New guidelines advising against routine mammograms for younger women and dismissing monthly breast self-examinations have shaken up — and even infuriated — some local breast cancer survivors and cancer experts.

“I was appalled when I heard that,” said six-year breast cancer survivor Stephanie Sorrick, of Chattanooga, who discovered a lump during a self-exam at age 48 in 2003.

“I can’t even tell you how upset about it I am,” she said. “What if I had not done my own breast check? If I would have waited for another nine months to go to the doctor again, I’d be dead.”

The recommendations from the U.S. Preventive Services Task Force say women should begin getting routine mammograms at age 50 instead of the previous recommendation of 40, and that those exams should come every two years instead of every one or two years.

The task force, an independent panel of primary and preventive care experts funded by the federal Agency for Healthcare Research and Quality, also advises against training women to perform monthly self-exams, which the panel said have no proven record of saving lives.

The task force does not recommend screening women over age 74 for cancer. Many of the elderly women diagnosed with cancer, typically slow-growing in older women, would die from other causes before their cancer ever would become a threat, the task force said.

When determining the guidelines, the panel focused on weighing the harms of screenings against the benefits, and the new recommendations aim to spare women from unnecessary biopsies and stressful testing for false alarms, said Dr. Lucy Marion, dean and professor at the Medical College of Georgia’s School of Nursing in Augusta, Ga., who’s been a member of the task force for five years.

Local reactions include vehement opposition from radiology groups that perform mammograms as well as breast cancer advocates, who say the new recommendations are a step back for women’s health care.

“It just doesn’t make any sense to me, their logic,” said Dr. John Nelson, medical director of Battlefield Auxiliary Breast Center at Battlefield Imaging in Fort Oglethorpe. “They didn’t even mention ... the benefits of less-invasive and less-disfiguring surgery that you can achieve if you’re diagnosing breast cancer earlier.”

Dr. Jessie Varnell, co-medical director of radiology at Chattanooga’s MaryEllen Locher Breast Center at Memorial Hospital, said that every day the center sees women in their 40s with breast cancer.

“To say they’re not worth that cost is ridiculous,” she said. “You’re talking about women in the prime of their life with children and families.”

Others, though, say the task force has raised legitimate questions about the value of routine screenings.

“Screening is not perfect,” said Dr. Laura Witherspoon, a breast surgeon with University Surgical Associates in Chattanooga. “There are cancers not detected by mammography and cancers that grow too fast and come up between mammograms, and those women aren’t helped by mammography.”

Researchers lately are calling into question long-held assumptions about the efficacy of screenings for breast and prostate cancers, in particular. An article published in the Journal of the American Medical Association last month said the results of 20 years of screenings for breast and prostate cancer are “troubling.”

Even though more early-stage cancers are being detected, there has not been a proportionate decrease in late-stage cancers, suggesting that screenings are detecting more low-risk cancers but aren’t able to catch many of the aggressive cancers that become fatal, the article said.

COST BARRIERS?

Some advocates are concerned that the task force’s recommendations will become a barrier to women seeking screenings, since Medicare and private insurers base their coverage decisions on guidelines from such entities.

BlueCross BlueShield of Tennessee’s coverage for mammograms — which pays for one baseline exam for women between the ages of 35 and 40 and an annual exam for women after 40 — is “extremely unlikely” to change its policy on mammograms any time soon, since it bases coverage primarily on the American Cancer Society’s recommendations, which haven’t changed, spokesman Scott Wilson said Tuesday.

Some argue, including doctors, that the recommendations seem geared toward cutting health care costs, not focusing on the well-being of patients.

“When I see something like this, I get very suspicious and very skeptical, particularly when it runs contrary to three or four other major recommendations from legitimate groups,” said Dr. John McCravey, medical oncologist at Erlanger hospital.

Chattanooga oncologist B.W. Ruffner emphasized the number of lives he’s seen saved by breast self-exams.

“Some of the meanest cancers, the ones most likely to kill people, can show up in between mammograms,” he said. “The disaster would be to say, ‘I had a normal mammogram in November, so I don’t need to worry about this lump I’m feeling now.’”

During a self-exam in 2003, breast cancer survivor Darlene Smith, 52, felt a large lump in her breast that turned out to be advanced cancer. After chemotherapy and a double mastectomy, she has been in remission for six years, she said.

“I’m wondering where the recommendation is coming from,” said the Chattanooga resident. “If I had not checked my own breasts, I would have died. There’s no two ways about it.”