Best way to get screened with dense breasts?

Kayla23, my situation was very similar to yours. I was told that since I had been diagnosed with LCIS, my mammos should always thereafter be diagnostic vs. screening and I always received my results right away. I had to get the media (usually CD) every time I had a mammo, US or MRI and bring it to my breast surgeon for further review. My breast surgeon did clinical exams 2x/year and wanted me to do MRIs yearly 6 mos after each mammo. I only did that a couple of times. I did an ultrasound once...not sure it was especially meaningful because 6 mos after the US I had a mammo and was told I needed a biopsy in 3 areas. Something happened that fast? My mammos have been the 3D variety for years and my ins carrier has never covered it...it's an extra $50 out of my pocket. It's only the incremental delta expense of regular vs. 3D that ins. won't cover. Whatever. FYI, last time I went in for mammo I heard the clerk tell a woman that 3D is now covered under Medicare.

If your gut tells you your not comfortable with the care you are getting, I would look for other options if I were you. I would not be comfortable having just the medical assistant do a clinical exam. Your BS should be doing that and reviewing your breast study images. Make sure the radiologist is aware of your history when you go for mammos and really pours over those images before rendering an opinion. You want all your studies either performed at the same radiology clinic or bring them the history so they can do compares. You should also keep copies of all your studies. Earlier this year I went for a 3D diagnostic mammo and nearly got out of there home free for another 6 mos. I had been told to get dressed and wait for my piece of paper. Minutes later I was called back for more images and told that instead of just benign findings I needed 3 areas biopsied. I have to say that really gave me pause to think about how much of a complicating factor the dense breast thing was for me. It scared me to think that I nearly got out of there with no recommendation for follow up. I ended up doing the biopsies and....it was more LCIS.

Best of luck to you. This crap is worrisome isn't it? After 7.5 yrs of this, 5 core biopsies, 2 excisions, no reduction in breast density, and no further medical consensus or encouraging clinical revelations on this topic, I decided to invoke the final solution. I'm 4 weeks out from PBMX. No regrets. No complications so far and no need to take meds or live my life around 6 mos screening events. It's a highly individual choice and probably took me 2 years to figure out that would be the best course for me. Take care.

Kayla, your history plus breast density might qualify you for a yearly diagnostic digital mammogram (or 3D mammo if available) and yearly breast MRI, alternating so you have one or the other every six months. That's a standard plan for some. I wouldn't be happy being denied a test simply because the facility didn't have the equipment. If there is a local breast cancer support group, maybe you could ask the women there what doctors they like and where they get screening done. I don't mind getting some of my exams from a physician's assistant or nurse practitioner as long as they have experience. In fact I figure that if more than one person checks, it's a good thing. I hope you can have a good discussion with a breast surgeon or oncologist about what screening plan is best for you and why, so you can feel more comfortable.

(PBMX=prophylactic bilateral mastectomy)

Dear Kayla:

You should always get a 3D diagnostic mammogram with an ultrasound if you have dense breasts.  Since you have LCIS, you should probably have an MRI alternating with the mammo/sono every 6 months.  However, insurance may only cover the 2D mammo and you would have to pay extra for the 3D, as MsVeryDenseBreasts stated above.  It is well worth the extra money.  It is also worth paying for the US and the MRI, if one is ordered.  The US and the MRI would give you peace of mind. 

Good luck.

Kayla23, re: the apron thing for mammo radiation protection....all I know is that any time I've ever gone for one, wearing the apron has been the standard of care at the radiologist I go to. Once a tech forgot to put it on me and was very chagrined about it. I'd rather be careful than not and would insist on it.

Re: looking for a new doc.....not sure what city you are in. If your city has a city-wide magazine that rates the docs annually by speciality, start there and then check Health Grades and other crowd sourcing sites that tell you the docs education, years in service, what ins. they take, patient reviews etc and ask around.

Have you been going to a breast surgeon in particular and not just a general surgeon? LCIS is such a weirdo, if you can, go to a breast surgeon. When I see mine she not only does a clinical exam but also shows me (and discusses) her opinions on the image studies I bring her and she discusses the latest in medical news based on what she's studied up on and conferences she's been to. Because I've been seeing her for years and she knows my history so well she's been a wonderful source of referrals to excellent radiologists and medical oncologists when I needed consults or biopsies. I've found that it helps to have a BS who is well wired into the breast health medical community in my area.

Don't be shy. This is your health not theirs. You want to be comfortable and have confidence in your medical team.

I think that I am dense and that may have nothing to do with my breasts!!  lol

For me, mammograms have never found anything.  That is because I have extremely heterogenously dense breasts.  The ultrasound is what detected my cancer as well as all of my other lumps throughout the years. I have always asked for an ultrasound and paid for it myself because mammo's have been useless for me.  I will always have a 3D mammo anyway because that is the standard of treatment.  I would never consider having a 2D mammo any more.  For me, the MRI gives me peace of mind.  However, I do not know how often insurance companies will pay for one.

Kayla:

You need to advocate for yourself and do what will make you feel the most comfortable.  You are already going to worry with LCIS so you don't need to add any more stress and anxiety to your plate. Good luck with your doctors and with finding a good doctor for a second opinion if you choose that route.

Penzance:

I am glad that you had the fibroadenoma excised.  It is really amazing that your PLCIS was detected.  You are lucky that you know about the PLCIS.  I have PLCIS too along with PILC.  Good luck.

MO (I had very dense breasts) told me mammo and US, together. First mammo, then and US. I preferred an MRI, if you can get your insurance to pay for it--which I could. My dense breasts hid 5 years or more of ILC through five ineffective mammograms that reported clear when I wasn't. You can see what happened to me in my signature line below. I don't trust mammograms.

Claire

I agree that the ultrasound should be the standard of care for people who have dense breasts and that insurance companies should pay for the ultrasounds. 

the mammogram missed my tumor for years, even though they took 8 shots of the breast they decided it was 'clear'. I think mammograms contribute to the cancer, so frankly, I'm happy to have my boobs GONE and never get one again. Flat and Fabulous for me at 40. I actually think it's easier to find flattering clothing and my friends say I look thinner with my 34DD's gone.