Mammogram questions

[Cookin4Love]

I had my "annual" mammogram on June 23. I put it in quotes, because I hadn't been for four years. I really didn't think it had been that long, but it was. Grad school, family health issues, etc. Anyway, I went. They told me my results would be back to my doctor in a week, and I would have a follow up letter from them in 2. Last week, I still hadn't heard anything, so I called my doctor. They hadn't heard either, but would follow up. My doctor's assistant called me yesterday and said she had spoken to the radiology office, and the delay was a result of waiting to compare these results to my previous mammograms. I asked her if that was routine, or if there was something they were concerned about. I got a long pause, then, "Um...it's probably just routine."

Right now, I'm a little bit concerned. Is the comparison to previous films routine now, or would they only do that if they saw an area of concern? Certainly, it would be good practice to always do the comparison. I know that the office I use does a visual reading as well as a computerized reading of the films. I'm trying to just shove it to the back of my mind, but it keeps creeping out whenever I slow down a little. I know that neither the radiology office nor the doctor are going to tell me anything until they have actual results--even if they do suspect something. I hate waiting and not knowing.

[muriel3002]

The comparison is routine. Last year I had my second mammogram. I went to the same place as the first and they asked me if I had had my mammogram with them. When I said yes, they proceeded to go and pull my file. So, I believe it is routine to always compare. I think it's just another step in the reading/interpreting of the results and probably nothing to be concerned about.

[avariell]

i have never had a mammogram so i cannot add any insight but i just wanted to say i hope it turns out okay. i know what it is like to have the idea of cancer hanging over your head (my lumps were just located elsewhere). just know that there are plenty of people here who can empathize with your worries. personally i would be persistent in checking back with the doctor's office.
good luck - i am sending positive thoughts your way!

[Mary Ann]

Right now, I'm a little bit concerned. Is the comparison to previous films routine now, or would they only do that if they saw an area of concern? I hate waiting and not knowing.

Yes, it is definitely routine. And yes, the not knowing is not fun. :( My thoughts are with you!

[ChristineVA]

Yes, it's routine. Usually they pull your old films before your appointment so they can do it that day, but it really depends.

Since you last mammogram was 4 years ago, I'm betting your films were archived and it took some time to retrieve them.

[Beth]

I think it's routine if they have anything to comapre. Density of breast tissue and other things vary, I am told. But I can understand your concern after all the issues, health and otherwise, you've had in your family lately. Hope you get an all-clear very soon.

[Cookin4Love]

Okay. You've helped put my fears on low simmer. Part of the problem is that I didn't have a "good feeling" when I went in, but it was probably guilt over waiting 4 years in between. ;)

[Robyn1007]

First, yes, comparing is very routine. That is why you get a "baseline" mammogram at 40 (usually, I've been told by my radiologist that I need to start at 35 because of lumps that were found in December). The likelyhood is that it is just routine comparison with more normal changes because of the time lapse than usual. If a radiologist suspected problems they most likely would have gotten you in much quicker for ultrasounds and/or MRI.

Now, I'm going to get on my soapbox a little. I have to urge you not to let this go again. Your breast health is very important to your life and well being and is not something to be taken lightly. Family health matters make it all that more important because I KNOW you want to be around to support them for many years to come. Too many people die every day because they put off tests that may have found problems much earlier. BC is VERY treatable if it is caught early enough.

Okay, I'm done, it just astounds and hurts me to watch people neglect it after what my family went through last year and with all of us knowing what Wallycat is going through now. :o :(

[Cookin4Love]

First, yes, comparing is very routine. That is why you get a "baseline" mammogram at 40 (usually, I've been told by my radiologist that I need to start at 35 because of lumps that were found in December). The likelyhood is that it is just routine comparison with more normal changes because of the time lapse than usual. If a radiologist suspected problems they most likely would have gotten you in much quicker for ultrasounds and/or MRI.

Now, I'm going to get on my soapbox a little. I have to urge you not to let this go again. Your breast health is very important to your life and well being and is not something to be taken lightly. Family health matters make it all that more important because I KNOW you want to be around to support them for many years to come. Too many people die every day because they put off tests that may have found problems much earlier. BC is VERY treatable if it is caught early enough.

Okay, I'm done, it just astounds and hurts me to watch people neglect it after what my family went through last year and with all of us knowing what Wallycat is going through now. :o :(

You're absolutely right, and I've already beaten myself up about it. I had been right on the money with it since I turned 40, then there was an insurance switch which complicated things tremendously--at the same time that three other critical things happened in our family--all within a week. That was also the week I started grad school while I was working more than full time. Things just went in a blur for--apparently--four years.

So, I do deserve to be spanked, but I promise, I've already done it myself. I've finally pulled everything back together emotionally, and did all of my top to bottom routine care and check-ups this summer.

In part, Wallycat's situation was the shock wake-up call I needed to not let this fall behind any longer. So, I hereby faithfully promise to and swear not to let it get behind again. :)

[LaraW]

Is 40 really the age for a baseline? I just ask b/c I will be turning 35 in 2 months, and I thought I remember my doctor telling me that I would have a baseline done at 35.

I was actually due for my annual checkup in March, but I put it off until Sept so that I could have my appointment co-incide w/ my birthday (my insurance won't pay for a baseline mammo until I'm 35, and so I didn't want to have my checkup w/ the dr. in march and then have to "remember" for 6 months to get the mammo).

Good luck, Cookin. It makes sense that they would compare the previous films, and if it was several years ago, it makes sense that they would be archived. I just went through something similar with applying for life insurance, and the insurance company needed medical records that were at a previous doctor's office. It took FOREVER to just get the records, and then the insurance company had to do their thing with them.

Take care-

[Robyn1007]

You're absolutely right, and I've already beaten myself up about it. I had been right on the money with it since I turned 40, then there was an insurance switch which complicated things tremendously--at the same time that three other critical things happened in our family--all within a week. That was also the week I started grad school while I was working more than full time. Things just went in a blur for--apparently--four years.

So, I do deserve to be spanked, but I promise, I've already done it myself. I've finally pulled everything back together emotionally, and did all of my top to bottom routine care and check-ups this summer.

In part, Wallycat's situation was the shock wake-up call I needed to not let this fall behind any longer. So, I hereby faithfully promise to and swear not to let it get behind again. :)

I hope you took that in the spirit in which I meant it. I care about you and I don't want you to have to go through another nightmare. :o Enough spanking, I'm glad you got a top to bottom check up this summer! :)

[BucknellAlum]

Is 40 really the age for a baseline? I just ask b/c I will be turning 35 in 2 months, and I thought I remember my doctor telling me that I would have a baseline done at 35.

Take care-

I think 40 is the general baseline, but many things can cause a doctor to have you have a baseline at 35 - a relative with breast cancer, previous lumps, etc etc. The Am Cancer Society website still lists age 40 for baselines.

For the OP, I found this on the ACS website about reporting results:

Reporting results: Mammogram clinics are now required to notify women in writing about the results of their mammograms. The Mammography Quality Standards Act, under FDA regulation, was recently changed in response to reports that some women may not have learned soon enough they had suspicious mammograms. Mammogram clinics are continuing to report mammogram results to the woman's doctor, who is responsible for ordering additional tests or treatments. The new amendment to the regulation requires clinics to mail women a separate, easy-to-understand report of their mammogram results within 30 days – sooner if the mammogram results suggest cancer is present -- so that the woman knows the results even if her doctor has not yet called to inform her.

[avariell]

Is 40 really the age for a baseline? I just ask b/c I will be turning 35 in 2 months, and I thought I remember my doctor telling me that I would have a baseline done at 35.


do you have any family history of breast cancer? i know that changes when you get your baseline. also - every doctor is different... maybe yours is just more proactive about mammograms? my general physician was (who recently moved to florida :(). even if i went in for a cold or ear infection or whatever, she would do a breast exam.

[Cookin4Love]

I hope you took that in the spirit in which I meant it. I care about you and I don't want you to have to go through another nightmare. :o Enough spanking, I'm glad you got a top to bottom check up this summer! :)

I did. No worries. I'm sure it's much the same response I have when friends of my husbands drive after drinking--after they watched the living hell our life became after he was hit by a drunk driver. I want to shake them! So, I consider myself e-shaken! :D

[Valerie226]

another issue is that in the last few years many facilities have switched to digital imaging, another reason to compare to older films. I was told to expect slower results last year ( or the year before) for that reason. I've had call backs for repeat imaging and for ultrasounds but end results were good. Waiting is still stressful and uncomfortable. Good luck.

[LaraW]

No family history of BC. But, it could be that my dr. is proactive about mammograms. I will ask again when I go in. She may have just said that insurance will ususally pay for a mammo at 35, and I took that to mean that I needed one at 35. It has been a while, and the last time I was in for a checkup, it was a postpartum check, so we were also talking a lot about the baby.

Sorry for the hijack, Cookin. :o

[Laurielee]

Laraw. I started having mammograms at 35 because my Dr said I had very dense lumpy breasts and its good to start early when they are like that. I think because they can read every year and see changes in the fibrous lumps vs something that could be cancer.

As for the mailing results, Make sure you contact your Dr if you dont get that letter. This was before the radiiology departments were required to send it. A few years ago I realized I never heard back about my mammogram and since my sister was just diagnosed with BC I called the radiology department and they sent me the letter they had sent my Dr which said we need to watch closely and suggest another mammogram in 6 months:eek: . I contacted my Dr and was livid an why wasnt I contacted. She said oh they mailed that letter to me, but I never recieved it, eveything is find and she is not my Dr anymore

Laurie

[SugarNSpice]

I too have heard and read that 35 is when a woman is normally supposed to start getting mammograms.

I have such a severe history of breast cancer that my family doctor has told me that I should start getting my mammograms done when I am 10 years younger than when the youngest woman in my history had BC. That would put me at around 28 - 30 because I had a great aunt who died very young from BC.

Has anyone else been told this by their family doctor?

[clairea]

Cookin4Love, I imagine this is just normal practice and it is being slowed down by the fact that your last films were taken so long ago. I wish the nurse had been more reassuring, and I hope that you get a definitive "all clear" soon.

LaraW, I had always read and heard that you should have a baseline mammogram at age 35. I asked my GYN about it this year (I just turned 37), because I haven't had one. With moving, and having to change doctors because of insurance the year before that, I wasn't sure if I had just slipped through the cracks. She said that 35 used to be a fairly common recommendation, but that now both the OB/GYN association and the American Cancer Society recommend starting at 40 unless you have a family history of cancer or other issues such as breasts that are hard to examine manually.

SugarnSpice, I have heard the same 10 year recommendation. DH has a strong family history of breast cancer, and this is what his sister was told. We have also been told to follow the same advice regarding DD (because they believe the particular genetic mutation in his family can be transmitted through the father as well) - this means having her start in her teens, but there is no question in my mind that it will be worth it.

[wallycat]

I have some thoughts on the matter (and for those that don't already know, I had a bilateral mastectomy in June because of breast cancer in my right breast).

First off, though digital mammography is a bit better at detecting things, mammograms are still not great at finding things in women who have DENSE BREASTS. Breast care is starting to get a bit better in terms of realizing that ultrasounds and mammograms are not the only way to detect breast cancer.
For women with dense breasts, a breast MRI is highly recommended.

Yes, they do compare mammograms from year to year--that is how they can detect abnormalities, but ....if you have dense breasts and, God forbid, a tumor hiding behind tissue, that mammogram will never pick it up.
I'm not trying to scare anyone. I know myself how many times I relied on an "all clear" to feel like I really was. Um....no.
My mammogram came back clean and NO changes. My ultrasound showed nothing. THANKFULLY, the tech I had listened to me when I said I had a horrible nightmare about my boobs 3 nights in a row and showed her the area and they sent me off for the MRI.
The breast MRI was THE ONLY machine that picked up my tumor.
I have dense breasts, but worse, I had a more rare cancer called lobular cancer (the most common is DCIS or IDC) and lobular grows flat and shallow (that is when they mention to check your boobs and not only look for lumps --I had no lump to speak of--but thickening or dents, or a boob getting smaller on you. Of course, I had none of that either.).
My breast surgeon, who does this for a living, said that if he gave me the physical exam and looked at my mammogram, he would have sent me home.
He has NO IDEA how I found my own cancer and told them where to look.

PLEASE, get to know your body. I know it is scary to do self exams...I was very fibrocystic and every lump or bump I thought for sure would "be it."
Thankfully, even though I wasn't good at BSEs, I knew my body enough.
TRUST your instinct and follow up if you are not OK with something.

Remember that 80% of lumps are nothing but you just don't want to let things go.

Best to all you ladies out there...I know what a nightmare this checking stuff is!!!
(and forgive the soapbox....:o )

[Robyn1007]

Ana, I had no idea that you found your cancer from a dream! Oddly, my aunt woke up from a dead sleep palpatating her lump. She believes it was her mother (who died fro lung/brain cancer) showing her she needed to get it checked out. Her doctors didn't think it felt like anything to be concerned about.

Wallycat is right, we all need to get to know our bodies AND listen to them.

[karen w]

On the subject of dense breasts. . .

I'm in a very fortuitous situation in that DH is a radiologist so every year when I get my mammo., I just hop on over to his office when I am done and he reads the images right along with me. I get the results instantly! And Yes. . . comparing your yearly mammo. to your baseline or a previous film is routine. However the year I had my baseline, his partner dictated the final results. In the body of the report she mentioned that my breasts were extremely dense and therefore one can not exclude a mass that might not be visible behind the breast tissue without a further imaging study(most typically ultrasound, but also MRI). Then on the bottom line of the report she dictated "Normal Mammogram." My gyn. got the report and called me to tell me all was normal since all she did was read the bottom line. Fortunately, I already knew the results and on DH's insistence had already had an ultrasound. My gyn. was pretty embarrassed when I caught her on it, too. When she went back and read the full report, she was very quiet. The bottom line is that now every year I get a mammogram AND a breast ultrasound. So basically I am reiterating what Wallycat already stated in relation to my experiences. But you don't all have to go asking for an ultrasound or MRI at your next mammo. If you have dense breasts, however, or there is an area in question, then you need another imaging exam.

Karen

P.S. Had my mammo and ultrasound last week. Normal! Phew! yuckier part is next week. . . .the yearly lady exam and PAP. UGH!

[BucknellAlum]

I
First off, though digital mammography is a bit better at detecting things, mammograms are still not great at finding things in women who have DENSE BREASTS. Breast care is starting to get a bit better in terms of realizing that ultrasounds and mammograms are not the only way to detect breast cancer.
For women with dense breasts, a breast MRI is highly recommended.

My mammogram came back clean and NO changes. My ultrasound showed nothing. THANKFULLY, the tech I had listened to me when I said I had a horrible nightmare about my boobs 3 nights in a row and showed her the area and they sent me off for the MRI.
)

I am aware that mammos cannot pick up everything, and every piece of paper I get at the appointment and from the doctor reiterate that. And the younger you are, the more dense your breasts are, I hear.

But Wallycat - they did an MRI based on just your nightmares? Of course, I am glad they did listen to their patient, but I thought you would need to jump thru hoops or have other symptoms to get anything beyond the basic mammo.

I have had cyclical pain in the same place off and on, and the doc wrote instructions to the tech on what to look at and they even had me come back for more films. But I was never offered an MRI (nor did I ask for one).

Do you think your experience in getting additional testing is unusual? I am also a little paranoid because I have had microcalcifications too, so I have gotten mammos every 6 months for a bit.

Oh and good for you for being your own advocate in your health. I wish you nothing but the best!

[Laurielee]

Laura and Wallycat, how do I go about asking for an MRI when I schedule? Do I just say I want an MRI and get it? I am sure its something I would have to get a pre okay for my insurance company?


As for lumps. My sisters BC was not a lump but cancerous calcifications so she would have never found it doing her own exams since they dont grow as lumps. I also have an aunt on my mothers side that had the same type of cancer so please beware there are other breast cancers out there that are not lumps.

Laurie

[Cookin4Love]

On the subject of dense breasts. . .

P.S. Had my mammo and ultrasound last week. Normal! Phew! yuckier part is next week. . . .the yearly lady exam and PAP. UGH!

My DD's and I call the mammo and the well woman the "Seize 'em and squeeze 'em" appointment and the "Isn't it great to be a woman?" Exam. :D

[Robyn1007]

I have had cyclical pain in the same place off and on, and the doc wrote instructions to the tech on what to look at and they even had me come back for more films. But I was never offered an MRI (nor did I ask for one).

Do you think your experience in getting additional testing is unusual? I am also a little paranoid because I have had microcalcifications too, so I have gotten mammos every 6 months for a bit.

Oh and good for you for being your own advocate in your health. I wish you nothing but the best!

Your last line says it all. If you are concerned YOU need to bring that up. Tell them you are not comfortable leaving it where it is and you'd like to have an MRI. If they say no, find another doctor if you feel strongly about it. You are your best advocate. I'm fortunate that I have a wonderful gyn that even after the radiologist said my ultrasound was okay she insisted on doing one more manual exam. She said to me that she promised herself she would never take breast health lightly and she wasn't starting with me.

[wallycat]

In answer to some questions...
I was VERY lucky that I did not have to struggle with getting the breast MRI.

I did not tell the tech I had bad dreams :p (though I did tell my surgeon AND my oncologist--that is still so weird to say that about the dream! ).
I pointed to the area I had concerns about. I didn't dream that...I just ran my fingertips over that area and it just didn't feel...well...right, normal, mine...something was off. It wasn't a lump so I can't claim I felt anything unusual, but my gut screamed at me to investigate it.

The tech was very kind and said that since I had an area of question, they would ultrasound it. The radiologist came in and said there was a tiny, tiny, tiny shadow in a certain area and it was toooooo small to biopsy, so she would suggest the next step---breast mri. I lept at the chance and I am lucky that the whole thing went quickly and smoothly. The MRI found a 9mm area that lit up. I was asked back to the ultrasound area to biopsy it but when I got there, the ultrasound could not pick up anything that was initially shadowed nor this new 9mm mass that the MRI indicated existed.
Back to MRI for a needle-guided biopsy.
The radiologist doing the biopsy met with us initially and showed us the films. I took one look and looked at my DH and said "well, looks like you'll be calling me back with bad news." The radiologist was stunned.
She insisted that this was not spiculated (starburst like, hinting at cancer) and it was so small and I was 1 month shy of 50..young :eek: :p ...plus NO CANCER...of any kind in my family). She said 3% chance this would be cancer...and I hesitated before I said...I've always beaten odds...darn it!
She sobbed when she called me with the diagnosis.

My (I adore him!!) breast surgeon said MRIs are 98% accurate these days; I told him he'd eat those words even before I went under.
Sure enough....the 9mm MRI image turned into a 1.8cm invasive lobular cancer. He called apologizing as well.

It's a gift...and a curse (quoted from watching Monk :D ;) ).


My sister (twin--fraternal) had a "watch and wait" mammo and when I called her with this news, her doc didn't hesitate to schedule the MRI. She had a lit up area as well. She had a biopsy.
Hers was, thankfully, negative.
Too bad they can't find a better way to find it, cure it and or treat it!!!!!!!!!!!!!!!!!

[slknight]

First off, though digital mammography is a bit better at detecting things, mammograms are still not great at finding things in women who have DENSE BREASTS. Breast care is starting to get a bit better in terms of realizing that ultrasounds and mammograms are not the only way to detect breast cancer.
For women with dense breasts, a breast MRI is highly recommended.

I have extremely dense and fibrocystic breasts. Even though I'm only 37, I've had several mammograms because I had a benign lump removed 5 years ago. I get called back for more images and an u/s every single time. Your story scares the crap out of me. I also have a family history of breast and ovarian cancer. I switch to a much better health insurance plan on September 1st and I'm going to try to push for a breast MRI then. I hope they don't think I'm nuts. :o

[wallycat]

I have extremely dense and fibrocystic breasts. Even though I'm only 37, I've had several mammograms because I had a benign lump removed 5 years ago. I get called back for more images and an u/s every single time. Your story scares the crap out of me. I also have a family history of breast and ovarian cancer. I switch to a much better health insurance plan on September 1st and I'm going to try to push for a breast MRI then. I hope they don't think I'm nuts. :o


I wouldn't give a crap who thought what of me, just DO IT! No doctor ever regretted sending someone home telling them they were fine.
With a history of cancer in your family and the new guidelines for breast MRIs for women at high risk and with dense breasts, you have a good argument.
I pray you are worried for nothing.