(FORTUNE Magazine) – For all the pink ribbons and breast-cancer walks, how much progress has society really made in detecting and battling breast cancer, a disease that strikes one in eight women? Not as much as you think. A major review of several large-scale studies has reignited a controversy over mammograms and early detection. Conducted at the Nordic Cochrane Centre in Copenhagen, Denmark, the review could find no reliable evidence that routine mammograms--the most highly touted screening tool--either prevent breast-cancer deaths or lead to better treatment. That may help explain why breast-cancer mortality rates haven't improved a whole lot in 20 years. "There is a misconception that [doctors] have a better handle on breast cancer than we really do," concedes Susan Love, a surgeon and medical director of

the Santa Barbara foundation that bears her name. In light of that depressing reality, you have a choice. You can join the skeptics who believe that the emphasis on early detection often does more harm than good, pushing women into traumatic treatments that may not have much effect. Or you can follow the overwhelming consensus in the medical community--and the advice of the American Medical Association--that such vigilance is worth it. If you are in the latter camp, here's the most up-to-date advice.

First, get a thorough risk assessment. We're still a long way from being able to look at our individual genomes and calculate precisely our cancer odds, but the newest risk-assessment models are a step in that direction. They take into account such factors as whether breast cancer runs in your family, your age, the results of past biopsies, and your childbearing history. (Bad news for a lot of professional women: Having your first child after 30 puts you at higher risk, as does having no children.) At the end, they spit out your individualized cancer risk. A 1.7% or greater chance of developing cancer over the next five years is considered high. Your gyno is clueless about such assessments? Consider visiting a breast specialist.

Once you know your risk, your doctor can customize a plan for prevention and screening. If you're at increased risk, he or she may recommend clinical exams semiannually instead of annually. You'll definitely want to think twice about hormone-replacement therapy, which has been associated with increased breast cancer risk (see Menopause). And you may want to consider the anti-estrogen drug tamoxifen, which, despite daunting side effects like increased risk of uterine cancer and blood clots, halved the incidence of breast cancer in clinical trials of high-risk women. Keep an eye on raloxifene, an osteoporosis drug that Eli Lilly is testing as a risk reducer for breast cancer; it may have fewer side effects.

As for screening tools, mammograms--for all their drawbacks--are still widely held to be vital, and newer computerized digital mammography may do a better job than film for women with dense breasts. A promising new screening procedure is called ductal lavage. It involves inserting a tiny hairlike catheter (approved by the FDA last year) through the nipple and into a milk duct, a process that sounds more painful than it is. Fluid is extracted and studied for atypical cells that could be a precursor to cancer. So far only a few thousand women have undergone the procedure, which is offered now at 130 clinics as a risk-assessment tool (it typically costs $450 to $650 and is sometimes covered by insurance). Down the road, the hope is that ductal lavage may develop into an effective routine screening device--a kind of Pap smear for breast cancer.

--BETSY MORRIS