Guaranteed Healthcare

Dear Eve,

A young women of 26 usually is at low-risk for cancer of the breast. An ultra-sound would be of better value than a mammogram because young women have dense breasts and the US of the area would give us an idea if this is fluid filled ( benign cyst) or fibro-cystic tissue. Most lumps in younger women are benign and not cancerous. They are either fluid filled cysts or fibrocystic changess. Questions should include: Discharge: present/absent, color. Pain which in the case of firbrocycstic lesions can increase around the week before menses and on menses and dissappears after. ALso knowing the women's history including smoking, environmental exposures and family history of breast CA in mother, grandmothers and sisters is important. I think it is part of our problem without single-payer/medicare for all that patients have no primary care provider and fear the costly care when they do seek a provider in an ER like this.

I would follow this woman for one or two mentral cycles unless the lesion is very painfull and increasing in size. If the latter, then schedule at the local public health clinic or women's clinic. A deck US could be done to rule/out fluid filled and then it can then be needle biospied (FNA) to release the fluid. If solid, then follow-up with women's clinic after watching lesion for two menstral cycles for resolution. Planned Parenthoods in some locations are also great places where women can get breast exams and sonos for low-cost or free with sliding scale. In the Planned Parenthood I worked at, two women physicians (breast cancer MD specalists) provided free screening mammograms and free biopsies for women who could not afford to pay and lacked insurance that would pay. In addition, Dr. Susan Love, MD has a great book out in its 6th edition on breast health that is affordable and readable for the lay person.

Biopsy is the gold standard to diagnose or rule out cancer. But biopsies can be FNA's (Fine needle aspirations) to Core sampling biopsies. But getting your daughter into another clinic that wouldn't scare the heck out of you with pricey bills is a good idea. ANd stick with a provider you like.

Hope this helps

Sincerely,

Nancy E. Lewis, FNP

This is not my daughter.

It was an email I received from a desperate American.

How sad and frightening that American citizens turn to me, a citizen/blogger/activist for help, having been abadnoned by their government.