A few years ago, a controversy over whether mammography actually saves lives threw women and their doctors into a quandary about whether it was worth getting screening mammograms to identify breast cancers too small to cause symptoms.

In 2001, Danish researchers analyzed the existing studies of the effectiveness of mammography. They concluded that the studies were too flawed to show any survival benefit in women who obtained mammograms compared with women who didn't.

The two best-quality studies suggested that women younger than 50 who got screened did not live longer than those who weren't screened, the scientists charged. Their analysis found only a modest survival increase in women aged 50 and older. Their findings were published in The Lancet, a respected medical journal based in Britain.

The idea that finding a breast tumor early probably wouldn't significantly increase a woman's life expectancy triggered a storm of controversy in the medical field and among organizations that advocate for women's health. The final resolution may never be found, but in the meantime, women want the best answers available.

While mammography often identifies breast cancer at the most treatable stages, it's an imperfect screening tool. Mammograms sometimes fail to show real tumors. Other times they show suspicious-looking masses that are actually harmless, leading to needless biopsies, surgery, expense and anxiety for the patient. When a mammogram does find a tumor, that tumor has usually been growing - and maybe spreading to other parts of the body - for several years already.

Nonetheless, when the American Cancer Society updated its breast cancer screening guidelines in 2003, it recommended that women start getting annual mammograms at age 40. The ACS guidelines added that women at high risk of breast cancer (such as those with a strong family history of the disease) might benefit from mammographic screening before age 40. Ultrasound and magnetic resonance imaging might also help screen high-risk women, the ACS said. The organization noted, however, "the evidence currently available is insufficient to justify recommendations for any of these screening approaches."

The National Cancer Institute has similar guidelines, recommending that women in their 40s and older get mammographic screening every one to two years, and that high-risk women "seek expert medical advice" about when and how often to get screened.

Conflicting advice can make the decision about whether and when to get mammograms perplexing.

I decided to go ahead with mammography. I figured that if a mammogram finds a tumor when it's still small, it's more likely to be treatable by removing only the lump rather than removing the whole breast. And who would choose to go through the rigors of chemotherapy if they didn't have to?

A recent study seems to support my conclusion. Researchers at Dartmouth-Hitchcock Medical Center found that women whose cancers were found by physical examination (meaning either the women or their doctors found their tumors) were three times more likely to have chemotherapy than women whose breast cancer was detected by mammography. And the women whose breast cancer was detected by physical examination were more than twice as likely to have a mastectomy rather than gentler surgery that conserved the breast.

Earlier treatment doesn't guarantee cancer will never recur, but it may slow or halt cancer growth. Even if mammography saves only a small percentage of lives, who can put a price on the value of a life?

So I'll stick with mammography, despite its flaws. Ongoing research may soon identify more accurate screening methods; digital mammography and ductal lavage are two methods that show promise.

Is money a barrier between you and a mammogram? The Montana Breast and Cervical Health program at the Lewis and Clark County Health Department offers free mammograms and cervical cancer screenings for women aged 50 and older who need financial assistance. The program also helps younger women who have a breast lump and who want a mammogram to help them and their health care providers decide what to do about it. For more information, call Martha Finley at 457-8923.

Don't let fear hold you back. Most breast cancer isn't fatal. An estimated 211,240 cases of invasive breast cancer will be diagnosed in 2005, and about 40,200 people die of breast cancer annually, according to the American Cancer Society. These numbers have stayed stable for the last several years, suggesting that about 81 percent of those who develop breast cancer don't die from it.

"Breast cancer death rates are going down," the American Cancer Society Web site says. "This decline is probably the result of earlier detection and improved treatment."

Laura Behenna is a development and public information specialist at the Lewis and Clark City-County Health Department.