In 1974, First Lady Betty Ford saved the lives of millions of woman with a simple act: she spoke openly about the fact that she had breast cancer and encouraged women to get mammograms, then a relatively new test. At the time breast cancer was one of those unspeakable scourges; even saying the words in ordinary conversation was considered somehow improper. After Mrs. Ford tore down this curtain of secrecy, women's health advocates took up the challenge of convincing women to get regular mammograms in order to find malignant breast cancer cells early, when there's the greatest chance of stemming their spread. Their efforts were astoundingly successful. By 2000 more than 70 percent of American women over 40 reported getting regular screening.

This campaign season a potential First Lady—Elizabeth Edwards—has also spoken openly about her own courageous struggle with breast cancer. You would think that by now mammograms would be routine, a part of every woman's preventive health-care arsenal. Well, you would be wrong. According to a report this spring from the National Cancer Institute, mammography rates have been steadily declining throughout this decade. Between 2000 and 2005, mammogram usage dropped roughly 7 percent among women between 50 and 64 and 4 percent among women over 65.

This is significant, because your chances of getting breast cancer increase as you age. Although there is some disagreement about how often women need mammograms, they are still generally considered the most effective first-line screening tool. The American Cancer Society recommends annual mammograms starting at age 40 for women at average risk (those with no family history of breast cancer). The National Cancer Institute guidelines recommend screenings every one to two years. To assess your personal risk, click here.

No one knows exactly what is behind the drop in mammogram use. Some researchers have blamed limited access to health care. While this could explain some of the decrease, it's clearly not the whole story. Perhaps the most surprising finding in the NCI study was that the decline was across the board, even among women who were highly educated and had good health insurance—women who have traditionally been the most likely to get mammograms. Another possibility is that women are confused by studies showing that mammograms can miss some cancers and sometimes identify possibly troublesome masses that turn out to be benign in biopsies. Even with these limitations, mammography is the best resource out there for lowering the risk of death, according to the American Cancer Society.

Finally, there's the issue of the mammogram experience itself. If you've ever had one, you know what we're talking about. It's like slapping your breast on a car fender and holding your breath as someone backs another car into you. In other words, it hurts a lot. For the uninitiated, here's a more technical explanation: You undress from the waist up and, with a technician guiding you, place one breast at a time between two plates attached to the mammogram machine. The plates squeeze your breast as flat as possible in order to get the clearest image. You have to hold your breath for a few seconds while the image is being taken. Generally, this experience is repeated four times, two images for each breast. If the technician notices something unusual, you may have to endure even more images. It doesn't take very long, but the pain can be intense. We took an informal survey of friends with small and large breasts, and both groups rated the experience only slightly more pleasant than root canal.

The discomfort of mammography is on our minds, because Barbara just had her annual exam. We wondered if there's anything we could do before the procedure to make it less miserable. Here are some tips from the experts: