As all of you in the field know, Patient Navigation is so much more than a reminder phone call to schedule a mammogram. Over time relationships are formed and trust is gained and these are the critical components that can lead to saving lives. Caring Connections story embodies this ideal.
In 2003 we enrolled a fifty year old woman of French Canadian heritage who I will call Lynn. Lynn lives in a town north of Bangor and works in a bakery. She had services through our program until 2006 when the over-time she worked at the bakery put her over our income guidelines.
We navigated her to another resource, so that she could continue to get mammograms.
In 2014, Lynn was working reduced hours and rejoined our program and had her mammogram, which was normal.
In the following year, she had her clinical breast exam and she and the provider decided she did not need a mammogram that year.
However, in 2016 she developed some other health problems that were not covered by our breast health program. She was having pelvic pain and required an abdominal CT scan. She was reluctant due to fears about the cost. She did have insurance gained through ACA so Caring Connections staff assisted Lynn and her husband to contact their insurance plan to determine what services they were eligible. They were also assisted to obtain a reduced care application from Eastern Maine Medical Center. Lynn eventually had the test done but she was frustrated by the process.
This frustration was evident during a phone call in mid-July she said to me “Now they want me to have this stupid mammogram!!” I don’t need this done. There is nothing wrong with my breasts! They don’t hurt. I don’t need this. I am going to cancel it.” I reminded her that she hadn’t had a mammogram in 2015 so this would be two years. I explained to her that mammograms can find very small changes in the cells that we would not be able to feel and that by having a mammogram regularly she would have a better chance of detecting a problem when it was smaller and easier to treat. I spent about 20 minutes on the phone with her encouraging her to go through with the mammogram and assuring her that all costs would be covered.
I was not sure if I had convinced her when I hung up, but she did have the mammogram. Her screening mammogram led to a diagnostic mammogram which led to a biopsy with the diagnosis of atypical hyperplasia. An excisional biopsy was recommended to remove the area where the cells were found. I attended the surgical consult with Lynn and her husband. The surgeon explained why, even though no cancer was found, it was very important to remove those cells as they can change over time and could possibly become cancer. The surgeon showed Lynn diagrams with the cell changes from normal to atypical to ductal carcinoma in situ.
Lynn’s excisional biopsy is scheduled for mid-October so we won’t have the final pathology for a few more days. Hopefully no cancer cells will be found. It was fortunate she did have the mammogram at this time. Without our conversation she might have put it off. This may not have made any difference but the cells may have continued to change and become cancer at some point.
But we will be here for her no matter what the outcome.