Doctor’s Orders

This past summer, Marie* went to get her annual mammogram and was told she needed a follow-up appointment for an ultrasound and additional scans. Marie is in her early 40s, and had only had a mammogram once before, when she thought she felt a lump. She had needed an ultrasound then as well, and when it was finished, the technician asked her, “You’re only worried about the right breast? Not the left?” When she nodded yes and asked if there was an issue with her left breast, the technician told her that she wasn’t permitted to tell her any additional information and that she would have to wait for a phone call from the doctor.

Shaken, Marie went home and spent the next several days in a prolonged state of anxiety, awaiting the call. Finally, it came: “You have a small mass, but it’s benign,” the doctor told her. “You should get another mammogram in six months.” Fast forward to this past summer, when Marie received a text from the doctor’s office that her follow-up ultrasound would cost $980. She was shocked. Her doctor had ordered this, and she had excellent insurance. She called the doctor’s office and spoke to the billing department, which informed her that it was a mistake and that the ultrasound and additional scans would instead cost $0.

Marie was incredulous; she asked how such a mistake could have possibly occurred and was informed that Colorado only passed a bill in 2025 ensuring that “medically necessary follow-up diagnostic and supplemental breast cancer examinations” would be covered by insurance. The doctor’s office hadn’t updated their automated systems, almost an entire year later; hence the erroneous message regarding the $980 appointment cost.

Sobering Statistics

Women with dense breast tissue are often required to have follow-up appointments. While medical professionals say that these additional exams should not cause the patient any concern, it’s also understandable why they do—the statistics are sobering. According to the American Cancer Society, approximately 1 in 8 women (13%) will develop invasive breast cancer in their lifetime. Breast cancer is the second leading cause of cancer death in women, after lung cancer, and in recent years, the rate of breast cancer diagnoses has risen 1% annually.

Add to that the financial burden of having to pay almost $1000 out of pocket for tests ordered by a doctor, and it’s no wonder that women don’t always get mammograms as regularly as advised. Thankfully, Colorado’s law, titled SB25-296, protects women from this financial hardship, and anyone who receives a bill from a follow-up, medically ordered breast examination should immediately call their doctor and confirm the bill’s validity.

Staying Aware

Dr. Erica Pollack, a Breast Radiologist at AdventHealth Porter, stresses the fact that “dense breast tissue is very common and normal; however, dense breast tissue can make small cancers harder to see on the mammogram.” Because dense breast tissue is also a risk factor for developing breast cancer, Dr. Pollack explains that, in Colorado, patients with dense breast tissue will be informed of this when they receive their mammogram results in the mail. “The most important thing patients with dense breast tissue can do is to be vigilant about getting their annual screening mammogram on time,” she advises. “Patients with dense breast tissue can also choose to have other screening tests, such as breast ultrasound or MRI; these should be done in addition to mammograms, not in place of mammograms. Keep in mind that breast density often changes with age, and dense breast tissue is less common in women after menopause.”

While the statistics might seem frightening, there is also some good news in the data. The American Cancer Society reports that “breast cancer death rates have been decreasing steadily since 1989, for an overall decline of 44% through 2023. This is most likely the result of finding breast cancer earlier through screening and increased awareness, as well as better treatments.” While the median age of diagnosis is 63, about 1 in 10 women diagnosed with breast cancer are younger than 45. Early detection is paramount to survival, and the best method of catching breast cancer before it spreads or metastasises is frequent mammograms.

Additionally, Dr. Pollack says technological advancements such as artificial intelligence (AI) have “been a huge topic in breast radiology, and there are new tools that have emerged to help us interpret mammograms and ultrasounds.” Interpreting those exams still requires a physician radiologist, but AI helps ensure accurate testing. “For example, at the Breast Cancer Center at AdventHealth Porter we use a tool called 3DQuorumÒ, which helps us identify suspicious areas and get results to patients quicker,” Dr. Pollack explains. “AI tools can also help us to identify patients that are at higher-than-average risk for developing breast cancer and who may need to have other types of exams in addition to mammograms.”

Advent Health uses tomosynthesis (aka “3D mammography”), considered the standard of care by health professionals. “Tomosynthesis can really be thought of as a ‘better mammogram’ because it gives us multiple images or ‘slices’ to examine while still remaining completely safe in terms of radiation dose,” says Dr. Porter. “Tomosynthesis allows us to detect very small early cancers more easily and also decreases the likelihood that we will confuse benign (normal) tissue with malignant (cancerous) tissue.”

Knowledge is Power

Certain ethnic groups, such as Ashkenazi Jews, have much higher rates of breast cancer than other groups. In Colorado, if a patient gets a genetic test to check for inherited gene mutations, such as BRCA1 and BRCA2, which increase one’s lifetime cancer risk, they might be asked if they have any relatives from the San Luis Valley or Northern New Mexico. This happened to Julia*, who ordered such a test after her mother passed away from brain cancer and wanted more information about her own cancer risk.

Julia lives in Denver, but owns property in the San Luis Valley and visits often. When she asked the doctor why her intake form inquired if she had family from Southern Colorado or Northern New Mexico, the doctor explained that many families living in that region have Ashkenazi Jewish heritage, but simply don’t realize it because their relatives had likely converted to Catholicism at some point. The more information a woman has about her family’s history, the better equipped she is to protect her health. Knowledge is power, and technology has made learning about one’s family tree more accessible than ever before.

No matter what, as a woman facing a breast cancer diagnosis of any stage, it’s important to always remember that you are not alone. There are more than 4 million breast cancer survivors in the U.S., and Denver has a variety of support groups for those dealing with breast cancer, such as CanCare, a nonprofit organization dedicated to providing hope to those facing cancer by matching them with a survivor who can help them navigate treatment and offer emotional support.

Dr. Pollack says that all women should have annual mammograms beginning at age 40 (or earlier for some patients who have relatives with breast cancer). “In addition to improving survival,” she elaborates, “mammography screening allows breast cancers to be detected at an earlier stage, and these can be treated (and cured!) with less invasive surgery and less aggressive treatment.” If you’re a woman in Colorado, put yourself first this October, and schedule your annual mammogram. Because being proactive about your health is the ultimate flex.

*names have been changed