The North Dakota program that helps women pay for breast and cervical cancer screenings intends to continue its program as it has, despite last week's updated analysis from a federal panel that starting mammogram screenings at age 40 is not needed.

At the same time, some area medical providers are concerned the latest recommendations from the U.S. Preventive Services Task Force may further discourage women from having mammograms.

Mary Ann Foss is the director of the North Dakota Department of Health Division of Cancer Prevention and Control, which oversees the Women's Way program.

Women’s Way provides a way to pay for most breast and cervical cancer screenings for eligible North Dakota women.

"Women's Way will continue to provide screening mammograms annually for program-eligible women starting at age 40," Foss said. The task force's new recommendations on Nov. 16 state getting screened for breast cancer so early and so often produces many false alarms and unneeded biopsies without substantially improving women's survival rates. Foss was completely surprised by the task force announcement and had no idea it was coming. Numerous national health organizations, including the American Cancer Society and Susan G. Komen for the Cure, support the need for women to begin regular mammography screening at age 40. She said this latest recommendation only creates confusion.

"On behalf of the women throughout North Dakota, the message I would want them to hear loud and clear is let us continue to follow the American Cancer Society screening guidelines," Foss said. "That is get the first mammogram at age 40 and annually the year after.

She also agrees that women under age 40 who have family health histories of breast cancer should get mammograms sooner.

"The primary risk factor is if it is a first-degree relative, a mom or sister," Foss said. "That is where the highest risk is. The risk by percentage changes as it gets to second-degree relative."

She is quick to add the first-degree relative may include a father, as men also suffer breast cancer.

Foss said during 2007, 536 new cases of breast cancer were diagnosed. Ninety-three of these new cases involved women ages 40-49.

Another 121 cases fell within the 50-59 age grouping, while 122 cases were between ages 60-69, 122 between ages 70-79 and 93 for 80-plus.

Foss admits false readings do happen as mammography is not an perfect science.

"But the side I prefer to look at is when you are the woman sitting there in that clinic, you are not a diagnosis, you are a woman," she said. "If you are a women age 40-49, you want to find your breast cancer early while you can still get it cured."

Overall, Foss said programs like Women's Way have worked hard over the years to get mammogram screenings started at age 40, "and it just feels like it went backwards" with this latest set of recommendations.

Meanwhile, Williston's Fairlight Medical Center holds true to the American Cancer Society recommendation for women to get a mammogram once a year starting at age 40.

"I think the changed recommendations communicated from the U.S. Preventive Services Task Force is very confusing because it contradicts the ACS recommendations and we know from research and experience that more lethal cancers occur in women in their 40s," said Dr. Leszek Jaszczak, a board certified radiologist who leads the clinic's breast health program.

"The quicker we can identify the cancer, the better chance for a cure," he said.

He understands that mammography, like many health procedures, has limitations create false alarms, unnecessary treatment or may miss come cancers.

"However, the facts do not change. The breast cancer screening using mammography starting at age 40 saves lives," Jaszczak said. "As someone who has witnessed first hand the benefits of screening, this is one test I recommend undeniably. I would recommend mammography to most women 40 and over, regardless if she is a patient, a stranger or a family member."

Billings Clinic medical oncologist Dr. Roger Santala serves patients at Williston's Mercy Medical Center and is concerned the task force message may be misunderstood.

"I think the key from my standpoint is that this may be misunderstood that somehow, mammography is not effective," Santala said. "In some ways, mammography may be more effective."

He said in the past five years, most health care providers working with imaging have moved to digital mammography, which is more accurate and cuts radiation exposure by about half.

"I think my biggest message is mammography is without question a life saver and should be used as a tool to detect breast cancers early," Santala said.

He said these latest recommendations are an update of earlier findings regarding mammograms and self-breast examination.

"In some ways, it was known there was controversy around the recommendations of when to begin screening and the frequency of screening," Santala said. "The challenges for mammography is it is physically more difficult to screen younger women because younger women tend to have more dense breasts."

The second issue is the frequency of breast cancer is higher in older women, he said. The fact that mammography screening is more effective in older women is something that always has been known, Santala added.

"The challenge is that many of us in medical oncology are concerned that this will maybe be misunderstood or misapplied," he said. "The place where I think there is the biggest concern is about a third of women are not having routine mammograms on any kind at any age."

One of the fears associated with the latest task force findings is that health insurance providers are now going to change their coverage limits. Blue Cross Blue Shield of North Dakota vice president for corporate communications Denise Kolpack said that nothing is changing.

"We are still obligated to follow North Dakota statute," Kolpack said in referencing North Dakota Century Code Chapter 26.1-36-09.1.

That statute states: 1. An insurance company, nonprofit health service corporation, or health maintenance organization may not deliver, issue, execute, or renew any health insurance policy, health service contract, or evidence of coverage on an individual, group, blanket,

franchise, or association basis unless the policy, contract, or evidence of coverage provides benefits, of the same type offered under the policy or contract for illnesses, for health services to any person covered under the policy or contract for:

a. One baseline mammogram examination for each woman who is at least 35 but less than 40 years of age.

b. One mammogram examination every year, or more frequently if ordered by a physician, for each woman who is at least forty years of age.

2. This section does not apply to individually guaranteed renewable supplemental, specified disease, long-term care, or other limited benefit policies.