Why do they keep telling me to get mammograms?

Hi Divecat and ballet12,

My comment:

"The perkier the breasts are, the more dense they are, the harder it is to see the calcifications to tell whether they are shaped and clustered like a cancer or not., and in general, the younger you are. So the trade-off is that the fattier your breasts are, the older you are, the easier it is to see the calcifications,  and the more the breasts sag."

I didn't say that one could tell by touch or by looking whether a breast was dense, just that in general the younger you are, the more dense the breasts are, which is supported by the information in the link you provided. I agree that there are a meaningful number of outliers at both extremes of age.

" Conclusion

I am glad the state notification was raised here. I live in CA and you get this letter which really seems like a CYA (cover your a##) informing you that you have dense breasts and what the imaging difficulties would be because if it.

Excessive radiation is always a concern- hip surgery and other fracture fixations where they are using intraoperative flouroscopy and heart caths can deliver fluoro time measured in hours.

wow- have to say I have been working in surgery since 1983 and have never seen a broken knife blade during breast surgery- its not unusual that they get "dull" and need to use a fresh one. A lot of the dissection can be done with electrocautery, harmonic scalpel and scissors depending on the type of breast surgery.

i don't believe it is some vast profit-driven conspiracy. It is simply (sadly) the best technology we have at this time.

LD- do you have cancer? This is the only topic you ever post about.

The new 3D imaging is wonderful from what I have heard. Our local rural hospital is the first rural hospital to get one and I have seen examples of a dense breast with the old technology vs the new. In my opinion anyone with dense breast should seek out a 3D mammography even if you have to drive a ways to get access to one.

Mammos do save lives, many lives. My point is there should be added testing offered to those of us who fall into the higher level BIRAD categories. We should be informed that there is a possibility that cancer may be missed with mammo alone. The state I live in now does not have to do this. The state I retired from, and that my insurance is based out of, has an insurance mandate to cover further testing. I know that even with mammo/us testing cancer can still be missed and it is up to each of is to fight for our own health. I just think that having better guidelines/protocols in place nationwide would benefit those who haven't had to find their way here yet.

I question some radiation because even the very least of it IS considered carcinogenic, and both we and our care providers should be more willing to acknowledge that very openly and take full responsibility for how to use it without over-using it.

Until a monitoring system that utilizes and maintains a cumulative count for each patient is implemented and the data from that is collected in a general way so that we aren't guessing and instead are acting on genuine information about the impact of every gray administered, that simply is not yet the case.

Given the cost of radiation use, implementing this is not something that is unreasonably expensive to do. We already have the computer systems in place that could process the information conveniently for us.

I think my PCP and my BS are quite caring and professional, and quite conscientious, but I also believe that without such a consciously designed and visible reminder keeping count of my radiation exposure, they continue to be quite clueless when it comes to how much radiation exposure I have had as a patient except when I make a point of outlining my history of exposure to it.

Hospitals and clinics, as businesses, recognize that radiation departments are money-makers. That can be an insidious fact, whether or not anyone consciously makes it so.

My personal experience includes innocently trusting in a medical system that provided me with mammograms and ultrasounds that indicated something was suspicious, which led to evaluation by a hospital-associated "breast cancer specialist" surgeon, who then did her own ultrasounds in her own office "for comparison". The first hospital set of mammogram and ultrasound for me came back as BIRADS 4, which recommends biopsy. The surgeon did her comparison, failed to tell me what the recommendation was, and recommended returning in 3 months for another hospital set of mammogram and ultrasound. At that point my cancer was 0.6 cm in size. No one notified me that anything was a problem of any kind. I returned for the hospital set of mammogram and ultrasound. Once again the report was not ready yet and she did her own ultrasound in her office. The hospital ultrasound and mammogram reported out as BIRADS 4 again. She again recommended waiting another 3 months and having another set of mammogram and ultrasound at the hospital and another visit to her office for her own ultrasound. No one even set up the third set, and no one arranged for a third set for me. I was alarmed and booked them for myself. I requested copies of my previous imaging. It was difficult for me to get time off but I went to the hospital on my lunch hour to get copies, and was told I could not have them because it was "lunch hour". I could not stay and requested they send them to me by mail. It took them 2 weeks, and when I got the results, they had sent the wrong reports. I could not reach the surgeon because she was "in Europe on a vacation". I then ordered my own 3rd set of mammogram and ultrasound. They again came back as BIRADS 4, this time with the tumor measuring 1.1 cm. Unfortunately during this same period I was being seen by a visiting PCP so the continuity of PCP surveillance was not maintained. With the help of my regular PCPs I changed to a Seattle surgeon for immediate surgery. I have received excellent care from that cancer center. I sent a letter of complaint to my local hospital, asking that the hospital board implement corrective procedures so that this could not happen to anyone else. They did not call me. They sent a letter referring me to the hospital executive but implemented nothing. A caring and responsible physician made a report in my behalf, which was then whitewashed by the "hospital quality control manager", who happened to be a surgeon who had retired just prior to the hiring of the surgeon I'd had, and in his retirement, was making extra money as quality control manager. Nothing was ever done about it. Eventually I was left with a very awkward choice to make under the legal and medical system in dealing with the problem and the issue of the indefiniteness of cancer. The law required me to file any case within 2 years of becoming aware of the problem, which I eventually did. But the reality is that I could not win the case because I had not "suffered any harm" (given that I had cancer regardless of the surgeon). Fortunately for me, the care I received at the cancer care center and my own body responses and my own choices since then have resulted in my continuing NED status. However, the medical system has those kinds of holes in it in reality. The original surgeon I was seeing, at the time I was seeing her, was on probation with my state medical board due to providing Rx's to her live-in. She also was under investigation with the state medical board where she had previously worked, for one patient death and one possible malpractice. For these she later received a slap on the hand. Since that time, in another state she has been involved in a car accident that killed a young child in the opposite car. She was proven to be driving under the influence and had to complete alcoholic counseling. The testimony as to fault was inconclusive, and that was the end of that.

Had there been a system in place monitoring the practitioners and the facility, as a patient I would not have been abused by it.

LizzieK,

There IS no excuse for not providing such information to the patient in a way that allows the patient to make decisions, whether or not those decisions are "convenient" for the provider. The excuse that has often been given is the elitist notion that patients can't be given the "technical" information because they either can't handle it or won't understand it. My situation happened over 10 years ago but even back then the facility doing a mammogram was required to provide some form of the result to the patient. However, there was no requirement to provide the actual report, because doctors have the reserved privilege of "more fully explaining it and answering any questions". Unfortunately that instead allows such doctors as yours and mine to fail to do so, and to put us on hold without any genuine knowledge of the real meanings included in the report that we or our medical coverage is specifically paying the radiology provider for. And in addition, the requirement only applies to mammogram results, not to any concomitant ultrasound report or any other radiologic report. So if the mammogram is not informative but the ultrasound is, it is still not mandatory to provide the ultrasound report to the patient. It is truly an umarked minefield for patients to try to cross.