Medicare does not pay for ultrasound screening for breast cancer

A year ago I was scheduled to have a mastectomy of my left breast. But, at the last minute, I changed my mind and canceled the surgery.

I have had breast cancer three times: in 1990, 2007, and in 2009. I had chemo and radiation twice, most recently in 2009/2010. After that, I got  Faslodex injections (chemotherapy) for five years. I was able to get it despite the fact that my breast cancer was Stage III and not Stage IV. I don't think that happens often.

After I finished Faslodex, I was afraid. I was certainly tired of the shots, the nausea, and the aching which followed them. But I was concerned that breast cancer would return with a vengeance. While I was on Faslodex, I got a left breast ultrasound each year. It was probably part of the treatment protocol, maybe because it is difficult for me to get a mammogram.

I finished Faslodex in July 2015. Since my oncologist suggested I be tested for the breast cancer gene mutation BRCA2, I asked about it. It took a while to get it approved. Genetic screening was done with a simple blood test and August 2015. It showed I was positive for BRCA2. When I told my oncologist,, he suggested a mastectomy to prevent further breast cancer in my remaining breast. I questioned whether having the mastectomy would increase my individual survival chances.

Back in 1970, when my mother had a left breast mastectomy, they removed her breast, lymph nodes, underlying tissue, muscle, and a lot of skin. They don't do that now. Now they think I woman should not have radical mastectomy if it does not raise her chances of survival.

In November 2015, I told my oncologist I would see a surgeon. He had told me I could no longer have ultrasounds to screen for tumors. I scheduled the mastectomy for February 2016. The day of surgery I change my mind. I decided I did not want to have a mastectomy, which would put my life in jeopardy, to try to maybe increase my survival chances.

Instead, I wanted a left breast ultrasound to see if I had a tumor. I almost had to move heaven and earth to get it. It was scheduled and canceled again and again because providers felt Medicare would not pay. But somehow I had the ultrasound.

I had an ultrasound at the end of February 2016. It's over a year later. I asked the nursing home about scheduling another left breast ultrasound. But, I have heard nothing.

I will ask my physician (the medical director here) if Medicare will pay for a left breast ultrasound in 2017. Medicare has a rule that it will not pay for breast ultrasounds as a cancer screening tool. It can be used for diagnostics, such as to do a biopsy.

When I first had breast cancer in 1990, I had to have a mammogram. That was so difficult because of my paralysis. I stood for the test which was torture. I am also sure that the quality of the mammogram was not good. After that, my oncologist said it was pretty much useless to have another. He told me hospital radiologists would require a mammogram first, before they would do an ultrasound.. He told me the ultrasound was as accurate as a mammogram. However, he said hospitals and clinics have to pay for their mammography machines, and they do that by doing mammograms.

For the following four years after that first breast cancer, I had no further breast screenings. I had x-rays, abdominal CAT scans, and bone scans to check for metastasis. But no ultrasounds were done. I did have two or three mammograms after I moved to my first nursing home. They were done as a cancer screening. I stopped getting mammograms because I was bruised so very badly during it.

I understand Medicare cannot pay for useless tests. But if Medicaid will not pay for an ultrasound. I will no longer get a screening. I know a chest x-ray could be done. it would show if there are any tumors in my lungs. I may have to settle for that. That's what I did from 1991 to 1995.

I would think Medicare would have some type of waiver policy for people like me with be able to have a simple breast cancer screening without all this uncertainty.