Would like to avoid the boob squisher, if I can...
June 11, 2010 8:06 PM Subscribe
I'm 36, and I have a lump in my breast. My doctor ordered a sonogram, and the place that does the sonograms won't do a sonogram without doing a mammogram. Do I need a mammogram?
I have had two mammograms in the past, and have been told in both cases that my breast tissue is so dense they couldn't see anything in the mammogram, and wound up ordering an ultrasound. I really, REALLY would rather skip the mammogram if I don't really need it because a) Ouch, and b) I do not want the radiation from the mammogram.
How necessary is the mammogram? I called my MD to ask if I could get sonogram and no mammogram, and the secretary answered the question and would not pass the question on to him: "You'll be so glad when it turns out to be nothing! Of course you need a mammogram, honey!" Aargh.
I have had two mammograms in the past, and have been told in both cases that my breast tissue is so dense they couldn't see anything in the mammogram, and wound up ordering an ultrasound. I really, REALLY would rather skip the mammogram if I don't really need it because a) Ouch, and b) I do not want the radiation from the mammogram.
How necessary is the mammogram? I called my MD to ask if I could get sonogram and no mammogram, and the secretary answered the question and would not pass the question on to him: "You'll be so glad when it turns out to be nothing! Of course you need a mammogram, honey!" Aargh.
call back, tell the secretary that you're looking for a doctor's opinion. any medical staff that laughs off my concerns isn't my medical staff for long.
since you've had 2 before that were useless, if it were me, i'd make sure the doctor had a damn good reason for thinking the result would be any different this time. going through it just to go through it doesn't sound fun or right.
posted by nadawi at 8:15 PM on June 11, 2010 [1 favorite]
since you've had 2 before that were useless, if it were me, i'd make sure the doctor had a damn good reason for thinking the result would be any different this time. going through it just to go through it doesn't sound fun or right.
posted by nadawi at 8:15 PM on June 11, 2010 [1 favorite]
I can't really answer your question, but would like to offer a word of encouragement. I am almost 36, found a lump recently, and had a mammogram/ultrasound just earlier today. The lump turned out to be a cyst (something, by the way, that only the ultrasound could truly diagnose). So, best of luck finding a provider that best meets your needs, and here's to a happy outcome.
posted by onepot at 8:24 PM on June 11, 2010
posted by onepot at 8:24 PM on June 11, 2010
This might, under other circumstances, be considered going too far, but I would seek a second opinion. If your doctor opposes this, you need a new doctor, no matter the subject or content of the original diagnosis. Most doctors welcome a second diagnosis as a means to "prove I was right." Ask doctor No. 2 if a mammogram is necessary based upon your history. Follow that doctor's advice.
posted by Old Geezer at 8:31 PM on June 11, 2010 [1 favorite]
posted by Old Geezer at 8:31 PM on June 11, 2010 [1 favorite]
It sounds like the issue is not with your doctor but the place he recommended do the sonogram. They won't do one without the other. Find another testing place.
posted by JohnnyGunn at 9:21 PM on June 11, 2010
posted by JohnnyGunn at 9:21 PM on June 11, 2010
I found a lump when I was 31. It took me about three arguments, all the evidence I could marshal, and a flat refusal in the third argument to go for a mammogram, to persuade the MD that I was serious. She eventually OK'd the "sonogram, no mammogram" with the sonogram-taking place. The lump turned out to be benign.
I really had to fight for it though. I think some of the arguing may have involved leaving messages for the MD with the secretary.
posted by cybercoitus interruptus at 12:53 AM on June 12, 2010
I really had to fight for it though. I think some of the arguing may have involved leaving messages for the MD with the secretary.
posted by cybercoitus interruptus at 12:53 AM on June 12, 2010
Yeah, as I understand it the entire reason that mammograms aren't generally recommended for women under 40 is that their breast tissue is usually too dense to see anything, so it's exposing you to the risks of radiation (however small that is for one image, over the course of your life it's not a good idea to expose yourself to more imaging than necessary for no reason) without any real benefit. It'd be one thing if your doctor had decided that it made sense for your particular case, but it sounds like your doc isn't ordering the mammogram, just the sonogram, and it's the imaging place that refuses to let you do just sonogram.
And that doesn't even take into account the fact that if you have any sort of deductible or co-insurance, you're going to end up paying more for something your doc didn't even ask for. Mammograms aren't free (to you) unless you've already blown past your max out-of-pocket limit for the year.
If it were me, I'd absolutely call up my doctor and ask for a referral to an alternative imaging center. I bet if you do that, he'll either call the original place and tell them to make an exception in your case, or give you another place you can go.
posted by iminurmefi at 6:24 AM on June 12, 2010
And that doesn't even take into account the fact that if you have any sort of deductible or co-insurance, you're going to end up paying more for something your doc didn't even ask for. Mammograms aren't free (to you) unless you've already blown past your max out-of-pocket limit for the year.
If it were me, I'd absolutely call up my doctor and ask for a referral to an alternative imaging center. I bet if you do that, he'll either call the original place and tell them to make an exception in your case, or give you another place you can go.
posted by iminurmefi at 6:24 AM on June 12, 2010
Just here to second that the issue is probably with the testing location. I have had ultrasounds for breast lumps a bunch of times and never needed a mammogram to go with. As onepot noted, if it's a cyst, which statistically it almost definitely is, the ultrasound will tell you that. And if it's not a cyst, or if the ultrasound is not conclusive, then you move on to other tests. And those other tests may still not involve a mammogram, for example your doctor may wish to do a fine needle aspiration of the cyst/lump to make sure the cells in it are a-ok. I have had this done a bunch of times as well (does not hurt at all, btw), and yet never ever had a mammogram even suggested to me by a doctor or testing place.
posted by dayintoday at 7:16 AM on June 12, 2010
posted by dayintoday at 7:16 AM on June 12, 2010
Just a point about the secretary - please make sure you report this to your doctor the next time you see him. And if it's a big enough medical practice to have an office/operations manager, report it to that person too. I HATE these secretaries/receptionists who think that they know more than you or your doctor. The overestimate their medical knowledge, and often underestimate your relationship with the doctor.
You have to be forceful. Just keep repeating "Please give him the message that I called and I would like to speak with him personally."
Twice recently I've had this happen where I got stonewalled by the receptionist (fortunately for less serious issues than a breast lump). Once I needed more contacts, and the girl told me I needed an eye exam to renew the prescription. I had to ask her multiple times to please ask the Doctor to call me. She finally relented, and when he called back he said "Oh no problem, you don't need to come in, I can just authorize that over the phone."
The second, I needed to talk to my dog's vet about something. I asked the receptionist to give him a message. "Well he's in surgery all day and he won't be able to call you back today. Just call him tomorrow." I finally convinced the guy to give the vet the message and let him decide if he wanted to call me back. 6:30 pm - voila the phone rings and it's the vet!
The second was
posted by radioamy at 9:16 AM on June 12, 2010
You have to be forceful. Just keep repeating "Please give him the message that I called and I would like to speak with him personally."
Twice recently I've had this happen where I got stonewalled by the receptionist (fortunately for less serious issues than a breast lump). Once I needed more contacts, and the girl told me I needed an eye exam to renew the prescription. I had to ask her multiple times to please ask the Doctor to call me. She finally relented, and when he called back he said "Oh no problem, you don't need to come in, I can just authorize that over the phone."
The second, I needed to talk to my dog's vet about something. I asked the receptionist to give him a message. "Well he's in surgery all day and he won't be able to call you back today. Just call him tomorrow." I finally convinced the guy to give the vet the message and let him decide if he wanted to call me back. 6:30 pm - voila the phone rings and it's the vet!
The second was
posted by radioamy at 9:16 AM on June 12, 2010
In my experience, it is rarely the secretary or receptionist who is establishing the ground rules for you being stone-walled. Generally, the doctor (or in the case of a large practice, the office manager) that tells the receptionist how to handle various requests. It is useful to tell the doctor that you are dissatisfied with how you are treated by the receptionist, but don't count on there being much of a change.
posted by Old Geezer at 10:04 AM on June 12, 2010
posted by Old Geezer at 10:04 AM on June 12, 2010
Malcolm Gladwell's The Picture Problem on the utility of mammograms is worth reading.
posted by neuron at 10:47 AM on June 12, 2010
posted by neuron at 10:47 AM on June 12, 2010
Your breasts are dense, but not so dense that they prevented your from feeling a lump. Mammograms are uncomfortable, yes, but typically they are also brief.
You found a lump. You need to find out what that lump is.
Malcolm Gladwell is well and good. The merits of mammography for the general population is debatable. Fine. You are no longer part of that general population.
There are risks from radiation, but there are also very serious risks in allowing a early-onset breast cancer to go untreated.
posted by Sara Anne at 8:13 PM on June 12, 2010
You found a lump. You need to find out what that lump is.
Malcolm Gladwell is well and good. The merits of mammography for the general population is debatable. Fine. You are no longer part of that general population.
There are risks from radiation, but there are also very serious risks in allowing a early-onset breast cancer to go untreated.
posted by Sara Anne at 8:13 PM on June 12, 2010
As I understand it from my medical experience as a patient, ultrasound comes first and mammogram would be later, for exactly the reasons you cited (less invasive/painful, less radiation risk) - I do not understand why they would do a mammogram first.
posted by Acer_saccharum at 5:29 PM on June 13, 2010
posted by Acer_saccharum at 5:29 PM on June 13, 2010
This thread is closed to new comments.
I think have a sonogram and if the sonogram shows something to then have a mammogram. I don't think the mammogram is necessary right off the bat.
As for the dense breast tissue, I was told vitamin E can help with that. (Are we related, mayhaps?) I haven't actually don much with it, but I remember my doctor telling me Vitamin E was good for women with dense breasts.
Obligatory IAMNAD.
posted by zizzle at 8:12 PM on June 11, 2010