The prestigious panel of medical experts who provoked a nationwide debate when it suggested fewer mammograms is standing by its recommendation that women 50 and older only get the screening every other year.

The U.S. Preventive Services Task Force issued an update of its 2009 guidelines on Tuesday, noting that women in their 40s with an average risk of breast cancer should discuss mammography with their clinicians and make individual decisions about whether to have the screening.

When the panel made the panel first made the recommendation, it provoked an outcry from some medical associations and cancer-awareness advocates who feared the advice would lead some women to delay having mammograms and put them at greater risk of death.

“In 2015, contentious discussions about breast cancer screening and prevention continued, with physicians, advocates, lawmakers, and scientists all lending their voices to the debate,” the Task Force said in an editorial on its website.

“Many of these stakeholders focused on the need for women to be able to make more informed health care choices about when to start screening without having to worry about the cost of an insurance copayment,” said the panel of experts, including Stanford Health Policy’s Douglas K. Owens, director of the Center for Health Policy and the Center for Primary Care and Outcomes Research.

“The role of the U.S. Preventive Services Task Force (USPSTF) in these discussions has remained unchanged: to empower women with the best scientific data about the benefits and harms associated with breast cancer screening, so they can make an informed decision with their doctor.”

Breast cancer is the second-leading cause of cancer death among women in the United States, according to the National Cancer Institute. In 2015, an estimated 232,000 women were diagnosed with the disease and 40,000 women died. It is most frequently diagnosed among women aged 55 to 64 years, and the median age of death from breast cancer is 68 years.

The task force determined that while screening mammography in women aged 40 to 49 may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger.

The balance of benefits and harms is likely to improve as women move from their early to late 40s, the task force said.

“In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime,” the Task Force said. “Beginning mammography screening at a younger age and screening more frequently may increase the risk for over-diagnosis and subsequent overtreatment.”

The independent panel of medical experts from around the nation said that women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.

Not everyone is pleased with the recommendations.

Florida Congresswoman and chair of the Democratic National Committee, Debbie Wasserman Schultz, issued a statement that suggested the Task Force recommendations could put younger women at risk because their insurance companies may stop paying for their screenings.

“These guidelines indicate that screening for women under 50 is less beneficial in detecting breast cancer than for older women,” said Wasserman Schultz, herself a breast-cancer survivor. “However, because insurance companies often use these guidelines to determine coverage for these critical life-saving screenings, these new recommendations could potentially bar millions of women from getting coverage for screenings they need.”

Judy Salerno, president and CEO of the Susan G. Komen breast cancer charity, said she worries the recommendation could target African-American women in particular.

“A lack of coverage would be most harshly felt in high-risk and underserved populations,” Salerno said. “African-American women, for example, are often diagnosed at younger ages with aggressive forms of breast cancer – and die of breast cancer at rates over 40 percent higher than white women. Screening at younger ages is a critical tool for these women.”

Members of the Task Force, however, emphasized that it was their role to evaluate scientific evidence and not make insurance coverage decisions.

“The USPSTF acknowledges the important role that insurance coverage plays in access to and use of preventive services,” the Task Force said in its editorial. “Coverage decisions are the domain of payers, regulators and legislators. Whatever we may believe about the importance of coverage in shared decision-making about mammography, we cannot exaggerate our interpretation of the science to ensure coverage for a service. This would lead to confusion regarding the state of science versus the politics of coverage.”