The brutal weather during my trip to the Regional Breast Center on Friday morning matched my discouragement from having just read a recent article challenging the effectiveness of mammography in saving lives.

As women have deservedly come to expect rapid screening results, I plowed through the snow to read what little screening mammograms were available. Here is a picture of a small treatable cancer found that morning. This finding forces one to reflect on the recent Canadian study in the British Medical Journal that has the potentially criminal effect of dissuading women like this from coming in for a "worthless" mammogram.

What I generally refer to as a "healthy debate" regarding the efficacy of mammograms has surfaced again.

While it is incumbent on physicians to often critically evaluate screening exams used in medicine, it is clearly "unhealthy" to imply there are not life-saving options available to women. The Canadian study in the BMJ is a shaky step in what would be a long uphill journey to debunk decades of studies proving a 35 percent reduction in breast cancer mortality with routine screening mammography.

This most recent criticizing mammography's value, along with similar earlier studies aimed at the same conclusion, is based on fatally flawed logic. For example, the recent study bases its data on imaging technology that is a generation old. But rather than pointing out the clear shortcomings of the study, I prefer to use the mammography debate as an ongoing motivation to develop more effective screening strategies.

As radiologists, we are aware of the limitations of mammography, but more aware of the lives mammography has saved by detecting small, treatable breast cancers. In addition, we are energized by the possibilities that new technologies offer.

Screening mammography remains a powerful life-saving tool, specifically in the hands of experienced breast radiologists and at high-volume diagnostic centers. Beyond that, however, we will soon experience a revolution in the way women's breast health is achieved. The days where all women adhere to the same regimen of yearly mammography may be soon disappearing.

The advent of new breast screening technologies as well as an increased realization of mammography's limitations in dense breasted patients is ushering in a new era of personalized breast screening. Specifically at St. Luke's, the question we are now asking is "What is the right screening test for you?"

In answering this question, we are taking into account a patient's risk factors and breast density to determine whether screening ultrasound, breast MRI, or 3-D mammography (tomosynthesis) may serve as an effective supplement to mammography. A combination of carefully chosen screening exams may lead to a significant increase in cancer detection rate while decreasing the amount of unnecessary return visits and biopsies.

When we look back on this time in future years, the hallmark of this era should not be that women stopped getting mammograms, but rather that this was a time when "personalized" screening strategies and technologies were provided to women, offering powerful weapons and options in the battle against breast cancer that were not available to their mothers and grandmothers.

Joseph Russo, M.D.

section chief of Women's Imaging

St. Luke's University Health Network