The new mammography guidelines from the U.S. Preventive Services Task Force have left women confused, frustrated and in some cases just plain angry. The Task Force’s new recommendations were a complete reversal of the guidelines women have followed, and relied on, for years: Getting mammograms annually, starting at age 40, was your best protection against breast cancer.

Task force recommendations say women should wait until age 50 for their first mammogram and then only have the test once every two years, until age 74. For all women, but especially black women who have a higher risk of getting breast cancer in their 30s or 40s, the new advice was a shock that left them unsure of how best to care for themselves. Here, experts weigh in on what possibly led to the recommendations and what we should do.

1. What were they thinking? The Task Force, a group of 16 health experts convened by the Agency for Healthcare Research and Quality that makes recommendations on all types of preventive services, “looked at the decrease in the number of deaths from breast cancer related to mammography and compared that statistic to the number of false positives and unnecessary biopsies performed as a result of mammograms,” says Carol Lee, M.D., attending radiologist at Memorial Sloan Kettering Cancer Center in New York. “Their interpretation was that the benefit from mammograms given to women under age 40—a 15 percent reduction in breast cancer-related deaths—was small compared to the anxiety suffered by women receiving unnecessary biopsies and false positives.”

2. Is it really about anxiety? “To some degree,” Dr. Lee says. “A primary care physician might only have two patients a year with breast cancer, but several who need biopsies and do not have cancer. I think it’s about medical care costs.” The Task Force has denied this charge, though its Web site clearly states its recommendations are, in part, for insurance companies and guide what preventive services should be covered.

3. What should you do? Several studies have shown black women are more likely to get breast cancer when they are younger than 45 than women in other groups. “It’s very important for them to be screened by age 40,” Dr. Lee says.

Just as important, “take that mammogram seriously and be prepared to follow up,” says Olufunmilayo I. Olopade, M.D., a researcher and clinician at University of Chicago, who is an expert on breast cancer in African-American women. “The most important part of the recommendations is the suggestion that women talk to their doctors. Black women are at higher risk for early-onset, aggressive breast cancers, so some may need more than a mammogram. If your mother or sister had the disease, you may need a mammogram and an MRI. So learn your risk as well.” —Sheree Crute