Evaluation of a Palpable Breast Mass in a Young Female: Implications when Working with Underserved Populations

Abstract

We report the case of a 37 year-old uninsured African American female who came to the office complaining of a breast mass for about a month. The patient was examined during the initial office visit and proper imaging was ordered based on current guidelines for this type of complaint. Literature shows that female patients who present to primary care providers with breast symptoms, approximately 42 percent of them report a breast mass. Even though most masses are benign, they are the most common presenting symptom in patients diagnosed with breast cancer. A palpable mass in a woman’s breast requires a prompt evaluation. Correct diagnosis of a breast mass is essential for optimal treatment planning, with the primary aim being to confirm or exclude cancer. Breast cancer is the most common cancer among women of all races, and it is the leading cause of cancer death among Hispanic women and second among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women. The triple test (TT) advices the evaluation of palpable breast masses by physical examination, mammography, and fine-needle aspiration (FNAC), and it has proven to be a reliable and accurate tool due to its technical simplicity and reduced expense and morbidity compared with open surgical biopsy. Low-income African-American women often report lower receipt of medical risk information, and due to lack of insurance they do not have a regular source of care, which in turn leads to decreased utilization of medical health services. This case highlights the importance of the utilization of the triple test when evaluating young females complaining of breast masses, but it also emphasizes the important role that providers play when working with underserved populations.