Fewer women are getting mammograms. Facilities offering mammograms are closing. Mammogram machine usage is declining. And we don't really know why.

"We're heading in the wrong direction," says Carol Lee, professor of radiology at Yale University School of Medicine and chair of the American College of Radiology's commission on breast imaging.

"If this decline holds up, it will be very worrisome," she says.

"We're looking at a possible increase in deaths if we see this continue," according to Diana Balma, vice president of public policy at Susan G. Komen for the Cure.

Studies don't show which women -- rich or poor, young or old, educated or uneducated -- are skipping these critical screenings, but there are a few possible reasons for this dangerous drop.

Think about this:

Perhaps there are fewer facilities, staffed by fewer radiologists and technologists due to high lawsuit rates and modest reimbursement. This is scary -- because the number of women old enough to get screened is increasing.

Women may be missing out on all sorts of necessary medical care because of inadequate health insurance or other access problems.

Women may be choosing, for whatever reasons, not to get mammograms, despite strong public urging that women age 40 and older get screened one time every year.

And now think about this:

Recent news about declining breast cancer rates may not be all that good. It may not be that fewer women are developing breast cancer. It may simply be that fewer women are getting early diagnoses because of irregular or nonexistent screening.

I am an expert in the game of what-if. I guess it's because my recent what if this hard lump in my breast is cancer worry turned into Oh My God, it is cancer that I am so polished at this exercise in all things irrational. Sure, some worries will be fulfilled by reality but for the most part, things turn out okay. But still, I worry. When a bone hurt in my arm last year, I was sure it was bone cancer. It wasn't. When I felt a soft bump on the roof of my mouth, I whisked myself to the dentist for my mouth cancer diagnosis. It was just a little bit of inflammation, probably from a cold. A headache landed me in a tube for a scan of my head. It revealed nothing interesting, and ibuprofen fixed me right up. And lately, I am checking every mole, freckle, spot, speck, and discoloration that adorns my fair skin.

I asked about each of these what-if marks yesterday at my annual skin cancer screening. Surprise -- nothing is wrong with me. But all unfounded fears aside, there is some method to my madness about skin cancer because I have had several bad burns in my life, have spent too many hours in the sun in search of a tan, and have already had a few pre-cancerous spots removed from my skin. So I do plan to monitor my skin -- just maybe not every day -- for the ABCDs of melanoma. And you should too -- because melanoma is the deadliest of skin cancers, and it is known for spreading, which makes treatment essential. So consider these what-ifs when screening yourself for skin cancer.

What if a spot on my skin is Asymmetrical? This means that one half of the mark on your skin does not match the other half. See your dermatologist.

What if the Border of the spot is irregular? This means that the edges are ragged, notched, or blurred. See your dermatologist.

What if the Color of the spot is not uniform? This means that shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance. See your dermatologist.

What if the Diameter is more than 6 millimeters? This is about the size of a pencil eraser. Any growth of any mole should also be of concern. See your dermatologist.

It is estimated that 44,000 Americans will develop melanoma annually. Of these people, 7,300 will die. But the death rate is declining -- because patients are seeking help earlier. Perhaps the ABCDs of melanoma are helping. I hope they help you -- and me too.