A digital mammogram and stereotactic biopsy in a foreign country

We don’t have health insurance. We pay as we go around the world, including yearly checkups. When my annual mammogram found something suspicious, a stereotactic biopsy determined it was early stage breast cancer.

Mammogram abroad

I paid just $64 for my annual mammogram this year in Croatia, and I didn’t have to wait.

It was done on a modern digital machine and it produced high-resolution images, which I got to keep on a CD at no extra cost.

I found the private clinic online. I went to the office with my husband Tedly to check it out and to see how much English was spoken.

One front office worker at Affidea in Split was fluent in English, as well as one radiologist. Another radiologist knew some basic English. I asked to make an appointment, but the receptionist said I could return anytime as a walk-in customer.

Affidea in Split, Croatia
The entrance to Affidea in Split, Croatia.

Croatians have free health care, or nearly free. But they may have to wait weeks or months for a routine test, and they pay high fees for specialized tests. Croatians can also forego public health care and go to private-pay doctors and clinics, like Affidea.

I recommend Affidea for any expat woman who wants or needs a mammogram while in Croatia. This private-pay health clinic is all over Europe. A link to the main page is here, and from there you can pick a country or city.

Just FYI – make sure someone who speaks English will be there when you get your results. I picked up mine on a late Friday afternoon, and the only words I understood before I could use Google Translate were “BIRADS 4” and “biopsy.”

My mammogram revealed a large area of suspicious pleomorphic microcalcifiations. A biopsy was recommended as soon as possible.

To determine the type of biopsy I should have, I made an appointment with a private-pay oncologist in Split for the next business day. She spoke English, and she came recommended by the people at Affidea.

The oncologist performed an ultrasound test to examine the suspicious area. She recommended a stereotactic vacuum-assisted biopsy as soon as possible.

Her English was broken, but clearly understood. She took her time to answer all of my questions. She gave me the ultrasound images to keep along with her written analysis and opinion. The fee for the test and consultation was $48.

Stereotactic biopsy abroad

There are two stereotactic biopsy machines in Croatia as of this writing. They both are in public facilities – one in Split, the other in the capital Zagreb. I went to the public hospital in Split to inquire about an appointment. This is where English was a big problem.

Diamond my angel in Split, Croatia
Me and Diamond, an incredibly kind man who helped me make a biopsy appointment at the public hospital in Split, Croatia.

The schedulers knew little English. Lucky for me, a security guard spoke English fluently. Through this angel, whose name translated into Diamond, I was able to make an appointment at the public hospital for a stereotactic biopsy.

It would be performed by an English-speaking doctor, trained at Memorial Sloan Kettering in New York. Diamond also translated the cost, what to expect, and what to bring.

He even walked me down the road from hospital grounds to help me set up a blood test at a lab that doctors would need pre-biopsy . Angels walk among us, indeed.

I waited two weeks for the appointment. The stereotactic biopsy was not painful, thanks to local anesthesia. The room was filled with medical workers, including the lead Sloan Kettering-trained doctor named Dr. Tade Tadic, who ultimately saved my life.

When it was over, Dr. Tadic showed me digital images of the procedure and the samples collected. I knew right then and there I was going to be diagnosed with cancer. I just somehow knew.

A billing translator (not Diamond) took me and Tedly to another building on the hospital campus, where we used a credit card to pay $2,888 for the biopsy. This was the foreigner price, and yes, it was a big chunk of money for us. But I had to know what was going on inside my breast, so we paid it.

A hospital worker told me Croatian women would have to pay $720 for a stereotactic biopsy — even with nationalized health care. That is an incredibly large sum when average net salaries are $930 USD a month ($1,250 before taxes).

As a bonus, I got to keep all the biopsy images on a CD at no extra charge. One of the differences between U.S. health care, and health care abroad: you automatically get your own specimens and images to carry around.

The pathology test was $219, payable when results were delivered. Results took another 10 days.

Diagnosis Abroad: DCIS, grade 3 with necrosis, ER+/PR+

The biopsy showed I had ductal carcinoma in situ, DCIS, also called “Stage 0” breast cancer. A non-invasive kind of cancer found inside milk ducts. Mine was grade 3 (the fastest growing) with necrosis (dead cells piling up).

The cancer cells were hormone positive, meaning my hormones made it grow even faster. It was not tested further for additional subtypes, since the pathologist saw no evidence in the samples of invasive cancer. However, she warned invasion outside the milk duct could happen at any time – she didn’t know when.

The DCIS covered a large area relative to my breast. The biopsy sample had been microscopic.

Biopsy rooms in Split, Croatia, hospital
Biopsy room entrance in the public hospital of Split, Croatia.

The lead pathologist gave me my cancer cells on microscope slides in case I wanted to have an outside pathologist to examine them.

She and Dr. Tadic each recommended immediate removal of the tissue. It was the first time I heard someone say “mastectomy” in relation to me. But, they said “maybe a lumpectomy.” They said ultimate treatment options would be presented through the expertise of breast surgeons and oncologists.

So, it was time to find more doctors abroad, and to educate myself about DCIS.

Dr. Tadic saw something highly suspicious on my mammogram, and that prompted me to get the biopsy. What was later discovered was quite a surprise — a small invasive tumor that was too small for any imaging to detect. But that wouldn’t be discovered until my post-mastectomy pathology report.

MEDICAL DISCLAIMER

The information contained in this blog is not intended to be used for medical diagnosis or treatment. It should not be used in place of the advice of your doctor or other qualified health care provider.

 

 

 

 

 

 

 

 

 

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