Mammogram shows something - now what?

in my experience, once someone says they see something, others won't disagree.

Yep, that's probably to be expected. 

I'm coming to realize my gut reaction: I wasn't feeling confident in their ability to read my films. And I'd rather find an expert in dense tissue now (and/or better imaging equipment for it), than continue this process, and my annual visits, with various people who seemed to get increasingly frustrated at not being able to see anything through my apparently opaque boobies.

My SMG OBGYN suggested 3D mamo due to dense breasts and a cyst seen last year.  They do it at SMG although she did say that some insurance doesn't cover it.  Thanks for the reminder, need to call for an apt.   

I am on the same boat. Dense breast tissue. Trying to see if a 3D will be covered by insurance. 

I thought there was some kind of NJ legislation within the past few years,  mandating insurance coverage for the additional scans you have to get if you have dense breasts. Screening v diagnostic seems to be a "covered" v "bad coverage" divide when it comes to the amount you get billed for (facility + radiologist to read the scans + labs if biopsy is taken. Close monitoring = v high unreimbursed medical For the consumer, v high billing for the provider).

breal said:

I thought there was some kind of NJ legislation within the past few years,  mandating insurance coverage for the additional scans you have to get if you have dense breasts. Screening v diagnostic seems to be a "covered" v "bad coverage" divide when it comes to the amount you get billed for (facility + radiologist to read the scans + labs if biopsy is taken. Close monitoring = v high unreimbursed medical For the consumer, v high billing for the provider).

Wondering about this. I just checked with my insurance and they confirmed that 3D is not covered. UGH!

I think in NJ notification of dense breast tissue is required.

Yep. I got my letter welcoming me to the club, but with no info on what to do about it now that I'm here.

Found an article on it from 2 years ago: It says: 

"Beginning today, all women who have mammograms will get a follow-up letter telling them they may have dense breasts and to raise the topic with their doctors.

New Jersey joins 14 other states in enacting a law ordering radiologists to raise the issue of breast density — which can make tumors harder to spot — in their patient reports.
The law also orders insurance companies to boost coverage for ultrasound screenings, which can turn up cancers that mammograms miss." 

But it doesn't say anything about 3D.  

http://www.nj.com/healthfit/index.ssf/2014/05/new_regulation_for_mammograms_in_nj_takes_effect_today.html

I'll see if I can find anything more recent...

did they recommend ultrasounds for you? 

This NYT piece gives kind of a nice overview & good links:

Study Suggests Dense Breast Tissue Isn’t Always a High Cancer Risk

http://www.nytimes.com/2015/05/19/health/study-finds-dense-breast-tissue-isnt-always-a-high-cancer-risk.html?_r=0

Yes, I had a follow-up U/S. Apparently, I'm so dense, they couldn't see well on the U/S either. First the U/S tech asked if I had just stopped breastfeeding recently (not unless 7 years ago is 'recent'!). And this is where the radiologist's frustration started to heighten. The tech said the radiologist didn't usually do the U/S himself... but he came in after seeing the tech's first set of images, took the hand scanner from the tech, then kept scanning... and rescanning... and rescanning. My armpit is still tender.

I felt like an unusual and frustrating case. Which didn't inspire confidence.

@pmartinezv

The Dense NJ Facebook page (who knew?) indicates that follow-up screenings in NJ are required to be covered by insurance:

https://www.facebook.com/DENSE.NJ/

Have you been declined insurance coverage for supplemental screening? DENSE NJ wants to know!

Our NJ Law requires insurance coverage for supplemental screening, including but not limited to ultrasound, breast MRI and/or 3D mammogram. If your insurance company has declined to provide coverage, your next step may be to contact the NJ Department of Banking and Insurance to file a complaint.

What is meant by "coverage"?  An annual screening mammography is just covered --with little or no copayment, as with a physical every couple of years. But you enter the zone of high co pays and deductibles, it seems, if the screening scan best fitted to your particular ta-tas is something other than a mammo.

Thank you! That is good to know. I may point this out to them and see what they say.

sprout said:

@pmartinezv

The Dense NJ Facebook page (who knew?) indicates that follow-up screenings in NJ are required to be covered by insurance:

https://www.facebook.com/DENSE.NJ/

Have you been declined insurance coverage for supplemental screening? DENSE NJ wants to know!

Our NJ Law requires insurance coverage for supplemental screening, including but not limited to ultrasound, breast MRI and/or 3D mammogram. If your insurance company has declined to provide coverage, your next step may be to contact the NJ Department of Banking and Insurance to file a complaint.

I've got mine on Friday, so this thread caught my eye. 

You might find this recent report reassuring.https://medlineplus.gov/news/fullstory_159927.html

I seem to be late to the discussion. I have very dense cystic breasts. I go to the Breast Center in Montclair. They have 3D mammos. I always get a sono and every other year I get an MRI. My mother and sister (younger) have both had breast cancer. Although not the genetic one. I did have a biopsy once. I really cannot understand not getting a biopsy if it is recommended. Although I can certainly understand getting a second opinion. 

wendyn said:

I had a similar issue last year and went to the breast group at Summit Medical Group in Berkeley Hts.  While everyone was nice and the medical care was great, they recommended a biopsy despite a 95% chance of being benign (no cancer in my entire family, I breastfed, etc.).  My hubby was too worried to let it go so I had one.  Like your mom I am still angry that I let myself get talked into it!  

So while I would recommend SMG for their medical acumen and care, I would go with your gut as to whether to have a biopsy.  You can wait 6 months and have another mammogram done and if anything changes THEN have the procedure.

Good luck

The problem with statistics is they only apply to the group, not to the individual.  If you are in the 5 percent category and have cancer, then it will happen to you 100% of the time.    And if the doctor's want you to get a biopsy, I would get a biopsy.  I did not go to medical school, nor from your description did you.  Your gut, or mine, is no substitute for medical advice.

Having had breast cancer, one of the most difficult memories is sitting next to a woman waiting for our daily radiation who explained that she refused a biopsy (and a breast MRI) because she had no family history, was a vegetarian, etc.  And by the time she got one, it was inevitably later in the process and more advanced.

So, short and sweet, do the biopsy if your doctor recommends.

And you should be happy you had a biopsy.

Sorry that is incorrect.   My first doctor told me she would wait 6 months and do another mammo, and if things had changed that is when we would move forward.  But she had me see a breast specialist, whose main job is doing biopsies.  The reasonable thing would have been to wait.   In most breast cancer situations it is not so aggressive that 6 months would make a difference in a treatment plan.

I don't have a medical degree but I'm not an idiot either.  This was a cya procedure that could have been handled differently. But hey my fault for listening to the guy and not piushing back.

No one is "refusing a biopsy".  It is entirely reasonable to explore the options because it's possible they'll be able to see the area in question better if 3D or MRI imaging is used.

Frankly, if better imaging allows them to see the area in question with more clarity, this would also increase the likelihood of hitting the right spot with a fine needle, if biopsy is performed.

mine was same- another mammo and ultrasound in 6 months or MRI. Breast specialist wanted MRI and everyone agreed after that. I think it was unnecessary as well. It wasn't that something was found, it was that they couldn't get a perfect look at something. Big difference so definitely explore the reason behind the biopsy or additional testing.  In hindsight for me, a 6 nth follow up would have been perfectly adequate. Luckily mine was an an MRI not biopsy so all I lost was time/$. I'd definitely question it more if recommendation was biopsy.

As the linked report says, most of the time, the people reading the mammograms can't agree on the results and make subjective recommendations for further testing - because of the current level of knowledge and technology. There's a mix of skills and tech in the 'marketplace' now, and if we're not lucky enough to be seen by someone familiar with the very best of both, who can adapt them to our individual breasts, it's professional guesswork whether or not we are called back. Most of the time when we're called back, the results are nothing to worry over.

Okay, after I typed up the below treatise, I finally figured out my lede: 

Can anyone recommend an NJ Insurance Coverage Expert with expertise with Anthem Blue Cross Blue Shield?  

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I am headed toward a breast MRI.  Ultrasound-guided biopsy was canceled DURING the procedure, when the ultrasound pix generated that day by the scanning doctor were judged by the needle doctor not to indicate the need for a biopsy. Needle doc said, first MRI. (I have a horrible feeling that I am going to be billed for everything anyway. I did undergo an ultrasound--at their own practice's wrong recommendation.)

Has anyone researched cheap places for breast MRIs?  My insurance may be the kind that doesn't have to pay attention to NJ regs relating to coverage of breast scans.   I think the issue may be that employers who self-fund their plans, even if said plans are administered by a public-sounding contractor (Anthem Blue Cross Blue Shield in my case) may not have to follow NJ's rules???

These are expensive tests to undergo on a regular basis.  

For a previous MRI (not breast), even after I had paid my deductible for the year ($600), costs that landed on me were: Facility fee: "co-pay" of 20%  PLUS big "co-insurance payment" (this means, additional cost-shifting to the patient, special for this specific test); Doctor fee: co-pay of 20% for doctor who looked at the scan.  My liability ended up being several hundred dollars (not counting my deductible).

And P.S., now comes word that the IV contrast chemical they use just sits around in your brain.

In response to your point, I have not heard about "IV contrast chemical just sits around in your brain".  Couldn't find on Google either.  There is known risk of kidney damage and unclear advice for nursing mother, http://blog.ercast.org/iv-contrast/.  Also diabetics who are on medicine, pills or insulin, have to use a specific sequence of medicine both before and after receiving constrast.

Regarding a "cheap MRI", I too have Anthem BC/BS, but i know it is tailored for my employer, which is a Fortune 20 company.  I know the plans vary.  Online there is a tool for estimating costs, and looking at MRI - One Breast, the cheapest is University Radiology of Bedminster, although the locations listed are Newark and Nutley.  Cost for the procedures is $1185.  I cannot tell what is included here and the cost will vary by whether you have met your deductible, copays etc., but your website may have a similar tool. 

So went for my annual, decided to do the 3D after the person signing me in at St Barnabas mentioned that United covered it. Also did the mammogram. All came back normal although it was stated once again that I have extremely dense breasts. So fingers crossed that they did not miss anything. I will let you know if I get a bill from the insurance in a few weeks regarding the 3D. 

Same thing happened to me on my first mammogram over twenty years ago.  In my case, I was breastfeeding at the time, so it was hard for them to sort out calcifications and milk ducts, etc., so I had several follow-ups at 3 or 6 month intervals for a year or two.  I echo those who say that if it was something obviously really bad, they would have done more tests right then and there.  

is a breast biopsy painful?  

I had one a few months ago.  The procedure itself was fairly painless.  The area was a little sore for a few days, but nothing that ice and Advil couldn't alleviate.  Overall, far less painful than a root canal.

The worst part is waiting for the results.

sac said:

Same thing happened to me on my first mammogram over twenty years ago.  In my case, I was breastfeeding at the time, so it was hard for them to sort out calcifications and milk ducts, etc., so I had several follow-ups at 3 or 6 month intervals for a year or two.  I echo those who say that if it was something obviously really bad, they would have done more tests right then and there.  

I'm getting flack from a new midwife at the practice for not yet having had a mammogram done (I'm 43).  However, I've been either pregnant or breastfeeding constantly since age 36, and I have heard from multiple sources that under those circumstances I am much more likely to get a false positive and I don't want to go through all the stress and extra tests that come with it.  The other midwives I see at the practice understood the situation and were fine with me waiting so long as I went as soon as my son is eventually weaned.  Frustrating.

Is your biopsy thru an MRI or mammo guided?