How to get a doctor to understand

michelleERRN

I am having trouble finding a doctor to order testing for me.  I am 36. My mom was diagnosied with LCIS at 50, DCIS as 52, she is now 60.  She was treated with Tamoxifen, radiation and a lump ectomy.  Her mother was diagnosed with DCIS at 72.  Her sisters, faternal twins, one was diagnosed at 47 yrs, the other now at 52 years.  The later was diagnosed at BRCA 2 +.  No one would order the test for my mother at the time, but she was recently tested.  I never could get a doctor to order a mamogram because it "was not indicated", but I paid for one on my own.  The results were "inconclusive, but patterns of immature califfication are present".  My last doctor would not order an MRI.  I am not sure where to go, what to ask, or how to find a doctor that will help me.

Any suggestions?  Any advise is welcomed.  Thanks

Beesie

The first big question is:  What were your mother's results on the genetic test? 

- If she tested positive, then you definitely should get the test as well, to find out if you are at risk.  If your mother carries the genetic mutation, then you have a 50% chance of carrying it too.  If you carry it, you are high risk.  But if you don't carry it, your risk may be no different than the average woman.

- If your mother tested negative, then even though other family members have the genetic mutation, you can't inherit it (at least from that side of the family); the BRCA gene doesn't skip a generation or skip people - it is inherited only via a direct line from one's mother or father.  So if your mother doesn't have it, you can't have it either (from her anyway; if it happens that the gene also runs on your father's side of the family and he has it, then you could inherit it from him).  If your mother tests negative, even though the cause of BC for other members of the family may be the genetic mutation, your mother's BC might be completely random, as approx. 85% of BC cases are.  In this case, your risk might be increased slightly, or there might be no increased risk at all - unfortunately there is really no way to know in the case of family breast cancers if the BRCA gene is not found.

The next big question is:  What was the BIRADs rating on your mammogram and did the lab suggest any follow-up?  Calcifications are most often nothing serious at all - approx. 90% of calcifications are benign and harmless.  Unless the calcifications form a pattern that could be cancer, the usual follow-up with calcifications is another mammogram in 6 months.  This is done to see if there is a change in the pattern, something that might indicate a problem.  If the calcifications do not appear in a suspicious pattern (either linear or clustered) in either the first mammogram or the follow-up mammogram 6 months later, then they are judged to be benign.  If the calcifications do form a suspicious pattern, either upon first viewing or in the follow-up, then usually a stereotactic biopsy (a needle biopsy) will be done.  In 80% of cases, the result is benign, but with a suspicious pattern, there is no way to know for sure without a biopsy.  So the question is whether the pattern of calcifications seen on your mammogram appeared normal (a scattered or random pattern, for example) or appeared suspicious. If it appeared suspicious, then an immediate follow-up, such as an MRI or a biopsy, would be in order.  Otherwise, a 6 month follow-up is more the norm.  What follow-up was suggested by your doctor?