We propose a method for local, region-based matching of planar shapes, especially as those shapes that change over time. This is a problem fundamental to medical imaging, specifically the comparison over time of mammograms. The method is based on the non-emergence and non-enhancement of maxima, as well as the causality principle of integral invariant scale space. The core idea of our Region Matching Algorithm (RMA) is to divide a shape into a number of "salient" regions and then to compare all such regions for local similarity in order to quantitatively identify new growths or partial/complete occlusions. The algorithm has several advantages over commonly used methods for shape comparison of segmented regions. First, it provides improved key-point alignment for optimal shape correspondence. Second, it identifies localized changes such as new growths as well as complete/partial occlusion in corresponding regions by dividing the segmented region into sub-regions based upon the extrema that persist over a sufficient range of scales. Third, the algorithm does not depend upon the spatial locations of mammographic features and eliminates the need for registration to identify salient changes over time. Finally, the algorithm is fast to compute and requires no human intervention. We apply the method to temporal pairs of mammograms in order to detect potentially important differences between them.