective test and a valuable tool in fighting against breast cancer. Yearly screening mammography beginning at age 40 is still the best, most efficacious method of reducing mortality from breast cancer."

In a statement released Tuesday, Health and Human Services Secretary Kathleen Sebelius urged women to do what they had always done – consult their doctors and make the decision that was right for them. She also clarified the role of the USPSTF.

" The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations," she said. "They do not set federal policy and they don't determine what services
are covered by the federal government."