A mammogram on a non-reconstructed chest wall???
Comments
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Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I
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Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have
-
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have
to -
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have
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Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have
-
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to
-
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to have
-
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to have
a -
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to have
a -
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to have
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Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to have a CT.
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Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to have a CT.
-
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to have a
-
Harley, my pcm says that I will have a chest xray every year to monitor the surgery side. But she also says that this policy varies from dr. to dr.
If there is an issue on the surgery side she says I will have to have a
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Harley,
I was told that a mammogram x-ray was NOT necessary. However, since I will now I think I shall talk to my pcp, and see if I can start with an US on that side. I had a skin sparing mrm, and with the Her2 positve, I want to be just as vigilant as I can be. My pcp said that she will order any tests that I want, so I'm not seeing a problem here. The problem is, of course, with insurance and if they will cover it or not.
Jennifer
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Thanks, YellowRose,
I am seeing that it is just like our tx, it varies from dr. to dr. I DO agree with my surgeon, that if there is a chance of local recurrence, I will definitely go get an annual test, but I just disagree about the mammo., and the risk of implant rupture. He even told me that he had a bc patient who went for her annual mammo, and the next week, he saw her, for a cbe, which he will do every year for me also. When he saw her, she said that one of her breasts was smaller, and ... yep, she had an implant rupture, from the mammo. I wonder why he thinks I don't remember his story??
Jennifer,
I DO think that insurance would have to cover these screening tests, since we have had bc, and, well, doesn't that put us at a slight increased risk for any type of recurrence?
Before my colonoscopy, my surgeon ordered a chest x-ray, but I don't think that is the same thing as a chest wall x-ray... I wonder if anyone knows the difference?
Just curious, because I want to make sure I'm doing everything I can.
Harley
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I didn't even think of LE for my bi mam last week. And boy did we have to work to get the shot the tech wanted. I didn't have a mastecomy, I had a lumpectomy, but where my cancer is, is above the breast where there is no breast tissue that you can really see. So by the time she was finished getting the shot she wanted, we were both sweating. I was told in London that if my BRAC test comes back positive I will then be able to receive MRI's. The process hurt like hell I felt like both boobs had been ripped off and left there. It's gone now but I'm glad I read this post because I will not let them do a mammogram on what I call my indent, ever again. Seems I always find theses topices after the fact, but still happy I found them. Thanks ladies.
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snowyday, your situation is different because you had a lumpectomy not a mastectomy. After a mastectomy, there may be microscopic bits of breast tissue left up against the chest wall or the skin, however there is no breast, just skin flat against the chest or a hard implant. So for those who've had a mastectomy there is nothing to put into the mammogram machine. In your case, I would imagine that because you still have breast tissue, it really does need to be checked, especially the area near where your BC was found. So while it might not be comfortable, I'm not sure that it's something that you can or should get out of.
I do think you should talk to your doctor about also getting MRIs. As far as I know In Ontario there is no rule that says it necessary to be BRCA positive to get breast MRIs - it simply takes a requisition by your doctor. My doctor recommended MRIs for me because of my history of breast cancer and the fact that my remaining breast is very dense. I did have the BRCA test but fortunately came up negative. I would think that for you, your doctor can recommend MRIs based on your BC history and the difficulty in getting a good view of area of your breast that had BC with a mammogram. Still, while I think MRIs are great, personally if I'd had a lumpectomy, if it was ultimately possible for a mammogram to get a view of the area of my breast that had BC, no matter how painful, I would do it, in addition to the MRI. As we all know, each screening tool views breast tissue differently and sees different things and I would want to know that I'd been thoroughly checked.
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Your right Beesie, I am going to insist on an MRI from now on the area they removed the cancer left an indentation about the size of a large egg, and for me with small boobs that's bit. I'm glad that you explained to me that you get MRI and your not BRAC Positive (congrats on that). I did do my bi-mam and like I said it hurt like hell to get the shot the tech wanted, and she said she got it. Now I have to convince my onc that my her2 status was wrong, I was in doubt when I finally got the copies of my path reports and aske Otter and Tender to double check what my concerns are and I was right. They are so brilliant they also looked up the Canadian guidelines for me, did the calculations, so at least I am now armed with the facts I need to be treated correctly. So I have to change my Dx at the bottom, I'm not triple negative, I am Her2 positive and should have been treated that way from the beginning. So I will start again and fight to hopefully get this bc under control as best as possible.
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I am new to all this I have just been diagnosed and things moved very fast more info then what one person can take in.There is lots of questions and that was one of mine.So this was the answer that my surgeon gave me. Since there is muscle in your breast still that you have to have it done. After having this mastecomy he will be very surprised when I tell him to take a flying leap beacuse there is no way he will even be trying to compress the little bit of skin that is left between those plates they have. I have a high pain tolerance but I think this may be pushing the limits.
Lostqueeny
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I have an update, since I asked the question that started this thread:
Yesterday, I had my first post-mastectomy mammogram, 6 months after my mast/SNB. I am happy to say that there was no mention at all of doing a mammo on the mast side. None.
In fact, as the mammo tech was escorting me into the room, she turned to say, "This should be really quick--all I need are 3 pictures." (My breast center does 3 views of each breast with a diagnostic mammo, which is what my surgeon ordered for a follow-up on my good side.) The tech never even said a word about trying to squish my chest wall or armpit on the mast side.
I was a happy camper, until the radiologist came out to give me the results. (At this breast center, you go back out to the waiting room after the mammo is done, and wait until the radiologist comes to tell you the results. Sometimes his/her oral report includes "We need to take some additional pictures," and/or "I saw something, and I'd like to do an ultrasound," right then and there.)
Anyway, the radiologist said, "Everything is fine--we didn't see a tumor, and there was no change from your mammogram in January. But, you need to know that the tissue in your right breast is so dense, you could hide a Mack truck in there and it would never be seen."
That was her way of telling me I am on my own in detecting tumors on the right side--a mammogram will do me no good at all, but I have to keep having them anyway. What I need to do is be diligent about self-exams, and report any changes or lumps. Then, they will do an ultrasound.
This "could hide a Mack truck" thing was not a total surprise, because there was a smaller, Chevy truck hiding in my left breast in January. (My 1.8 cm IDC was never seen on any of my mammograms.) So, I guess the report was good news and bad news.
otter
[Edited to correct my misspelling of "Mack" truck--a sign of OCD?]
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Otter -- how "colloquial" of her ("Mack truck") -- is there no mention of doing ultrasound routinely, given your history? MRI once in a while? My IDC was not seen on mammo or ultrasound, so my follow-up is mammo/US of remaining breast once a year, MRI of both breasts (R breast, L silicone implant) once a year, halfway between mammos. My insurance (United Healthcare) is covering this.
My BS ordered mammo/US, but the radiology place kept taking US "off the menu" -- breast surgeon and I tried to order it 4 different times between us, but on the day of my mammo, the tech insisted, "the radiology says there's nothing suspicious on your mammo, so you don't need US." I said, "Even with my history of BC in the contralateral breast that was never seen on mammo?"
Scurry, scurry, scurry. Whisper, whisper, whisper. Return: "Get Dr. G (breast surgeon) to order it." Me: "she has ordered it, about 4 times." They: "Oh. Well, we can't fit you into our schedule for US today." Me, fuming to myself, "but I have only been saying 'plus ultrasound' until I'm blue in the face trying to book this appt for the last 4 months" but I bit my tongue and just said: "Okay, when can you?"
So, a week later, I got my ultrasound. Clear. (That's good!) And I'll have MRI in about 6 months.
I think that if you would prefer more than annual or semiannual mammo, you could at least call your insurance to see what they'll cover? Also, maybe your BS or onc has a different imaging protocol in mind than your radiologist (or her staff) does, and if they prescribe it, radiologist and insurance might comply?
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Oh, Ann, I wish!
Back in January, when the IDC I had long been able to feel was finally seen (with ultrasound), my onco surgeon and the rad onco who was also part of my "team" discussed future screening strategies. The rad onco suggested to the surgeon that screening by US might be "acceptable". She named someone (as in, "acceptable to 'X' "). I don't know if that person was a hospital policy person, someone in the radiology section, or a gate-keeper at my insurance company.
In any case, I had a brief discussion yesterday with my onco surgeon, concerning screening strategies. She was the one who said it was important that I continue having mammograms, despite the scattered (benign) calcifications and overall high density of my breast tissue. She pointed out that Arimidex should result in a decrease in breast density. I don't know if that's been documented, but it would be true theoretically--that is, if dense breast tissue in a 5-year post-meno woman is due to endogenous estrogen.
My surgeon also volunteered that there wasn't enough evidence of a benefit from using MRI as a screening tool. She is a data-oriented person (think, "evidence-based medicine"), as is my med onco. My surgeon said there hasn't been a good, sound study documenting the advantages of MRI over mammography.
Anyway, she said, insurance companies aren't inclined to pay for screening MRI's. (I don't recall exactly what words she used, but the message was, "Insurance won't pay for it.") My health insurance policy is a state employee/retiree policy, so it's familiar to everyone and she ought to know what it will cover.
I did have an MRI after my dx but before my surgery, and my insurance squawked about it for a whole day. They finally agreed it was justified because of the density of the tissue and the failure of mammography to reveal the tumor we knew I had. Actually, that's something my surgeon mentioned--she said insurance is more likely to cover an MRI in someone who already has a dx of cancer and needs the MRI to find other suspicious areas prior to surgery.
I wonder if this isn't another of those situations where, eventually, the diagnostic methods will be customized to meet the needs of each individual patient.
My dh said this morning that he can't understand why they won't at least agree to do US as a screening method on me. He's ready to write out a check each time.
Dang it, now that I know my fingers will have to be my main--pehaps sole--cancer screening technique, guess how many "suspicious" lumps I felt in that breast this morning? That's just since the BSE I did last week, and having been felt up by 2 physicians and a 4th-yr med student yesterday... Sheesh.
otter
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Dear Otter,I must admit, I am slightly taken aback by your turn of events as related in your post. It burns me quite some that the radiologist said what she/he did without advising you as to improved methods for radiologic imaging on your dense "good" breast.We are not in the stone ages here, and to dismiss mammogram (other than for visualizing calcification) as irrelevant because of the density issue (and more and more radiology and oncology articles are warning about density as associated with an increase breast cancer risk) and to offer nothing else is poor medicine, to my way of thinking.A MRI is fully justified in your situation due to 1) failure of mammogram to establish diagnosis on primary breast cancer 2) established history of increased risk of contralateral breast cancer 3) current density of breast reducing accuracy up to 35% as addressed by reading radiologist and 4) best architectural screening method given 1-3 above (sorry, but screening ultrasound does not have the accuracy or detail you need given your history).I would urge you to simply present these facts to your insurance, with a note from your radiologist attesting to the high risk of false negativity given density. If the insurance company bucks, I would supply them via certified letter a)your breast cancer pathology summary sheet,b) a copy of your current mammogram with the failure disclaimer highlighted on the bottom c) radiologist's note if available and d) the best recent article on MRI utilization in this situation, with a copy to your file, your oncologist, your radiologist and lawyer (may be a family friend, just needs Esq.)No breast cancer patient should be hung out to dry at insurance's expense in this type of situation. With proper persuasion, I believe insurance should come around. To do otherwise on their part, is tantamount to a fool man's folly.This is my way of thinking, of course. Best to you and all,Tender
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Otter, I'm in a similar position to you in that I had a single mastectomy and my remaining breast, which has had various problems and a bunch of biopsies over the years, is considered by the radiologist to be "extremely dense". Because of this, the radiologist recommended that I alternate MRIs with mammograms on a 6 month basis, and my surgeon and PCP both agreed. So that's my screening now.
I think your docs are out of date with regard to MRIs. Information came out last year that led to the recommendation from the ACS (and other groups) that MRIs should be used on women who are high risk, women with extremely dense breast tissue, and women with a history of BC. MRIs have been shown to be more effective. I agree with Tender that this is something that you should be able to push with your docs and your insurance company.
You can see here that you clearly fit within the ACS guidelines for MRIs:
To me it seems irresponsible for your screening facility to say that mammograms are pretty much useless for you and then not to recommend something else, and specifically, not to discuss the option of an MRI.
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Thanks for all the encouragement.
Since I had an MRI in January '08, just before my surgery, I'm not going to fight this "dense breast" battle quite yet. That MRI showed my right breast to be completely clear. The US in January that dx'd the tumor in my left breast also included a thorough scan of the right side, and it was clean by US, too.
I also had a digital mammo in January and again this past week, both of which were fine (though dense, of course!).
So, unless something pops up fairly quickly, I think I'm OK for now. I'm thinking I'll make an appt with my onco surgeon some time this fall, to discuss this whole issue. She is the director of the "breast health center" (not just BC), so I can continue to go to her for mammos and breast exams for quite awhile.
otter
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