After you've been treated for breast cancer, does your medical center/health care provider order an annual screening mammogram, or do they order a diagnostic mammogram?
I ask because I recently discovered my new medical home has a protocol of always ordering a diagnostic rather than screening mammogram for yearly followup of all people who have had breast cancer.
I was told that even if a doctor orders a screening mammogram for me, if the person who schedules the mammogram sees that I had breast cancer, he or she will change the order to a diagnostic mammogram. Something about the radiologists preferring it this way.
So what's the difference between them? As it was explained to me and as I've experienced it, with a diagnostic mammogram, the radiologist tech trots the results down to the radiologist, who reads them on the spot and either gives you the all clear and lets you go or keeps you there for further imaging such as an ultrasound or MRI. By contrast, you leave after a screening mammogram, the radiologist reads it when she/he gets to it and your doctor gets back to you with results sometime after that.
The other huge difference is that since 2010, screening mammograms have been covered 100% with no co-pay. That's not the case for diagnostic mammograms--all your deductibles and co-pays and co-insurance apply.
Which is a big deal for someone like me, someone for whom mammograms don't work anyway.
I'd prefer to skip mammograms and their radiation completely, but every health insurance I've ever had makes me get one to prove I have dense breasts, which means you can't tell what's going on in there with a mammogram.
What I need is an MRI, which I can use a failed mammogram to get. But why should I have to pay for that mammogram if there's no reason to? After all, I need to save that money to pay the several hundred dollars I'll still have to shell out every year for an MRI.
I thought we were supposed to be moving toward individualized health care, a protocol like this belies those claims. After all, if a patient tells you mammograms don't work for her but we still need one to get the MRI, why would you order the cadillac version? Just to charge her?
Actually, this is one instance I would call medical waste. A diagnostic mammogram should only be used when there is stong suspicion of an immediate issue. When I turned up six years ago for my first-ever mammogram because I felt two huge lumps, that should have triggered a diagnostic mammogram. Some quick turnaround and followup testing would have been useful all the way around. But I'm guessing I didn't get the diagnostic mammogram because I didn't have any history of disease at that point.
I also didn't know then that mammograms are useless for me and for up to 40 percent of other women.
I know this now and am finding it both frustrating and expensive that medical professionals act like they don't know.
I offered this constructive criticism to my medical providers: The protocol should be always order screening mammograms since they are free, unless specific cases would benefit from a diagnostic mammogram. The health care provider should then have to explain why the person would benefit and then also explain there will be a cost for this type of mammogram over the screening mammogram.
That would at least give me a chance to tell them they're full of it and get what I need.