The Four Crucial Questions You Need to Ask at Your Mammogram Appointment


Let's assume that one thing is true for you. You assume, that if you're being diligent and you schedule your mammogram, taking time away from your very full life of family, home and work to be proactive and show up for that mammogram appointment, that you could fully trust the results when the radiologist says, "there are no signs of breast cancer". Well done, and we will see you in a year.


That's the news we all hope for.


The thing is, that isn't necessarily a lie, there may not be signs of breast cancer. However, the reason the radiologist may not see signs of breast cancer, is because they aren’t able to clearly read the mammogram. This is true for 50% of womxn over the age of 40 because they have dense breast tissue. Yes, that's half of the womxn of screening age possibly receiving incomplete screenings.


The fact is, for 50% of the womxn of screening age,

their mammogram is inconclusive.

Adjunct screening in the form of

Breast Ultrasound or Breast MRI is required.


Breast density is recognized as one of, and possibly the strongest risk factor associated with development of breast cancer, according to the National Institute of Health. Dense breast tissue is made up of more connective tissue and it appears white on a mammogram, you can not feel it. Cancer also appears white on a mammogram. Cancer is often hidden by the connective tissue in dense breasts. One radiologist, described it as trying to find a polar bear in a snowstorm.


In addition to their cancer going undetected by mammogram, womxn with dense breast tissue are up to six times greater risk for developing breast cancer. They are at a greater risk of being diagnosed at an advanced stage de novo than womxn without dense breast tissue and at a greater risk for recurrence once diagnosed with breast cancer.


By now you may have even already had your annual mammogram and if so don't worry its not too late to circle back and ask some crucial questions.


Imagine you receive this notification on after your mammogram:

"Your mammogram is inconclusive."


My guess is you’d have some questions, AND that’s precisely what I want for you. You deserve more information, you deserve peace of mind, informed choice, accurate screening and knowing with certainty if there is evidence of disease and knowledge of your risk factors in addition to support for next steps.

Below are the four crucial questions you need to ask.


1. Will my insurance cover Breast Tomosynthesis (3D Mammogram), and adjunct screening, Ultrasound or MRI if necessary? Chances are, even if you are told you have dense breasts your insurance company is not required to cover additional screenings. This is absurd and needs to change. You may need to have your physician advocate to get your screening covered. Please persist. Full breast ultrasound costs $360 on average nationally and the radiologist may still charge an additional fee to interpret the images.


2. Do I have dense breast tissue? The radiologist at the screening center should tell you. If they don’t tell you the day you get your mammogram, then you need to follow up with your referring doctor. Do not just assume you don’t have it or you don't need to know. If the answer is yes, you need a breast ultrasound or breast MRI to accurately screen for breast cancer. Do not assume they will tell you if you do. You will need to do the follow up work to get the answer.


3. Is genetic testing or counseling recommended? Even if you don't have a family history of breast cancer, and even if you've had genetic testing or counseling in the past it's a good idea to check as new developments and testing options become available.


4. How can I get a copy of my mammogram report? Once you receive your mammogram report check to see what your BI-RAD rating is, keep in mind this can change throughout your life so you need to review it after each mammogram.


Far too many people out there don't even know they have dense breast tissue and are not being supported with next steps. They are being misled by notifications with confusing language and no clear direction.


Please remember to discuss all your risk factors with your doctor in addition to your breast density so that you can make the best decisions and advocate for your best health care.


While we wait for the national standard to disclose breast density to be enacted it's important to ask direct questions and receive a clear plan of action to ensure you have an accurate screening.


Even the people who are informed that they have dense breast tissue are not routinely being offered the adjunct screening and receiving support for the costs associated with it.


Please help us bridge the gap in these barriers to care and end disparities in breast cancer outcomes, by donating to our online auction HERE

More Resources:

Open letter to the FDA

Breast Density Notification

Understanding your mammogram: What are BI-RADS?

References:

  1. UCSF Dense Breasts Eclipse All Other Risk Factors https://www.ucsf.edu/news/2017/02/405711/dense-breasts-eclipse-all-other-known-breast-cancer-risk-factors

  2. Dense Breasts, Breastcancer.org

  3. National Reporting Standard densebreast-info.org

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