What Young Women Should Know When They Are Denied a Mammogram

Recently, a young woman from California shared her breast cancer story to help alert other young women after she was denied a mammogram when she discovered a marble-sized lump in her breast.

The Saga of Philecia La’Bounty

Philecia La’Bounty was just 29 years ago when she discovered that lump in her breast. Because she didn’t have health insurance, she sought care at a free clinic. They performed an ultrasound and told her she had a benign cyst and not to worry. Her blood work was normal, and she was asymptomatic. The staff tried to reassure her by telling her that she was too young to have breast cancer. She requested a mammogram because she still felt uneasy about the lump. The clinic physician sent a request which was denied because she had no family history of cancer and her young age. The clinic told her to come back if the cyst bothered her.

Eight months later, the lump had grown larger — so large, in fact, that it was noticeable in some of the clothing she wore as a model, and the lump had become uncomfortable. She returned to the clinic.

The staff immediately scheduled emergency ultrasounds and a mammogram. The young woman relates that the technician left the room several times, and La’Bounty began to realize that her situation was probably serious. The clinic scheduled MRI imaging, a PET scan, and a biopsy, confirming her diagnosis of Stage IV breast cancer that had spread to her lungs, lymph nodes, and sternum. Her tumor then measured 8 cm.

The young woman is now 35. She received six months of IV chemotherapy, her fallopian tubes and ovaries were removed, and she takes hormone blockers — propelling her into early menopause.

Since then, she has received oral chemotherapy in five-week cycles of three weeks on and two weeks off. A recent PET scan revealed that she is in remission — no evidence of disease. But she will most likely remain on “chemo for life” to help keep her cancer dormant.

La’Bounty says, “Trust your gut. If you don’t feel comfortable with your diagnosis, go to another doctor, and get a second opinion.”

Statistics for Breast Cancer in Women under 45

Although breast cancer is uncommon in women under 45, it still accounts for about 9% of new diagnoses of breast cancer in the United States each year. Let’s look at the most recent statistics from the CDC for 2019.

So while rare, breast cancer is still possible, so younger women need to know what to do if they detect a lump in their breast.

Most healthcare professionals don’t recommend mammography for women until they reach 40. One reason for this recommendation is that younger women are more likely to have dense breasts which appear white on mammograms — cancer also appears white on a mammogram making it challenging to distinguish a cancerous growth from dense breast tissue. The only exception is young patients with immediate family members (mothers or sisters) who have been diagnosed with breast cancer.

The Value of Breast Self-Exams

Although the American Cancer Society doesn’t recommend regular breast self-exams, many breast health experts continue to recommend monthly self-exams. Their reason is simple — you’ll get to know your breasts so that you can detect changes in your breast. Some changes that younger women might experience are:

• Differences in shape, size, or color
• Changes in the nipple or nipple discharge
• Changes in the feel of the skin on your breast or dimpling
• Pain or discomfort, not associated with menstruation
• Lump or thickening in the breast or underarm
• A nipple that becomes inverted
• Itchy rash

What Doctors Recommend for Young Women Who Detect a Lump in their Breast

First of all, don’t panic. Most breast lumps are not cancerous — only one out of every five lumps turns out to be cancer. Call your primary care physician, OB/GYN, or your local health department if you feel a lump. Be sure to tell them that you’ve felt a lump and want it checked out as soon as possible.

Your healthcare provider should access your lump and diagnose you using the following steps.

• Clinical breast exams include a visual exam looking for changes in size, shape, and skin texture and palpating your breasts and underarm area to check for lumps or thickening of the tissue.
• Diagnostic mammograms are specialized mammogram that focuses on the area of concern. The exam includes views from several angles and at higher magnification.
• 3D mammograms, also called tomosynthesis, benefit women with dense breasts. Your radiologist utilizes the three-dimensional image created to study your breasts one layer at a time. 3D mammography is becoming more common among many providers as their standard of care.
• Breast MRI, meaning magnetic resonance imaging, helps radiologists create more detailed information about a cancerous lump to determine the extent of the cancerous lump.
• Ultrasound is another form of imaging used by mammographers that uses sound waves to create an image of the inside of the patient’s breast. Ultrasound images will show whether lumps are solid or filled with fluid, and it’s more probable that solid lumps are cancerous.
• Breast biopsies are usually performed by a radiologist utilizing a hollow-core needle to remove a tissue sample. Occasionally, a surgical biopsy might be required. Patients must remember that only about 20 percent of breast lumps are cancerous.

What if you don’t have a healthcare provider? Lumps in your breast should be evaluated. Ask a trusted friend or family member where they go for breast cancer screenings. You can also call your local health department or the local hospital.

Don’t let lack of insurance deter you from seeking help. Many mammography centers offer discounted “self-pay” rates for uninsured patients.

And most importantly, trust your gut feelings. You know your body, and you’ll recognize when something doesn’t feel right. Don’t be embarrassed or shamed into believing that it’s okay to wait or that you’re too young to have breast cancer. Get a second opinion — be proactive for yourself.