Dense tissue--dense issue

Have you ever been told you have dense breast tissue?

If so, an annual mammogram is not a very effective way of finding out whether you have a small tumor.  

Your report can come back stamped "Normal"--no signs of any cancer.

But that white stuff that fills part of your x-ray can be masking a tumor.

An ultrasound is a much better way of finding a small cancer, perhaps before you can feel a lump.

My mammogram last March was rated negative--no cancer.  

But some guardian angel in the medical world recommended a follow-up ultrasound, and in that image the tumor popped up on the screen dramatically.  

Both the technician and I could see it.  The only question was whether it was benign or malignant, and a biopsy answered that question.  Yep, cancer.

Half of all women have dense breast tissue, but the issue of whether we should get a follow-up ultrasound comes down to money.

There's been a lot of debate over whether insurance companies should cover ultrasound for us.  After all, many of those ultrasounds will not reveal a tumor.   Many of the follow-up biopsies will show the tumor to be either pre-cancerous or not cancer at all.

When one type of screening suggests further follow-up, and that follow-up shows that there is no problem, the first screening is considered to be a "false positive."  In other words, insurance companies wish they hadn't paid for the follow-up.  It wasn't needed, in their view.

In my view, a follow-up that says I do not have cancer is just as important as a follow-up that is positive for cancer.  The first one saves my peace of mind, the second one saves my life.  

Insurance companies, of course, want to do fewer mammograms and ultrasounds. 

Women don't need to start annual mammograms at age 40, some are saying.  Starting at age 50 is better.  Not many cancers are found between ages 40-50.  

Another suggestion is that women over 50 only get a mammogram every other year.

Insurance companies are interested in saving money, not saving lives.

Ten years ago I was told that I have dense breast tissue and that I needed a follow-up MRI after my mammogram.  

I did it.  The result was negative--no tumor.  My health insurance company didn't want to pay for that MRI, but they finally did.

When the doctor recommended a follow-up ultrasound this year, I was worried about the cost.

"Will insurance pay for it?" I asked.

"Yes," they said.  I made the appointment, the cancer was found, and treatment began.

In both cases the message was just "Dense breast tissue... follow-up recommended."

If not for that ultrasound, my cancer would be growing this summer from stage 1 to stage 2 or 3.  

I'd be going in for my mammogram in March, 2015, and getting bad news.