“Why do I have to get a Mammogram before an Ultrasound?” 2

Hello bOOb bloggettes!

I wanted to re-post something that got responses and a topic that many women on my “bOObs” Facebook page (and elsewhere) ask me: Why do I always have to get a mammogram before an ultrasound, even if I have dense breasts and/or want to avoid radiation?

This is an excellent question and I’ll do my best to answer it based on what I’ve learned from MDs and other women who have looked into this mystery. First know that 90% of us have some degree of dense breast tissue, with only 10% of us categorized as having “fatty” breasts. (Who these 10% of women are I’ll never know as I’ve never met one — another mystery!) That leaves the other 90% of us with some degree of density, which is of concern because this tissue on a mammogram appears white — and cancer on a mammogram also appears white. Therefore radiologists have a heckuva time differentiating between the two. (We’ll learn in a later blog that the denser your breasts, the more they crank up the radiation to “see through” the dense tissue — and no one is telling us that, are they? Nope!)

Many of you have already been told by your doctors or via your mammogram report that you have dense breasts, but many of you were probably not told what that means — which is exactly what happened to me. But it boils down to this: The mammogram has difficulty finding cancer in your dense breasts (again, both are white) and many times can miss tumors, some even in late stages. Some women will be told by their OBGYN (if that doctor is on the ball) to go get an ultrasound when their mammogram report shows high density. Why? Because the ultrasound oftentimes does a better job at differentiating the cancer from the dense tissue — almost 50% better for women in the highest category.

Many of you are now thinking this: Then why, if I have really dense breasts, do I have to get a mammogram first if they’re going to order an ultrasound anyway? Can’t I somehow avoid the radiation? The answer comes down to two things: The insurance reimbursement schedule and what’s known as Medicine’s Standard of Care (SOC).

The SOC is what doctors basically must (or should) follow if they don’t want to get into legal jeopardy. It was explained to me by a crackerjack lawyer this way: View the SOC as a type of average that doctors follow that acts as a guideline which gives them legal coverage if something should go wrong. So OBGYNs are most always going to tell a woman she MUST get a mammogram before she can get an ultrasound, even if the woman knows she’s in a high density category and the mammogram will do close to almost zilch in catching a cancer OR she wants to simply avoid radiation (of which there is plenty in a mammogram, but that’s in another upcoming blog). It’s also a way for the OBGYN to hide behind a CYA excuse of “Oh sorry we didn’t see your cancer before now, but I did order the mammogram, so my a** is covered!”

So the medical establishment’s SOC is one problem, but the other problem is insurance coverage for breast cancer screening tests. Medicare (the federal government’s insurance company and the largest in the U.S.), I’ve come to learn, basically sets in stone what is going to be covered by its insurance and then private insurance companies usually follow Medicare’s suit. So somewhere along the line, Medicare got it in their bureaucratic heads (maybe some lobbying entities put it in there?) that women MUST have a mammogram before an ultrasound if the woman wants any chance of the ultrasound being covered by insurance. If a woman is lucky enough to afford paying for an ultrasound on her own (around $300 or so), then that’s her prerogative and she can skip the mammogram. But  unless the doctor is smart enough to figure out a way around the billing codes to get the ultrasound (US) covered without having a mammogram prior — and I’ve heard from some women that this does happen on occasion — then the woman will not get reimbursed for an US regardless of her breast density.

What I’ve come to learn after studying these issues for some six years now is this: It’s simply crazy what is happening out there in the breast cancer screening program and much of it isn’t based on any common sense that I can see. We need to get the decision-makers on Capitol Hill (many of whom are thankfully now women! :))) to understand what’s really going on and to help change it.

Help spread the word so we can build a bOOb coalition to change such non-sensical situations for women! Together our voices are strong.

Please feel free to comment on this blog below. Let’s learn from each other’s experiences.

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DISCLAIMER:  THIS BLOG DOES NOT PROVIDE MEDICAL ADVICE. I am not, nor am I holding myself out to be, a doctor/physician, nurse, physician’s assistant, advanced practice nurse, or any other medical professional.  The statements on this blog reflect the author’s personal opinions.  The content of this blog is for general informational and educational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice.  The information presented is not intended to replace or substitute for professional medical advice or care, should not be used for diagnosing or treating a health problem or disease, and is not intended for diagnostic or treatment purposes, prescribing any medication, or for use in diagnosis or treatment of any medical or health condition. You should consult your doctor for medical advice or services. Never disregard professional medical advice or delay in seeking it because of something you have seen or read on this blog.