A few questions after callback letter

TColorado

I recently had my first mammogram and received a letter calling me back for further testing. Hope you can help me with a couple of questions. My first question is typically how long do you have to wait for follow up testing? The mammogram report and letter calling me back for more testing showed up in my patient portal a couple of hours after I had my mammogram. I tried to schedule an appointment a few days later and was told they needed an order for the testing from my PCP. I left a message with my PCP a week ago, but I have received no communication back from my doc and am still waiting on the order. Is it typical for it to take a while for them to get the paperwork in order for follow up testing?

My second question is about a sort of freckle on my right areola. The freckle first appeared a few months ago, it was tiny at first and I never gave it much thought. It has grown a bit over the last couple of months, it's has an irregular border and is now about 1/2 CM. As I said I hadn't really been to concerned about the freckle, but when I saw that there is a mass posterior to the right nipple I wondered if the freckle something I should be concerned about? If so is there anything I should watch for? Thanks for your help!

Here is a portion of my mammogram report:

FINDINGS: CC and MLO 2-D and 3-D tomosynthesis views of bilateral
breasts were obtained utilizing digital technique. An exaggerated
lateral CC view of the right breast was also obtained. The breasts are heterogeneously dense, which may obscure small masses.There is a circumscribed nodule in the posterior right breast that measures 10 x 9 mm and is best seen on slice 21/61 of the MLO series. This is directly posterior to the nipple. Scattered calcifications are noted in both breasts. Overall Mammography Assessment: BIRADS 0 Need Additional Imaging Evaluation and/or Prior Mammograms for Comparison

RECOMMENDATION: Ultrasound.
Right

Beesie

Every facility and doctor is different. Many facilities require a requisition from a PCP for the initial screening, but often the Radiologist will order any diagnostic imaging that is required as a result of the first visit. The fact that they need your PCP to provide a requisition, and the fact that your PCP is taking so long, is specific to your facility and your doctor. I'd suggest you follow-up with your PCP. Could your PCP's office have sent the requisition directly to the screening facility?

If you are worried about the freckle, I'd suggest a dermatologist. I doubt it's connected to the mass seen on your mammogram. If I have my terms right, the nodule is at the back of your breast (i.e. close to the chest wall) but is directly in line with your nipple. So I don't think it's actually near your nipple. Hopefully someone will come by to correct me if I got that wrong.

From the description, it sounds as though you might have a small cyst. Ultrasounds are much better than mammograms at identifying cysts, which are fluid-filled; the ultrasound can "see" the fluid whereas a mammogram just "sees" the mass and can't identify if it's solid or fluid-filled. Hopefully that's the case, that this is just a harmless cyst. If the mass appears on the ultrasound to be solid, then it's possible that a biopsy will be recommended. If that happens, the important thing to know is that 80% of biopsies turn out to be benign.

Good luck!

TColorado

Thank you so much Beesie!

I really appreciate you taking the time to reply to my inquires. It's difficult to not let anxiety get the best of you when you get an unexpected test result with no explanation. Thank you for sharing your expertise, you have really eased my mind! I'll keep pushing my small Colorado mountain town doc to order further tests, but I will sleep better tonight knowing that in all likelihood I have nothing to worry about

Ingerp

TColorado--Beesie is a treasure and all I can do is agree with her. Odds are greatly in your favor of it being benign. But I'd start to be the squeaky wheel with your PCP's office just to get this behind you. I've also never heard of any mole/freckle on the skin being related to breast cancer.

djmammo

"...but often the Radiologist will order any diagnostic imaging that is required as a result of the first visit"

A quick note: Its a small semantic, but important difference. Technically the radiologist is not actually "ordering" your additional exams, as this creates a problem with who is legally responsible for follow-up and treatment. If a request is submitted that orders only one exam, the techs are required to call the ordering physicians office to get an order for the additional views while you wait. If the ordering doc is flexible, the rad can have the techs take the next set of images and have the office send the order later on.

Our office printed up and distributed mammogram order forms to all referring docs that included additional specific wording: (mammogram)...and any additional procedures recommended by the radiologist including additional mammographic images, ultrasound, MRI, and/or breast biopsy" thus making it unnecessary to call the requesting office before scheduling your follow up. This significantly speeds up the diagnostic process and avoids the frustrating situation described in TColorado's post above.

Beesie

djmammo, thanks for the clarification. That's interesting - from reading this board, it sometimes sounds like a lot of women move from test to test without gettting requisitions from their PCPs, so I wasn't sure what the process was in other jurisdictions. What your office does with the requisition form makes sense.

I'm in Ontario. The requisitions from my PCP's practice do not include the same wording as yours (I was curious so I just checked), but there have been many years when I've been shuttled straight from a mammogram to an unscheduled ultrasound, or immediately booked for a follow-up diagnostic mammo, ultrasound or biopsy, without my PCP's office being contacted first. That said, the final reports always have my PCP's name listed as the 'ordering physician'. I think the difference may be that this is a single payer system, so there is no issue about getting insurance approvals or anything like that - if the test has been ordered by a doctor, the government will pay. There might be some unwritten agreement that Radiologists have the authority to order any additional tests that are immediately required and either a separate requisition is not necessary, or perhaps because approvals and payments aren't a concern, the paperwork (i.e. getting a requisition from the PCP for the files) is dealt with later.

djmammo

Beesie

Yes its probably the differences in our medical systems, related to payments from our insurance companies and to our hospital regulations (which always reflect financial and medico-legal concerns first).

TColorado

Thanks to everyone for sharing your knowledge! I took the advice on being a squeaky wheel with my PCP. They finally responded to me and put the order in, I am now scheduled for a US & diagnostic mammogram in a couple of weeks.

The American medical system can be incredibly frustrating at times. The people you actually have the opportunity to communicate with (nurses, techs, ect) are not allowed to tell you anything. As a patient, unfortunately it's easy to feel left in the dark when it comes to your own health because often the people who communicate with you aren't authorized to tell you much.

This forum has really helped ease my mind, it is a true diamond in the rough! Thanks to you all for sharing your knowledge and your time!