Continuing Adventures in Breast Health

Last year was the first year in several that when I had my annual mammogram, the radiologist didn't request an additional sonogram while I was there. Nevertheless, my breast specialist wanted me to go ahead and get the MRI six months later just to keep an eye on things (because I'm officially a high-risk candidate to develop breast cancer, donchyaknow).

I had the MRI done in February, which was a couple months late thanks the delayed arrival of "Aunt Flo" during that period of time (no pun intended). That was all clear too, although I can't begin to tell you how much I enjoyed the round and round with my former employer's crappy insurance company trying to get the claim submitted properly. (Side note: thanks to the recent change in my employment status and Mr. Remarkable Monkey's as well, we are now once again covered by a decent BCBS plan through his employer. Thank heavens!)

So last week, I went for my annual mammogram. I wondered if my luck would hold or if I would need a sonogram as well. The tech said no... the Rx was written for just a normal screening mammogram, so they wouldn't be doing any additional imaging. This was the first time in several years that the Rx was for a "screening" mammogram and not a "diagnostic" mammogram. I believe when it's written as diagnostic, they can go ahead and do any additional imaging if needed right then, such as sonograms. "Screening" vs. "diagnostic" can also make a big difference to some insurance companies when it comes to covering it 100% as an annual mammo. I learned that the hard way.

Well yay for me then, right? I figured maybe they're now familiar enough with all my usual lumps and dense tissue that they don't need all the extra imaging they've done for the past several years. I bounced out of the breast center confident that the results would be nothing other than "Yep... all good," and maybe I could even skip the MRI this December.

Fast forward to this afternoon, when the breast center called. "The radiologist saw a suspicious asymmetry in your right breast. We need to do more imaging." Oh joy. So basically, I have to go back in for them to squash my right boob some more to investigate said asymmetry. "We may also need to do a sonogram. Your breast tissue is very dense."

Ya don't say! Duuuuuh! This has been a known fact for years. Now, if the Rx had just been written as a diagnostic mammogram to start with, they could have done all this while I was there last week. Maybe they didn't because my current plan doesn't cover diagnostic? I thought BCBS covered it as annual either way, but maybe they don't? Who knows. All I know is now I have go to another appointment at the breast center. **siiiigh***

It's not so bad. As I've said before, the place has been remodeled and it's gorgeous! It looks like a high-end boutique hotel lobby. Check out these pictures....

I think this is actually the lobby of the NICU unit, but the breast center's lobby looks pretty much like this too.

This is one corner of the large inner waiting area... the one where you get to hang out with the other ladies in your lovely pink hospital gown top while waiting for them to call you back for the actual boob squashing.

A view of the other side of the large inner waiting area. There's also an INNER inner area with changing rooms and lockers, and a bathroom, and a small alcove with a sink, water cooler, and teas... and sometimes crackers.

Yes! It was this issue!
I am not making this up!

Pretty, isn't it? But ya know what those photos don't show? The old, beat up magazines available to help you kill time while you're waiting. They're not all old... some are from the past year or two. But get this: when I was there last week, I enjoyed flipping through an issue of Vanity Fair.... FROM SEPTEMBER OF 1997! I kid you not... Renee Zellweger was on the cover, with an article about how she's Hollywood's next big thing since she had recently appeared in "Jerry Maguire". (Yeah...THAT prediction was dead on... Not.) Seriously?? You spend a lot of time and money creating this beautiful, lush space for the patients, but you can't spring a few extra bucks for some magazines that aren't 15 years old? Really???

I found it hilarious. But maybe that's just me. I'm actually sort of looking forward to my additional appointment next week, despite the inconvenience of having to make a second trip... I think I saw a 1999 issue of People somewhere in the stacks of magazines. I need to catch up some celebrity gossip.

Guess They've Never Seen a Pink Ribbon...

So... my funbags continue to provide me with hours of "entertainment". Get this... the benefits summary of my health insurance plan states that it covers "Preventive Mammography (within recognized standard guidelines)" at 100% with no deductible. And yet, they are denying coverage of the annual mammogram I had in July because it was a "diagnostic" mammogram and not a "screening" mammogram. WTF???? Seriously? Damn insurance company bastards!

Nowhere in any of the materials that I can find does it say diagnostic mammograms are not included. Any reasonable person would infer that one annual mammogram, regardless of how it's coded when billed, would be covered, right? Every annual mammogram I've had until now has always been covered as part of the 100% pre-deductible preventive care stuff, and they've been "diagnostic" for at least the past five or six years thanks to my dense breast tissue, cysts and family history. This is the first time I've run into this situation, and it stinks.

This is a new insurance company for me since my employer seems to change plans almost every year trying to save money. Fortunately, although I have $5,000 deductible, my employer generously covers a large percentage of it, so this mammogram will ultimately end up on their dime. But what about women who's employers don't help out with deductible costs? What happens when they go in for their annual mammogram, thinking it's covered under their preventive package, and then get stuck with a $400+ bill? If their budget is much tighter than mine, it would be difficult for them to come up with the funds to pay it. And it would probably lead to many women skipping this life-saving preventive tool! It's just not right, I tell ya. I won't mention this craptacular insurance company's name, but I will tell you that it rhymes with "oven tree".

The billing department at the facility where I had my mammogram done said they're seeing this situation more often. I did some quick Google research this afternoon, and learned that some companies do not make a distinction between "diagnostic" and "screening" mammograms... both are covered at 100% pre-deductible as part of their preventive packages. Kudos to those companies! That's the way it SHOULD be done. A mammogram is preventive regardless of whether it's diagnostic or simple screening, and it should be covered as part of any pre-deductible preventive package that includes mammography.

I've gotten nowhere arguing this point with my S.O.B. insurance company, but a customer service manager there DID suggest that I file a grievance/appeal, which I will do. I also contacted every local network media outlet today and suggested they look into this situation, since October and Breast Cancer Awareness Month is coming to a close in a week. I doubt any of them actually will, but I hope they do because I really think women need to be aware of it.

It's wrong, wrong WRONG! Well, I think so anyway. But maybe it's just me.

Ladies, don't let it keep you from getting your annual mammogram... most of you won't be getting the "diagnostic" version anyway, but just be aware of it. Check your benefits coverage, and work with your healthcare provider to try and avoid these *%&@# insurance issues. Take care of your boobies!

Adventures in Breast Health Part 3: Results and Risk Management

Well, Campers... are ya ready for the big reveal? Wanna know what the biopsy results were? The breast specialist's office called me when they got them the day before my follow-up appointment to let me know...  Just as expected, the tests came back negative. Normal. Nothing to worry about... at least for now. Here's what the report said:

DIAGNOSIS
Breast (Left, 10 o'clock, 5 cm from nipple), core needle biopsy:
- nonprolferative fibrocystic changes.
- no atypia or malignancy detected.

COMMENT: The fibrocystic changes include stromal fibrosis, adenosis, and slight duct epithelial hyperplasia.

What does all that mean? Basically, that I have lumpy boobs (which we already knew), but nothing cancerous. At least for now.

So on to the follow-up with the fabulous ARNP (Advanced Registered Nurse Practitioner) that is my breast specialist from the breast surgery medical group I was referred to last year. She is awesome. She checked the biopsy site and said it looked like it was healing fine, no edema (swelling), no bruising. She did a breast exam, and pointed out a lumpy cyst or two for me to feel... they were familiar (I've felt them there before), but I'll keep an eye on 'em. Then we talked about my future adventures in breast health. Let me tell ya... sounds like it's gonna keep on being interesting. I'll explain...

I am now officially in the "high risk" group. Last year, I was rated at 18.7%. This year, based on a whole bunch of factors, I am now rated at 21.4%. Or maybe it was 18.4% last year and 21.7% this year... can't remember. Regardless, 20% is the magic number. If you cross that line, you are considered at high risk for developing breast cancer at some point in your lifetime. Well heck... I was damn close to 20% last year, so it's not that big of a difference. BUT... now that I am officially high risk, it makes me a candidate for breast MRI.

Oh boy. Yep. Back on THAT rollercoaster after all! But at least now it is actually warranted. And here's why, as my breast specialist so eloquently put it: "At this point, mammograms are pretty much useless for you. You're too dense." Well, it ain't the first time someone has called me dense! I CAN be a little slow on the uptake at times. But what she meant was that my breast tissue is so dense that a cancerous tumor could easily be hidden on a mammogram. A mammo is still good for showing calcifications, but all those lumpy, dense fibroids hanging out in my funbags would help hide any pesky tumors that might decide to camp out there. An MRI will smoke 'em out. And that's a good thing.

Unfortunately, it's also possible that the MRIs could lead to more biopsies because more suspicious (but benign) areas may show up on the images. But that's okay... I feel the same way as the 2-year survivor PA who performed my biopsy does: If you see ANYTHING remotely suspicious, stick a needle in it and let's find out for sure! I'd much rather sit through a few needle sticks every year than miss a cancer in the early stages and have to endure THAT kind of treatment. (Seriously... I cannot stress enough how painless the biopsy was.) Not sure yet how often they'll want to do the MRIs. Could be every six months, or once a year, or every other year. Depends on what they find after the one I'm supposed to get six months from now.

So I'll be scheduling a breast MRI in December if I've met my deductible by then, or January if I haven't so that the out of pocket cost can go toward next year's. Yeah... chalk up another penalty courtesy of my boobs: I get to pay for an expensive MRI or two every year. Even with my insurance plan's discounted rate, it's gonna be pricey. I'll have to squeeze our tight budget just a little more. And just like with the small band/big cup syndrome, I'm left wondering what women who have the same breast issues as mine but smaller budgets do. What do they have to give up to get the screening they need? How will I afford regular MRIs myself if I ever lose my insurance or they opt not to cover them? Would I have to risk developing an undetected cancer because I can't pay for an MRI that would catch it? Probably. Fingers crossed I'll never have to make that choice. My heart goes out to the women who do.

I am also now required to have a manual breast exam twice a year. (By a professional. Sorry... I'm not looking for volunteers!) I already get one at my annual "well-woman" visit. I can't remember if my GP does one at my annual physical, which coincidentally and conveniently usually falls about 6 moths after my well-woman exam. If not, I'll just call for an appointment with the specialist. What the heck... it will get me closer to meeting my deductible, right?

So all is well for now, and my current adventures in breast health are complete for the moment. Who knows what kind of circus will crop up when I get the MRI at the end of this year. But I'll definitely share the fun with y'all! Hopefully, it will help put you at ease if you find yourself in a similar situation.



This has been a public service post. And now, back to our (ir)regular programming.

Adventures in Breast Health Part 2: The Left Jab

The preparation info sheet for my scheduled breast biopsy recommended that I "wear a snug fitting bra, preferably a sports bra" the day of the procedure. As I mentioned in Part 1, it's difficult to find a bra in my size at all, let alone a sports bra. A friend recently clued me in to Nordstrom's lingerie department... I was gobsmacked! They actually carry (and keep in stock!) lots of small band/large cup sizes! It was almost like Nirvana for a petite but overly-endowed girl like me. So off to Nordstrom I went, in search of a 34DDD sports bra to wear to my biopsy appointment. I was pretty sure I'd find one there, though I held out no hope of finding one without an underwire. (Do they even make them without one at that cup size?)

A very helpful sales associate assisted me in locating the sports bras in my size, and also pointed me in the direction of a sales rack with other bras in my size. Woot woot! Then I went to try some on (I've learned to NEVER buy a bra without trying it on). Now, my boobs really don't seem any bigger to me, so maybe companies are just making their bra sizes run small these days, because my helpful sales associate took one look at one of the 34DDD bras I tried and suggested that I was probably a 34G (that's 4 Ds). WTF???? Seriously??? As if it isn't freakin' hard enough already to find a dang bra!!! Oh joy. Anyway, thankfully Nordstrom has even my new voluminous size IN STOCK!! Not a lot of variety, but enough, and some pretty ones too! I left with a new sports bra (yes, with underwires) and two other bras, just cuz they were pretty and on sale. But here's the deal... even on sale, they weren't cheap by any means. My heart goes out to all ladies who suffer from the small band/big cup size syndrome. If your budget is tight, how the heck can you afford a 34G bra, on the rare occasions that you can find one in stock at a place like Norsdstom? It was a stretch for me to squeeze it into the budget. And really, is it that small of a niche market that more companies wouldn't make and/or carry them? Really?

So, on to the biopsy. I arrived at the hospital's breast center at 8:00 am for my 8:30 vacuum assisted needle biopsy appointment as requested. I was sent down to the biopsy scheduler's office to sign some papers, then back to the breast center waiting room. The ultrasound tech called for me at about 8:40 or so, and led me over to the procedure room. She had me swap my bra and shirt for a hospital gown, and explained everything they were going to do. I was told to lie face-up on the gurney (with a nice comfy pillow), and she confirmed via sonogram the location of the area they wanted to biopsy. It was just about center, above the nipple of my left breast, exactly where it was on the previous sonogram. (She also took a quick look at my lymph nodes and said they looked normal, though she's not really supposed to say anything about what she sees.) She marked the area with a pen. So far, so good.

Then the physician's assistant (PA) who would be performing the biopsy came in. She explained everything to me again, and answered any questions I had. Then we got started. First, she confirmed which breast (left) and wrote "yes" on it, in case any of the three of us in the room forgot at some point. (It's funny, but they have to do that just to be safe.) Then she cleaned the area with some cold stuff. At this point, the tech zeroed in with the sonogram to guide the PA to the area in question. The PA started with several injections of a local anesthetic (xylocaine, I think). She said to let her know if I felt anything after the first couple tiny pinpricks. I did not. I'm guessing she made the small incision next (I didn't feel anything), and then inserted the bigger biopsy needle. I was watching the needle come in on the sonogram screen, but seriously did not feel a thing! When the needle tip was in the area they wanted to sample, the PA said "you'll hear a click in a second..." And then I heard a loud click, kind of like a spring release or something. I didn't feel anything except maybe the very slightest tiniest bit of pressure... barely noticeable at all. The PA confirmed that the click was a tissue sample being taken. They took several samples, maybe five or six or seven, all guided by the sonogram. Finally, a tiny surgical clip was placed in the area they tested, as a marker for future reference. It's the size of a sesame seed and made of titanium. With the marker in place, the PA removed the needle and held gauze on the incision to stop the very little bleeding there, while the tech labeled the sample container for the lab. Then they put some special surgical tapes over the incision, and then taped a small piece of gauze over that. I was only in the procedure room for a total of about 20 minutes, beginning to end! Quick and virtually pain-free!

(Not to tell other people's stories, but the tech had been through a fine needle aspiration like the one I had done last year, and the PA had the same procedure she just performed on me a couple years ago... she's now a two-year breast cancer survivor! It's comforting to know that they've been through it and know what it's like to be the patient. They also know first-hand how important it is to have the tests done correctly!)

One final step left, and that was to have a mammogram of my left breast to make sure the surgical clip was in the right spot and showing up as it should. And no, they don't squash your boob as tightly for that as with a normal mammo. They just need to make sure the marker shows up. After a few minutes of waiting in the "inner" waiting room of the breast imaging center, the mammography tech said everything was in place and I was free to go. Less than two hours for the entire visit, beginning to end, and absolutely no pain.

Well, the procedure itself was painless. I DID have just a little bit of discomfort yesterday evening, but very minimal. I wouldn't even call it pain, really. A couple Tylenol knocked it right out. I HAVE felt a very few twinges of minor pain for a second or two every now and then, but not many. I also have a couple cool little round gel ice packs that I can insert into my bra if I start feeling any discomfort. So yeah, I'd still stay the whole thing has been almost completely pain-free.

I gotta say, that breast center is amazing. Every person I've come in contact with there has been so pleasant and helpful. I even got a call from the "nurse navigator" this morning, who was just checking in to see if everything was okay. LOVE them!!  I'm glad I have access to such a great breast center. They seem to be up-to-date with current medical advances and guidelines. The needle biopsy I underwent was SO much less invasive than an open biopsy. Ask your doctor if it's an option for you if you ever need a biopsy. In most cases, it should be the preferred method.

I should get the result when I see my wonderful breast specialist later this week. I'm expecting the results to be negative... 80% of biopsies are. Stay tuned!