Last week I drove to Charlottesville for my yearly mammogram. As soon as I sat down in the waiting room, a health care worker plopped down beside me and informed me that I was eligible to participate in a study of women with dense breast tissue.
I agreed to take part in the research project that was funded, strangely enough by the US Department of Defense. She extracted a vile of blood, asked me a number of questions about my lifestyle and family history, then guided me back to a procedure room for my regularly scheduled mammogram.
When the technician asked if I’d felt anything different since last time, I allowed as how I thought there might be a slight hardening – the size of a BB in my right breast. Nothing I hadn’t felt before, and these things always turned out to be nothing of concern.
“Well then, we’re done here,” she said. “We can’t do a screening if you feel something and we don’t have the equipment here to do a diagnostic. You’ll have to go to the main campus for that.”
“Let’s just pretend we never had this conversation,” I told her. “My insurance company pays for the yearly screening exclusive of our deductible, but not the diagnostic.”
“It’s out of my hands. Besides,” she added. “According to your chart, your breasts are really dense. These screenings wouldn’t be that reliable anyway.” She handed me a pamphlet which warned me that “mammography is not as definitive for detecting breast cancer for women with dense breast tissue.” It goes on to say that the risk of developing breast cancer is higher for these women, so much so that “women with extremely dense tissue are about four times more likely to be diagnosed with breast cancer than women with fatty breasts.”
If you didn’t catch that the first time, here’s the key point again: REGULAR SCREENING MAMMOGRAMS ARE NOT ALL THAT EFFECTIVE FOR WOMEN WITH DENSE BREAST TISSUE.
Why, I asked her, if everyone knows this, don’t they just skip the screening mammogram and go straight to a more effective procedure?
“The insurance companies require it,” she told me. She was kind enough to arrange for the main hospital to see me later in the day. This involved getting a phone order from my primary care physician (also required by the insurance companies) back in Nelson County.
I fumed as I drove back across town. This would cost us hundreds of dollars. Kevin and I had just raised our deductible in order to lower our monthly payments. This was not in our budget.
It must have been a slow afternoon at the main hospital, because several health care workers were chatting at the registration desk where I complained sort of good-naturedly, about my plight.
“Oh, you did the right thing,” said a medium sized woman with short frosted hair and dark eyeliner.
“How much is this going to cost?” I asked another woman at a computer. She looked it up. “Close to $600 with the ultrasound,” she replied.
“I’m tempted to just forget the whole thing,” I told them in all honesty. I’ve felt these things before and they’re always benign cysts.” They looked dismayed.
“Get it, and then fight with accounting later,” the computer woman said.
I hate those nagging yet conflicting feelings. The practical one whines about the cost and tell me to leave without the test. The fearful one threatens me with ‘what if?’
I like my breasts. They may be small and dense, but I’ve been known to purchase bathing suits and other clothing to show them off to their best advantage, and my husband adores them. I’d hate for anything to happen to these girls.
The frosted hair tech escorted me to the mammography room. “I apologize for complaining earlier,” I told her. “I have a great life and absolutely no reason to gripe about anything.”
“I understand completely,” she said, then added emphatically, “But it’s a good thing you’re here. You should never, never miss a mammogram, and if you feel anything, always get a diagnostic.
“Why only last week I had my yearly screening.” She stopped. Her eyes filled with tears. “Next week I go in for a biopsy. The doctor saw something large and ominous and said that it has to come out.”
I felt foolish for having complained. While I do what I can to reform America’s health care system, I have savings to dip into. That alone makes me far richer than most people on the planet. The fact is, I could choose to stay or go. That I have these choices at all makes me wealthy.
But here is something that bothers me: The UVA pamphlet goes on to say that there are even more reliable tests available for women with dense breast tissue, such as tomosynthesis and breast MRI. However, the brochure cautions, many insurance companies do not yet cover the cost of these tests.
So that wellness benefit? The one the insurance company pays for exclusive of your deductible? If you have dense breast tissue, apparently it isn’t all that great a benefit. You should pursue a better diagnostic tool, and first you’re going to have to meet your deductible and even then depending on the procedure, your insurance company may not be willing to foot the bill.
One at a time, the technician stuffed my breasts in the machine, smashed me and photographed me, taking several images of my breasts as pancakes. “Wow. You really do have dense breasts.“
“That’s what they tell me,” I said. She went on to explain that after this mammogram, I would go to another room for the more reliable ultrasound. I don’t think you have anything to worry about,” she told me, “although that’s not official. They’ll confirm this with the ultrasound.”
Given what is known about cancer and breast density, I asked her why the doctor didn’t just skip straight to the more reliable ultrasound.
“The insurance companies require it,” she said.
I left UVA that same afternoon with the knowledge that all was well with my smallish, but very dense breasts. I hugged my technician farewell, and wished her luck with her biopsy.
On the way home, I thought about the conversation that I plan to have with my insurance company to encourage them to make exceptions in their wellness coverage for women with this condition. As I drove, I realized how fortunate I am to have the energy and health to pursue this. For me, it’s been a good day.