The new guidelines to limit mammograms are deeply vexing. In recommending that the screening not be routine for women between the ages of 40 and 49 (except for those at high risk), the U.S. Preventive Services Task Force cited the high risk of false positives, unneeded biopsies and the resulting stress.

They say only one death is prevented for every 1,900 women ages 40-49 receiving annual mammograms over 10 years.

Those 1 in 1,900 cases are known to many as a wife, a mother or a sister.

The federal guidelines could have given those women a false sense of security and they may not have bothered with the not-so-pleasant test or the breast self-exams that the task force also says not to bother doing. There are many 1-in-1,900 cases that will come in the future.

Breast cancer is second only to lung cancer in causing cancer-related deaths among women, the task force report said.

The test used most often to screen for it, the mammogram, is fairly inexpensive, costing an average of about $100.

Is that too much? The whole discussion raises the specter of rationing and whether health reform might include more such chilling cost-benefit decisions to save a few bucks.

The report also called for every-other-year tests for women ages 50-74 rather than yearly screenings.

In the past, such federal guidelines have been used to make coverage decisions by the government and other insurers.

Hopefully that won’t be the case here, and Health and Human Services Secretary Kathleen Sebelius stressed that the guidelines were issued by “an outside independent panel of doctors and scientists who … do not set federal policy and … don’t determine what services are covered by the federal government,” according to a Washington Post article.

If the government and private insurers don’t use the report to cut costs, the guidelines could be helpful.

It is clear that the mammogram has much more limited value in younger women, whose breast tissue is denser. The false positive rate is 60 percent higher for those in their 40s, a Bloomberg article said.

The task force report should be a rallying cry to develop better screening tools for younger women, whether that be ultrasounds, MRIs, digital mammography or other techniques yet to be developed.

The guidelines also could be helpful in leading those who have no family history of breast cancer to have a discussion with their doctor about when they should begin getting mammograms.

Ultimately, the doctor and patient should be the ones to decide.