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Oct 19, 2010 11:32PM
, edited Aug 20, 2013 05:58AM
This issue of risk associated with dense breast tissue came up (again) when I had my annual mammogram and recheck with my breast surgeon last month.
My mammogram (digital, diagnostic - 3 views) always come back "BIRADS-2: no abnormalities". It's BIRADS-2 rather than BIRADS-1 because I have some coarse, vascular calcifications that haven't changed for many years and are almost certainly age-related. And, as usual, this year's reportt noted that the tissue in my remaining breast is "primarily dense (glandular) tissue." That's what the report said for the mammogram that was done an hour before the ultrasound-guided core biopsy of the tumor we knew was there.
Standard procedure at my breast center is to do an ultrasound if there is a palpable lump. It doesn't matter who finds the lump -- patient, tech, or doctor -- the mammogram is followed immediately by ultrasound. I really appreciate that policy. I also like the fact that the radiologists come out and talk to the patients, and they can act on what they find in an image without having to check back with another doctor first (i.e., if the mammogram shows something suspicious, the interventional radiologist will do a biopsy).
This year, I asked the radiologist what "primarily dense (glandular) tissue" meant in terms of a density rating. He said some centers use a BIRADS scoring system, but this center uses a 3-level rating. The lowest density is recorded as "primarily fatty tissue." Mine is the highest, he said. I asked about using MRI, and he said I would need to get that cleared with my doc.
So... I asked my breast surgeon about MRI (again). We had the usual discussion, which followed what leaf said in her most recent post. MRI's are not approved for screening in low- or moderate-risk, asymptomatic women. But, high-risk women -- for instance, those with BRCA mutations or a lifetime risk greater than 20% -- would qualify for screening with MRI.
I do not have a BRCA mutation; and my lifetime risk according to the GAIL model is ... oh, that's right. I can't calculate my lifetime risk with any of the calculators, because none of them are valid for someone who has already had breast cancer. As soon as you mark "YES" for "personal history of breast cancer," the software bumps you out with an apology: "We're sorry, but you cannot use this method to calculate your risk if you've already had cancer. Please consult your doctor." Also, as leaf noted, the formulas don't yet take breast density into account.
I pointed all that out to my breast surgeon during our conversation, and I asked her how I was supposed to calculate my lifetime risk. She agreed about the frustration of the risk calculators not working for women who've already had BC. She hesitated, and said, "Well, your risk is increased because you've already had breast cancer; but your risk is lower because you're on Arimidex. However, your risk is higher because you have dense breast tissue. So, ... let's see what your insurance company says. Let's see if they'll approve an MRI." I told her I would pay for it if my insurance denied it.
A week later, I got a notice that my MRI had been scheduled. Turns out, it was "pre-certified" by my insurance. That doesn't mean it was approved, though, or that they will actually pay for it. I had the MRI last week, and everything looks fine -- there was no evidence of an abnormality in my right breast (or anywhere else, presumably).
I'm waiting to see the "Explanation of Benefits", which ought to be arriving any day now.
2008, IDC, Stage Ia, Grade 2, 0/3 nodes, ER+/PR-, HER2-