Would my mammogram be considered medically necessary if my mom died from breast cancer?

Question

I am going to talk to my doc tomorrow about getting a mammogram. My mom had breast cancer when she died, two weeks ago. My insurance doesn't cover until 35 and then you can only get one mammogram b/w 35 - 39. My insurance will cover it if it's medically necessary. I will pay either way, but I wonder if my insurance will pay for it b/c my mom had the disease.

BTW- I am 31, but I have heard of numerouse stories of people my age dying of breast cancer.

Answer 1

Please review these guidelines from the National Cancer Institute. Essentially it says that if you have a family history and need a mammogram prior to age 40, you and your physician need to evaluate the need for this. Depending on your insurance company, you might be able to argue the case with them. Perhaps you health care provider can appeal it to them if they refuse to pay. I have been able to get insurance companies to pay for tests that they refuse to pay for initially after appealing it.
Please be aware though that women who are younger have denser breast tissue and it is more difficult to see malingnant lesions on the mammogram. MRIs tend to be better for women with dense breast tissue, but they are not yet the standard of care for screening for breast cancer.

http://www.cancer.gov/cancertopics/factsheet/Detection/screening-mammograms

Answer 2

You need to undergo yearly breast mammograms five years before the age your mother was diagnosed with breast cancer. You should be performing self breast exams on a monthly basis now at the very least. I would also consider ultrasound as a back-up to mammograms, as mammorgrams do not detect cancer 100% of the time. Talk to your gynecologist.

Answer 3

In Canada this would be covered by our Medical. Increased risk is there. Your Dr. is the first stop. I had cancer in my right breast. Not to my knowledge is there a history of it in my family. I was told that most cancers occur in people with no history. While your risk may be higher, the warning goes out to all women to be on the ball. Especially after 50. All bets are off. Take care of your self. I made it through with no spreading. Feeling great. For now anyway. So finding it soon & getting the treatment makes a difference. Good luck!

Answer 4

I am sorry for your loss. I also lost my mother last year to breast cancer. She was 56 and it went undetected for several years. She was diagnosed in January 2005 and passed away in March 2005. I am also 31 and would like to see mammograms started earlier than 40. Several Woman on my mother's side have been diagnosed with breast cancer, including her mother and 2 aunts, and my grandmother on my father's side was also diagnosed. I wen to to see my physician this year and voiced my concerns. He still advised me that I shouldn't need one until after the age of 35. I feel that if there is a significant risk- the insurance companies should make allowances for earlier detection. It's far less expensive for them if it is prevented rather than treated.

Answer 5

First of all I'm so sorry for the loss of your mother.

It is only considered medically necessary if your doctor says that it is. You are absolutely correct that many people under the age of 35 get breast cancer. My suggestion is to join the American Cancer Society Cancer Action Network. The ASC CAN lobby our politicians to make insurance companies cover cancer detections methods earlier for those who are at higher risk (i.e. a family history) as well as many other wonderful causes related to cancer. Check it out at www.acscan.org.

Answer 6

Personally I think a mammogram should be part of a woman's check up from the start. There are so many out there that are much younger ...why wait till 40??? Your Doc can justify you getting one and the insurance will pay. If they don't send them a claims dispute with your family history.

Answer 7

Your doctor should be able to deem it medically necessary if your mom died of breast cancer. Beginning age for a mammogram is 35 if no breast cancer history in the family. if there is, you should have one earlier, and since you are 31 your doctor should be able to consider it necessary for a baseline.

Answer 8

I had this same issue with my insurance company (Kaiser Permanente). I had to get very angry and I told them that if I got breast cancer, that I would sue them for negligence in not performing a mammogram knowing that I had a history of breast cancer in my mother. They eventually relented and I started getting mammograms at age 31.

Nonetheless, you need to be religious about monthly breast self-examination. That's how most breast cancer is caught anyway. Get someone knowlegeable to teach you how to do it and do it every single month for the rest of your life..

Answer 9

At the age of 31, mammography is not going to be a good imaging tool for you. Dense breasts are very difficult to image with a mammogram. Young breasts are dense. Dense breasts appear white on the film. Things that would show up on a mammogram which would indicate cancer (masses or microcalcifications) also appear white on the film. Your best way of finding an early breast cancer, at your age, is religious monthly self breast exam and clinical breast examinations by qualified medical personal. Also, the denser the breast, the more radiation is needed to penetrate the tissue. Therefore, your risk from the higher dose of radiation, usually does not justify an exam which probably will not give you reliable readings.

"The breasts of young women contain many glands and ligaments, which appear dense on a mammogram. This radiologic density makes it more difficult to spot tumors, or to tell cancerous conditions. With age, the glandular and fibrous tissues of the breast gradually give way to fatty tissue. Because fatty tissue has less radiologic density, mammograms can more easily see into the breast tissue and detect abnormal changes. Although mammograms are not generally recommended as part of regular screening for women under age 40, women at increased risk (family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (such as breast ultrasound and MRI), or having more frequent exams."

http://www.womenswallstreet.com/giving_back/faq/Index.aspx

"In general, regular mammograms are not recommended for women under 40 years old, in part, because breast tissue tends to be more dense in young women, making mammograms less effective as a screening tool. In addition, most experts believe the low risk of developing breast cancer at a young age does not justify the radiation exposure or the cost of mammography. However, screening mammograms may be recommended for younger women with a family history of breast cancer and other risk factors."

http://www.medicinenet.com/breast_cancer_in_young_women/page2.htm

Answer 10

Not numerous. Whether you are more likely to get it depends on whether you have the gene for breast cancer. Can you get that checked? In any case, you need a mammogram every couple of years to 40 and then yearly. If you have the gene yearly.