screenings: who gets annual breast MRIs?

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peggy_j
peggy_j Member Posts: 1,700
edited June 2014 in Stage I Breast Cancer

When I finished Tx in May 2011 the plan for screening was an annual mammogram and an annual breast MRI offset by six months. Guess what? My insurance refuses to authorize the B-MRI. Apparently my breast tissue isn't dense enough and the fact that it's heterogeneously dense but found around the site of my tumor doesn't matter. arg!  What are your screening plans? Should I be worried?  

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  • gentianviolet
    gentianviolet Member Posts: 316
    edited November 2012

    Peggy - I get a breast MRI every year, and I do not get a mammo.  My implants are 40 years old and very encapsulated, to the point that they can't squeeze them at all.  I don't know what to suggest......so far my insurance has not refused the MRI, (I am on medicare) but perhaps a refusal is in my future.  I hope others can give you some good advice.  Good thoughts.

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  • LRM216
    LRM216 Member Posts: 2,115
    edited November 2012

    I am 3 years 8 months out since diagnose, and up until this year I have been having a mammo on the cancer breast at 6 months and both breasts six months after that and a yearly MRI at that time.  This year, however, my insurance company (BCBS) refused the MRI and I went without it after my BS tried to fight it 3 different times.  BCBS came back each time saying that it was not necessary since there was no other cancer in my family and therefore it would be merely "diagnostic" and without any reason.  What?????  What difference does it make that I am the first on both sides of my family with BC - the fact is that I have the freaking disease - and triple neg to boot.  And as for being "merely diagnostic" - hello - so is a mammo and that was how my cancer was found - deeply buried in my breast so no lump was ever felt.  I think insurance companies are crazy.  Three different old fart doctors working for BCBS (I'm assuming they are) none of which is a Breast Surgeon or Oncologist have decided that I, a triple negative cancer patient, don't need any MRI until a problem arises.  Makes sense, huh?

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  • Eileen0417
    Eileen0417 Member Posts: 16
    edited November 2012

    Peggy this makes me mad! I don't understand how insurance companies can override the opinion of doctors that are experts in oncology and work with patients every day. They are the ones who know!!

    I was diagnosed with my 1st tumor in 2006 and have had annual MRIs very year. My tissue is very dense and there are three other women in my family who had BC, no first degree relatives however my Mom's sister died of it.

    Fortunately my insurance has never questioned the MRIs. In fact, my second tumor was found in the same breast, a new primary on my MRI in september. It did not show up on my mammo last december and my doc did a mammo of that side the morning of my biopsy and it still did not show. And it was not felt on exam either.

    My surgeon said this is the exact reason that MRIs should be covered by insurance in high risk women. This latest cancer could have taken another couple years to be seen and would have been more advanced. It is to their benefit to pay for the tests because if the cancer is found earlier then they will most likely not have to pay for chemo etc...

    My surgeon said he has many patients who he thinks should have the scans and the ins. will not pay for it.

    My radiologist recommends the test every year and my medical oncologist writes the script. This tumor was 2.2cm which is not large but big enough that it should have been seen on a mammo. My med onc said that some tumors produce calcium and others do not and the makeup of it determines how well it can be seen.

    Perhaps you should have all of your docs sign off on the script for the ins. comany. My doc writes "dense breasts, personal and family history of BC" on the form.

    Good luck, keep fighting and hopefully you will get approval.

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  • peggy_j
    peggy_j Member Posts: 1,700
    edited November 2012

    Thanks everyone for the replies.

    LRM216, interesting that they no longer cover them. FWIW, I have Blue Shield and this year is the first time (post-Tx) that I've tried to get the B-MRI. I went through their entire "internal" appeals process and even did the external appeal (a group outside of Blue Shield). When that external group rejected it, they cited the reasons they would recommend it, and it included family history. Like you, I thought, WTF? Isn't my personal history more relevant? arg!

    Eileen, thanks for your comments. I agree with you completely, especially the cost-benefit to the insurance companies for avoiding chemo. Anyway, apparently there are different grades of dense tissue and I'm in one of the "medium" grades. It's scattered (meaning the entire breast isn't dense) but it is dense where the tumor was. Yeah, I've heard of many women who have tumors that are not detected by the mammogram--I know of the three women offhand. In my case, they caught my tumor when it was small because it was just 1 cm from the skin. But guess what? It was seen from the top-view but not the side-view of the mammogram. That does not make me feel very confident in these mammograms. My tumor was at the 11 o'clock position on my right breast--how far could it have been from the side, maybe 2 cm?  I wish it would help to get more docs on board. At one point, all four of my cancer docs (BS, MO, RO and diagnosing radiologist--the one who reads the mammogram) said they recommended that B-MRI, but then they seem to backed down and say, "well, maybe it's not really necessary." My MO seems to think my breasts are less dense due to tamox. OK, maybe, but my original DX was done the previous year and that mammogram missed it from the side. How much less dense could it be in a year? Anyway, I'm rambling. I've run out of options. I've gone through the appeals process and lost.   My husband says if I feel strongly about this I could always get it and we could pay out of pocket, but it's something like $5,000. Maybe I should try to get an ultrasound or ? FWIW, I've even written my State Senator (!). The state of CA recently passed a law (effective April 2013) requiring that women be notified if they have dense breast tissue. But that's the limit of the law. It does not require the insurance companies to pay for additional screening. (!) So I wrote my Senator asking if they give the law some teeth.

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