"In  an influential panel of medical experts ignited a nationwide uproar by suggesting that women needed fewer mammograms httphealth.nytimes.comhealthguidestestmammographyoverview.htmlinlinenytclassifier than had long been recommended. Instead of starting at age  and being screened every year women with average risk of breast cancer httphealth.nytimes.comhealthguidesdiseasebreastcanceroverview.htmlinlinenytclassifier could safely begin at  and be tested every other year the group said citing extensive data to support its advice. It also said that after  there was not enough evidence to determine whether routine mammography was worthwhile. Outrage ensued from advocates for screening who said the advice would lead to delayed diagnoses and deaths. On Monday the same panel issued an update of its guidelines  and it is sticking to its guns. The basic advice which applies to women with an average risk of breast cancer was unchanged. The recommendations are not immediately expected to affect insurance coverage. In December Congress passed a bill https requiring private insurers to pay for screening mammograms for women  and over every one to two years without copays coinsurance or deductibles through . Advertisement But advocacy groups said they were worried about what will happen after . It would be great if screening could be covered forever said Carli Feinstein chief of staff for Bright Pink https a national group focused on prevention and early detection of breast and ovarian cancer httphealth.nytimes.comhealthguidesdiseaseovariancanceroverview.htmlinlinenytclassifier. The Susan G. Komen for the Cure foundation also expressed concerns about insurance payment and issued a statement saying that a lack of coverage would hit high risk and underserved women hardest particularly black women who are more prone than whites to aggressive types of breast cancer. The panel issuing the guidelines is the United States Preventive Services Task Force http an independent board of doctors and other experts appointed by the Department of Health and Human Services to evaluate screening tests counseling and medications intended to prevent disease or detect it early. Panel members are volunteers and consider only the scientific evidence in their evaluations not cost or insurance coverage. The mammography guidelines http along with four editorials and seven supporting articles were published on Monday in the Annals of Internal Medicine.  The task force emphasized that it was not advising against screening for women under  or over  or against screening every year as opposed to every other year. Rather it says that women should choose for themselves  but that its guidelines offer the best overall balance of benefits and risks.  The task force also examined data for two subjects not included in its  report and concluded that there was not enough evidence to recommend for or against either of them. One was additional testing such as M.R.I. httphealth.nytimes.comhealthguidestestmrioverview.htmlinlinenytclassifier or ultrasound httphealth.nytimes.comhealthguidestestultrasoundoverview.htmlinlinenytclassifier for women with dense breast tissue which makes it difficult to detect tumors with mammography. The other was screening with a newer test called D mammography or digital breast tomosynthesis. Breast cancer is the secondleading cause of cancer httphealth.nytimes.comhealthguidesdiseasecanceroverview.htmlinlinenytclassifier death in women in the United States after lung cancer. In  there were about  new cases of breast cancer and  deaths. The highest incidence is in women aged  to . Dr. Constance Lehman a professor of radiology at Harvard Medical School and director of breast imaging at Massachusetts General Hospital who is not on the task force said she was pleased to see that although its advice had not changed the group had placed more of an emphasis than before on the importance of womens having the freedom to decide how often to be screened and when to start. The guidelines state that from ages  to  screening will reduce the odds of dying from breast cancer with women  to  benefiting the least and those  to  benefiting the most. The task force said it concluded with moderate certainty that the benefit was moderate in women  to  and small in women  to . For every  women screened repeatedly over  years four lives are saved in women  to  eight in women  to   in women  to  and  in women  to  the task force found. The science supports mammography as an important tool in the fight against breast cancer said Dr. Michael LeFevre a former chairman of the task force and a professor of medicine at the University of Missouri. He noted that breast cancer deaths have decreased since mammography came into widespread use in the s though some of the decline he said was also due to better treatments. We believe the benefits increase with age. But there are harms and particularly in their s women have to make a decision for themselves. One potential harm is false positives in which a suspicious mammogram finding leads to more tests sometimes even biopsies but turns out to be harmless. The guidelines relied in part on a study of records http from  women who had digital mammograms from  to  which found that false positives were common especially in younger women. Among those  to  who had regular screening for every  women tested . had a false positive.  Sign up for Science Times Well bring you stories that capture the wonders of the human body nature and the cosmos. Advertisement Another study httpannals.orgarticle.aspxarticleid in  found that  percent of women who had yearly mammograms starting at age  had at least one false positive by the time they were . Being tested every other year instead of every year cut the rate of false positives significantly to about  percent. Another potential risk is overdiagnosis meaning that some of the tiny cancers found in mammograms might never progress or threaten the patients life. But because there is now no way to be sure which cancers will turn dangerous they are treated anyway. Researchers agree that overdiagnosis occurs but they do not know how often.  Dr. Therese Bevers medical director of the Cancer Prevention Center at the University of Texas MD Anderson Cancer Center in Houston said she thought the task force overemphasized the importance of drawbacks like false positives. Dr. Clifford A. Hudis the chief of breast cancer medicine at Memorial Sloan Kettering Cancer Center also expressed concern The harm of a missed curable cancer is something profound. The harm of an unnecessary biopsy httphealth.nytimes.comhealthguidestestbiopsyoverview.htmlinlinenytclassifier seems somewhat less to me. Leading medical groups offer different advice about screening that leaves women and their doctors to puzzle it out for themselves. The National Comprehensive Cancer Network http an alliance of prominent cancer centers recommends mammograms every year starting at age . The American College of Obstetricians and Gynecologists http recommends them every year or two from ages  to  and every year after that.  In October one of the most influential groups the American Cancer Society dialed back its advice http Although for many years the society recommended mammograms once a year starting at age  it now advises that screening start at  continue yearly through  and then shift to every other year. Recognizing the confusion the cancer society the cancer network and other groups will attend a private meeting in Washington on Jan.  and  to try to produce a single set of guidelines. Representatives from the preventive services task force will attend but the task force cannot sign onto consensus statements. It can change its advice only by issuing new guidelines Dr. LeFevre said."