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Breast Cancer: Should You Really Wait Six Months After an 'Abnormal' Mammogram?

It's what many women are told to do before more testing is done. A West County breast surgeon shares her thoughts on waiting six months and on what women need to know to be in charge of their health.

It's a common practice. Women are often told to come back six months later for a follow-up exam after receiving an "abnormal" mammogram.

"Six months was the amount of time that was figured out in medicine that things don't go horribly wrong," explains Jovita Oruwari, an oncologic breast surgeon with Mercy Clinic St. Louis Cancer and Breast Institute. "And we know that because that's been studied in a lot of women."

As previously reported by Patch, one West County woman followed that standard procedure and found out six months later that she had breast cancer.

(Read Previous Story: Breast Cancer: My Mom's Lesson in Patient Advocacy)

Since that time in 2006, she's taken steps to become more of an advocate for her own health care.

"You must be your own health advocate," my mom, Dianes Barnes, tells me. "Any and every type of medical preventative testing I've had since, I have made sure I get a hard copy of my results. I keep them in my own personal file.

She does this is because she never saw any of the reports prior to being diagnosed with breast cancer and it's always haunted her that she simply took the letter that comes in the mail from her OB/GYN as the only information she needed to be a well-informed patient. 

"An actual size had been given to the dense breast tissue. That would have just alerted me to ask more questions and be more aware," my mom now says. "If that size had been over a centimeter, I would have had to have chemo and would have had to have gone through a much more intense treatment than I did. Even if it had been the same type of cancer cell. So to me, the size is very important. It's one of the tools that determines your treatment. I talked to several (physicians) to decide how I wanted to proceed... every physician I spoke to, that was the first thing they asked me, 'Well, what size was it?'" 

My mom's breast surgeon, who removed the cancer, tells Patch that size is only one of many factors that determine treatment for breast cancer. Oruwari also says the rationale behind the six-month waiting period is that often radiologists notice what turns out to be a benign matter, like a cyst, that is fine six-months later. The time period also avoids unnecessary biopsies.

"It's disheartening of course, nobody wants to be told six months later that they have cancer. I think in your mother's case it did not change the management or the stage or anything," Oruwari tells Patch. "It takes cancer a long, long time to develop, to grow to where they are."

That said, Oruwari does not always agree with or recommend the six month waiting period and advises patients to push further and seek a second opinion if they are concerned.

"For me, as a physician, I take care of many patients, but each patient only has themself to take care of. Just on the off-chance that a physician missed something, I'm not saying they did, but on the off chance, it gives the physician another chance to look at it," Oruwari explained. "When people come to see me with x-rays and we look at this and it's something new, I'm not entirely comfortable waiting six months in a woman who is already 40. I give them the option to wait six months or get a biopsy at this time. That is just me personally, so I cannot discredit the radiologist."

She agrees with my mom that compiling your own health care information is a good idea and helps each patient be in charge of their own health.

"I keep my own records even though I trust the institutions where I get my imaging," Oruwari tells Patch. She recommends patients keep a record of their health like they do they do their bills. "This is your health care. It's just as important, if not more important."

Oruwari said what is also important is knowing what to do as a woman when it comes to breast cancer and having the information.

She tells Patch, 80 percent of women diagnosed with breast cancer do not have a family history. If a woman's mother is diagnosed before menopause, it increases her daughter's risk of the disease. The risk is higher if more than one first degree relative has breast cancer. The risk also increases the younger the relative was at the time of diagnosis.

Oruwari stresses that mammograms save lives. She says most women should begin mammograms at age 40 and continue every year after. For a woman with a family history of breast cancer, Oruwari said her mammograms should begin ten years younger than her mother was when she was diagnosed.

"No test is perfect, unfortunately, and it does miss 10 percent of breast cancers, either because the cancer is too small or the woman's breast tissue is too dense that we can't see the lump," Oruwari said.

In my mother's case, it was the only the mammogram that detected the "dense tissue." It was never diagnosed as a "lump" and it never stood out as anything significant on the unltrasound that was also conducted.

Oruwari also recommends having he mammograms done at the same place each year so they can be compared to previous years when looking for changes in breast tissue. She also says the x-rays should be done at an accredited and dedicated breast center so the radiologist reading the report is specialized in mammograms.

"It's also important to do those monthly breast exams because some lumps we can feel, before we can actually see it on the mammogram," Oruwari adds.

As my mom reflects on her situation, hindsight is 20/20, but moving forward she makes sure she knows as much as she can about her own health. She encourages all women to do the same.

"Make sure you get an actual hard copy of the radiation report so you can see exactly what the physicians are documenting about your mammogram. Don't rely on the little note sent out in the mail that says, 'Your report is negative and you're fine. See you in a year'" my mom says. "Know what's really on that report so you know how to really follow up, truly follow up to protect your health."

*NOTE: Gabrielle Biondo has been the editor of Town and Country-Manchester Patch since its launch in November 2010. She is telling her mother's story as part of Patch's coverage of Breast Cancer Awareness month.

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