When Alma Ramos first noticed a lump in her breast, she didn’t have health insurance. Although she had the chance to get insurance through her work as a licensed vocational nurse at a memory care facility, she thought she could get by without it. She was 27 and healthy.
“I had never gone to the hospital, I never broke a bone, I never got sick, so I never felt the need to seek health insurance because I never really needed it,” Ramos said.
After speaking to her family, she learned that an aunt had a history of breast cancer. She also remembered learning in her nursing training that non-movable lumps, like the one she had found, were abnormal. She took her symptoms seriously, although she knew the risk of breast cancer was lower for young women.
Ramos sought out an appointment with a gynecologist at Lone Star Circle of Care. She was able to access the appointment through Central Health’s Medical Access Program, which provides health coverage to low-income Travis County residents who lack insurance and do not qualify for Medicare or Medicaid.
After feeling the lump, the gynecologist ordered an ultrasound on Ramos’ breast. Ramos knew something was wrong when the ultrasound technologists told her they also needed to do a mammogram, which was not part of the doctor’s original order.
“I knew it wasn’t a good thing, because I had just gone in for the ultrasound, which I thought might just be for cautionary reasons,” Ramos said.
After that, there was more testing, and within a couple of weeks, a diagnosis came. Ramos had Stage 3 breast cancer. Her original doctor referred her to Ascension Seton’s Breast Care Clinic at the Cancer Care Collaborative (CCC) for further care. There, Kimberly Ellison, an advanced practice nurse, helped Ramos understand her diagnosis and treatment options.
“I remember when I heard about her referral because she’s so young,” Ellison said. “When you have a patient with a family history and a mass that’s that suspicious on imaging, it’s sort of all hands on deck. You’re waiting for biopsy result to come through, and [you’re thinking], ‘Okay, what are we going to do to help this young woman?’”
Ramos began chemotherapy in April and managed to miss only two shifts at work while undergoing treatment, despite experiencing typical side effects. The chemo was successful; her tumor was gone by the end of her last treatment cycle in August.
Her care team recommended a bilateral mastectomy, a surgery in which both breasts are removed, as the next step. This presented a complication: while MAP covers mastectomies and certain kinds of reconstructive breast surgery, it would not cover the specific kind of reconstruction Ramos’ doctors recommended.
Ramos credits Jennifer Dinh, a nurse navigator with the CCC, for giving her an idea that would open up her options. Knowing that Ramos was engaged to be married, Dinh asked if she had considered moving up the wedding date. In the world of insurance, marriage is what’s known as a “qualifying life event," a circumstance that can make someone eligible to enroll in insurance outside of the regular annual enrollment period.
When Ramos brought the idea up with her fiancé, she said he was immediately supportive.
“He was like, ‘Perfect. Just tell me when, and we’ll get it done,'” she said.
They had a courthouse wedding on Aug. 21, and Ramos became eligible to enroll in her workplace’s insurance. Her surgery is scheduled for Nov. 13.
While navigating cancer has been difficult, Ramos expresses gratitude for the way things have unfolded — that she acted quickly when she noticed the lump, that she was able to get coverage through MAP, that physicians took her condition seriously and that she was able to secure insurance that would give her the best surgical options. She calls herself “a living miracle.”
Now, she wants to share what she’s learned about breast cancer with other women, especially those who, like her, may not realize they’re at risk.
“Get to know your breasts. Do self breast exams,” she said. “If there’s any change, seek medical help and talk to a doctor about it, because they will listen.”
Resources are available for people in the Austin area who don’t have insurance, such as MAP coverage. Additionally, uninsured and underinsured women over 40 — the age women are recommended to begin receiving regular mammograms by the Centers for Disease Control and Prevention — can get free or low-cost mammograms from Lone Star Circle of Care’s Big Pink Bus, a mobile clinic that makes stops around Central Texas.
For younger women who, like Ramos, are outside the typical breast cancer screening window, Ellison says to begin developing a plan for breast health: learn your family history and establish regular care with a doctor who can answer questions if any concerns arise.
“If you’re under the age of 40 and you notice skin changes that don’t go away, … a mass that is new or nipple discharge, talk to a provider about it,” Ellison said. “Because the key for breast cancer is always to diagnose it as soon as possible.”
Correction: This story was updated to clarify that some, but not all, uninsured and underinsured women over 40 qualify for free mammograms on Lone Star Circle of Care's Big Pink Bus. Others will qualify for low-cost mammograms.
