Wednesday, May 1, 2013

Screening Versus Diagnostic Mammograms: What's the Difference and Who Needs What?

I often get phone calls from patients who are upset because they didn't get an order for a diagnostic (or comprehensive) mammogram but rather a screening mammogram.  They may have needed a diagnostic mammogram in the past and are under the impression that they will always need one, or perhaps they have a family history of breast disease.  Actually we are required to follow some pretty strict guidelines regarding ordering diagnostic mammograms, which include a palpable mass, focal and persistent breast pain, skin retraction, personal history of breast cancer, spontaneous nipple discharge, and follow-up of a previously (usually within the last 6 months) seen mammographic abnormality.  A family history, breast implants or fibrocystic breasts may or may not require the additional views and radiation associated with a diagnostic study.

Actually most people aren't aware that the basic screening mammogram is done exactly the same as the diagnostic study:  same machine, same technician, etc.  The main difference is that in someone with a stronger likelihood of an abnormal finding, the radiologist reads the first two views on each breast while the patient is still physically present in the building.  The doctor reading the films can then decide then and there if additional views or sonography (aka ultrasound) is indicated, saving the patient a trip back.  This does incur a higher charge level, however, and so without the appropriate reason for the study to be diagnostic, the extra cost could be declined by the insurance company and passed onto the patient, and that could be considerable.

About ten percent of screening mammogram studies lead to a "call-back" for more views.  I have had that experience myself, and it certainly can produce anxiety.  However, be reassured that most of the additional studies end up showing no evidence of serious breast disease in the end.  We have the same experience with our patients in our office when we have to call and tell them to come back to evaluate abnormal Pap smears.  Just as in the case of breast disease, however, we only rarely will actually diagnose a life-threatening condition.

We rely heavily on our radiology colleagues to guide our decisions regarding whether a patient needs a diagnostic versus screening mammogram.  Usually their reports to us will tell us when to order the next study and what kind of study to order.  As guidelines change in the future, we are kept informed and in turn will keep you informed of the need for and timing of various types of breast studies.

No comments:

Post a Comment