I have dense breast tissue and need ultrasounds after my mammograms. I wish my insurance would automatically cover them.

• My doctor recommended I start getting regular mammograms a couple of years ago.
• I have dense breast tissue, which makes it harder to detect potential problems in mammograms.

Several years ago, I started to get regular mammograms, as recommended by my doctor, and quickly discovered that "routine," for me, was far from routine.

I'm one of the 40% to 50% of women in my age bracket who have dense breast tissue. The Susan G. Komen Foundation has found that women with dense breast tissue are four to five times more likely to develop breast cancer. Additionally, abnormal findings are harder to detect with mammograms if you have dense breast tissue.

When I had my first mammogram more than five years ago, I was called back for additional images because of abnormalities. The follow-up appointment couldn't be scheduled for several days, so I spent those days convinced I had cancer.

That weekend, the future I imagined was dark. I thought about chemotherapy. I imagined telling my preteen sons I was sick. I thought of all of the mundane routines my well-meaning husband was clueless about. They couldn't survive without me, I thought, but what if they had to? Fortunately, the ultrasound revealed a harmless cyst.

The same scenario plays out every year

Unfortunately, I was destined to play out the same scenario over and over again, because our insurance system requires me to walk through the regular preventative steps every time, even though I will inevitably need a diagnostic ultrasound.

This year I had to wait five nights between my first 3D mammogram and the follow-up appointment for more images and the ultrasound. That meant five nights of worst-case scenarios and tearful bargaining with God.

I thought about the many women I know personally who had survived breast cancer. I recited their names, counting them like beads on a rosary. Those were my hopeful moments.

But I was grateful for my good health overall. Other than surgery for impacted wisdom teeth and some stitches from a mishap with a serrated knife, I had dodged every serious bullet. No hospital stays, no serious infections, no broken bones. Surely, though, it had to be my turn. I wondered how my last days would play out. Those were my hopeless moments.

After five interminable days and nights, the morning of the appointment finally arrived. I donned my vintage Johnny Cash T-shirt and remembered I couldn't wear deodorant to the appointment. As I pulled on my favorite bralette, I cursed my small, dense breasts. If they weren't big enough to necessitate a "real" bra, why should I have to deal with yet another breast-cancer scare?

Ultrasounds are considered diagnostic treatment and not preventative

My appointment was scheduled at a speciality breast clinic, where I received top-notch care. Every step was explained as I went from waiting room to waiting room and counted the minutes until I had the results.

Before the gentle ultrasound tech left me to clean the glob of cold jelly off my breast, I asked her the question I had been thinking about for five nights.

"If I had started out here at this clinic with my first appointment, could I have avoided all of this extra waiting? Would I have just started with the ultrasound and skipped all of the unnecessary mammography appointments?" I sputtered, my anxiety making me more awkward than normal.

She patiently explained that no, I would still have to wait for the ultrasound because it was considered "diagnostic" rather than "preventative." My insurance company wouldn't have allowed the appointments to happen on the same day. In the best-case scenario, an appointment would be available the next day, but I'd still have to wait.

I'm not the only waiting woman I know. My sister has the same dense tissue. Seven years my senior, she also now has a needle biopsy under her belt. I'm betting that's in my future, too. But I'm in good company, with several other friends who have had multiple follow-up mammograms and ultrasounds.

Soon the doctor came in to share the good news: another cyst.

Of course I was thankful, but I am ultimately frustrated by the insurance system in this country, a system of anxiety-inducing appointments and superfluous charges creating barriers to care. My experiences with mammograms provide a yearly reminder of that bleak reality.