Screening vs Diagnostic Mammography

[Shirley]

Hello all,

My onc and I discussed me having another mammogram. I had a unilateral (right side) mastectomy in late August and have an expander in place right now. When I called for the appointment they told me he ordered a diagnostic bilateral mammo, which puzzled both the scheduler and myself because how would they do that with an expander in place (it's hard as a rock), and also is it even necessary. I can understand doing the one remaining breast but I'm not understanding why the fake side.

But the thing I'm curious about is why a diagnostic on the "good" side instead of a screening test. I was told that I'd have to pay my deductible for a diagnostic test but not for a screening test.

I suppose a more involved diagnostic test would give me greater peace of mind because it is presumably more thorough. I just thought that the distinction between the diagnostic vs screening was odd. Shouldn't they all be "thorough"? BTW, this place uses the new 3D mammography.

Thoughts on this, anyone?

[jaykay]

Hi Shirley,

First of all, they can't do a mammogram on an expander - it would probably burst it (a lovely thought).

It's pretty standard to order a diagnostic for someone who had/has breast cancer. The plus is that they give you the results immediately. In my experience, screening and diagnostic are the same process but the radiologist reads it immediately and you don't leave without the results.

For women who have had mastectomies, MRI is preferred method.

Best,

Janis

[Becky]

I know nothing about expanders but I got diagnostic mammos for the first 5 years after bc (the first two years I got them every 6 months). After that, they changed to screenings.

At my place, the diagnostic and screening mammos are the same. Its just with the diagnostic the radiologist comes out and discussed the reading with me so it took so long as they have to carefully read it and then discuss it with you (right then) versus reading it carefully at their leisure and then write a report (they write a report in both cases). My first screening one I wanted the radiologist to come out and tell me everything was fine right then and that's when the mammo lady told me the difference. The mammogram part itself though is the same in both cases.

[Jackie07]

Then there's surveillance ... http://www.ncbi.nlm.nih.gov/pubmed/24407530

Breast Cancer Res Treat. 2014 Jan 10. [Epub ahead of print]
Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors.
Wirtz HS, Boudreau DM, Gralow JR, Barlow WE, Gray S, Bowles EJ, Buist DS.
Author information
Abstract
Clinical practice guidelines recommend yearly surveillance mammography for breast cancer survivors, yet many women do not receive this service. The objective of this study was to evaluate factors related to long-term surveillance mammography adherence among breast cancer survivors. We conducted a retrospective cohort study among women ≥18 years, diagnosed with incident stage I or II breast cancer between 1990 and 2008. We used medical record and administrative health plan data to ascertain covariates and receipt of surveillance mammography for up to 10 years after completing breast cancer treatment. Surveillance included post-diagnosis screening exams among asymptomatic women. We used multivariable repeated measures generalized estimating equation regression models to estimate odds ratios and robust 95 % confidence intervals to examine factors related to the annual receipt of surveillance mammography. The analysis included 3,965 women followed for a median of six surveillance years; 79 % received surveillance mammograms in year 1 but decreased to 63 % in year 10. In multivariable analyses, women, who were <40 years or 80+ years of age (compared to 50-59 years), current smokers, had greater comorbidity, were diagnosed more recently, had stage II cancer, or were treated with mastectomy or breast conserving surgery without radiation, were less likely than other women to receive surveillance mammography. Women with outpatient visits during the year to primary care providers, oncologists, or both were more likely to undergo surveillance. In this large cohort study of women diagnosed with early-stage invasive breast cancer, we found that important subgroups of women are at high risk for non-adherence to surveillance recommendations, even among younger breast cancer survivors. Efforts should be undertaken to actively engage breast cancer survivors in managing long-term surveillance care.