Susan Adler was 42 years old when she found a lump in her breast. The road that followed was a series of chemotherapy, radiation and surgeries until the Cranston resident emerged a cancer survivor three years ago.

She believes it was early detection that saved her life, and as women across the country are presented with conflicting information, she thinks survivors need to take a stand.

“It’s our responsibility, especially for all those women who have died from breast cancer,” she said.

Adler’s comments come in the wake of findings released last week by the U.S. Preventive Services Task Force, which recommended routine mammograms start at the age of 50. It also advised against self-examinations. This is a departure from earlier medical advice that stated such precautions should be taken starting in a woman’s 40s.

“It really scared me,” Adler said. “I thought that to tell women they shouldn’t do self-breast exams anymore was irresponsible – that’s how I found my lump – and I thought it really set women back tremendously.”

The blowback from the announcement has been mixed among survivors and health care professionals. The task force maintains that the recommendations are not an edict, nor are they politically motivated. In their report, which is based on aggregate data from new mammography studies paired with six groups commissioned to look at available statistics, they state that the decision to get a mammogram is a personal one between a patient and their doctor. That decision, they say, should take factors such as family history into account.

Still, some residents are concerned that the consequences of the report will be serious.

“It all comes down to money. They’re not looking at the personal level,” said Barbara Manni of Cranston, a breast cancer survivor who also found a lump during a self-examination at the age of 41. “It was a tough road and it would’ve been way worse if I hadn’t been diagnosed early on.”

Now in remission, she takes breast cancer awareness seriously. Manni even started a company called KareChiefs (www.KareChiefs.com) that produces headscarves for women who have lost their hair from cancer treatment. A portion of the profits benefits cancer-related charities and organizations.

Like others in the debate, Manni has questioned how the report will impact health insurance coverage of cancer screenings and have tied the findings to the current battle over health care reform.

“When one person dies, so many others are affected by it. I don’t know why they would think saving one life wasn’t worth the cost,” she said.

“It’s really bad that you have to put a price tag on people’s health,” Adler added.

Marlene McCarthy, the co-founder of the Rhode Island Breast Cancer Coalition, is a survivor like Adler and Manni. She has had invasive breast cancer twice, first at the age of 44.

The situation is upsetting for her too, but not for the same reasons.

“Women are angry, and they should be, but not at the new message,” she said. “They should be insulted by the old message that annual screening saves lives. Women believed and trusted this message, when in fact, it was another ‘marketing tool’ totally contrary to scientific evidence.”

In an e-mail sent out to members of the coalition’s mailing list, McCarthy pointed out that there are risks associated with mammography screenings. She says that the radiation held in the body through such procedures can be problematic, though conclusive figures are not available to support one side or the other.

“It is outrageous that with the amount of money spent on breast cancer research, so little has focused on new forms of screening,” she said.

McCarthy, speaking on behalf of the coalition, says that there is no scientific evidence that annual mammography screening is necessary. Women in their 40s, then, are faced with unnecessary biopsies and anxiety. She supports the task force’s stance that age 50 marks an appropriate turn in the testing approach because with menopause comes a shift in hormones that makes breast tissue less dense and mammograms easier to read. The American Cancer Society, however, isn’t convinced.

“The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40,” said Dr. Otis Brawley, the chief medical officer at ACS. “Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider.”

In 2003, Brawley says that the ACS did their own review of available data not unlike the figures factored into this most recent report. It is true, he said, that mammography has its limitations and effectiveness increases with age, but a life saved is reason enough.

“This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger or a family member,” Brawley said.

ACS data shows that approximately 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s and 22 percent in women in their 50s. Brawley agreed that better testing systems should be a priority in breast cancer prevention, but that it shouldn’t detract from methods already in place.

“As scientists work to make mammography even more effective, the American Cancer Society’s medical staff and volunteer experts overwhelmingly believe the benefits of screening women aged 40 to 49 outweigh its limitations,” he said.

Moving forward, survivors like Manni and Adler hope to keep women educated about their options.

“I think as long as we keep speaking about all of this, that is grassroots right there and that’s important,” said Adler.

She kept her two children, 15-year-old Joshua and 11-year-old Shoshana, in the loop about the entire process of her treatment from diagnosis to chemotherapy. She believes being open and educating others is key to the fight against breast cancer.

“I couldn’t hide my head in the sand and think this couldn’t happen to them,” she said. “I wanted them to be armed with all of the information so as they move forward in this world they’re educated in what’s going on.”