Not Just Semantics

You learn something new every mammogram.

When I went for this year's mammogram, my second in Los Angeles, the technician asked why I was having a screening mammogram, rather than a diagnostic mammogram.

I looked at her blankly—for all of my experience, this was a first. I never knew that mammograms came in two flavors.

Now I do.

Screening mammograms are like regular check-ups. You have no reason to think there's a problem, but you go through the process just in case.

Diagnostic mammograms are done when there is reason to be suspicious—some symptom or some finding (like a lump) from a recent breast exam. They generally include additional views—basically, extra X-rays taken from other angles to give a more complete picture of the breast.

The technician said I should always have diagnostic mammograms given my history. In fact, she said, I'd had one last year.

I thought back and remembered that in 2008 my new (now former, which is another story) LA gynecologist referred me to the cancer center's imaging center for my annual mammogram. I called and made an appointment, then went in for the test. On the way out, I was asked to schedule my 2009 mammogram—a great idea, I thought. I picked a date, and off I went.

Neither time was I asked what kind of mammogram I wanted.

The technician explained that I don't get to choose the kind of mammogram I have—it's up to the doctor who writes the prescription (for outside doctors) or the order (for those, like my oncologist, who is at the cancer center).

Well, no one wrote a prescription or order for this year's exam, so I guess I was scheduled for screening mammogram by default.

Now that I know the difference, I assume that my first mammogram, back in 2001, was diagnostic—it was at the behest of my gynecologist, who had detected a very subtle change in the tissue of my left breast. But all the mammograms I had in New York after that? I have no clue.

I saw my oncologist the following week, and he agreed that I should have been scheduled for a diagnostic mammogram. But he also said that because my results were normal (hooray!), and because I'd had a normal breast MRI six months earlier, and because I had no symptoms and no abnormal breast exams (clinical or self-), he didn't feel that I should go back and have the supplemental films taken—it was unnecessary to expose me to the additional radiation.

I'll have another breast MRI in the spring, I'll continue to do my monthly breast self-exams, and I'll continue to have clinical breast exams several times a year. But I'll also be sure to confirm that my 2010 mammogram is of the "diagnostic" variety.

This doesn't mean that everyone should have an annual diagnostic mammogram, of course. But someone with my history? Absolutely.

(And yes, the grammarian in me thinks that there should be a different term for "diagnostic" mammograms given to people with histories like mine. Because in the absence of a red flag, they're not truly diagnostic—they're screening. More thorough, yes, but screening nonetheless. Maybe "heightened screening"?)