Here's a familiar story: Trish Roberts had a mammogram at 45. That screening test found an aggressive form of breast cancer early. And she's alive today to tell the tale.

Here's a different one: A mammogram failed to pick up Nancy Ryan's breast cancer, which had spread to eight lymph nodes by the time she noticed a breast abnormality. Twenty years later, she too is alive to tell the tale.

A growing furor this week over new national recommendations on breast cancer screenings have providers and advocacy groups squabbling over the benefits of mammography, the breast imaging test most often used to detect early stage breast cancer.

Many advocates and breast specialists say the test should be used early and often to detect as many cancers as possible. But the U.S. Preventive Services Task Force, a federally appointed group that provides preventive guidance to doctors, has convinced many primary care doctors that regular screening of younger women may not be useful enough to justify the costs, false positives and over-diagnoses that can result.

Both sides agree, roughly, on the numbers. For women between 40 and 50 years old, about 1,900 women must be screened to save one life. Of those 1,900 women, nearly half will require additional testing sometime during the decade. In 10 years, about five will still die. More than six women will receive breast cancer diagnoses and be treated for the disease.

What those numbers mean is more controversial.

The task force concluded that the statistics were not persuasive enough to recommend the test for women under 50, but it continues to recommend mammograms every other year for women between 50 and 74. The American Cancer Society, examining the same data, reached the opposite conclusion. It continues to recommend annual mammograms for women beginning at 40.

"The ACS looked at that and still says the benefits outweigh the risks," said Beth Richards, the society's New Hampshire vice president of development.

Locally, several breast surgeons dismissed the new guidelines as cost-motivated. Early mammograms allow doctors to detect more early cancers, which can be more effectively treated, they said.

"There are a lot of false positives - a lot of things that end up needing biopsies or additional imaging, and it costs a lot to follow them up," said Dr. Sharon Gunsher, a breast surgeon at Concord Hospital. But, she said, mammograms also detect potentially treatable cancers. "The data do show that if you screen women annually, starting at age 40, you reduce mortality."

Roberts, now 55, said she credits her life to a timely mammogram. At the time of her diagnosis, her breast tumor was still small, but it had already spread from her breast.

"For me, I feel like I am here," she said. "If I had waited until 50? There was no lump."

But Ryan, who is now the chairwoman of the New Hampshire Breast Cancer Coalition, said the new studies confirm what researchers have known all along: that mammograms are not nearly as useful in preventing cancer deaths in young women than many people had hoped. That doesn't mean women should dismiss testing out of hand, she said, but it means that deciding when to get a mammogram is a decision that should be made after considering the studies and your own health history - and talking with your doctor.

The numbers are important, she said. Just because mammography didn't find her cancer doesn't mean it's a test without merit.

"It's complicated, and it's very nuanced, and it's not an easy message for women," Ryan said. "Unfortunately, breast cancer does not fit into a sound byte. It just does not."

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