Although it would be possible to train people who aren't doctors to read mammograms effectively, Smith said the threat of malpractice litigation poses a huge obstacle for the supervising physician. But, he added, with more than 1 million new women entering the screening age range each year, "we may need to do something quite extraordinary to make sure that access to screening doesn't become a major problem."

New screening technologies will also be important to reducing the death rate from breast cancer, the report said. It called for greater collaboration among researchers, funding agencies, insurers, and doctors so that new technologies for detecting breast cancer can be developed, tested and put to use faster.

Researchers also must continue to refine their understanding of breast cancer risk factors, the report said, so that screening recommendations can be tailored to individual women. Genomic and proteomic tests or other biomarkers are technologies believed to have great potential, but Smith noted that these technologies are still in their infancy.

The report also called for better tools to help women and their doctors understand breast cancer risk. Many younger women overestimate their risk of getting breast cancer, while some older women underestimate theirs. A better understanding of breast cancer risk could help women make better choices about screening and other lifestyle factors that could influence this risk.

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