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Breast Health

TMC receives $25,000 grant from Avon Breast Health Outreach Program

Avon Breast Health Outreach Program in Tucson

The Avon Breast Health Outreach Program has again awarded a $25,000 one-year grant to Tucson Medical Center to increase awareness of the life-saving benefits of early detection of breast cancer.

Breast cancer is the most common form of cancer in women in the United States and early detection still provides the best opportunity for successful treatment .

Tucson Medical Center created the TMC Breast Health and Education Program to educate Tucson-area women and refer them to low-cost or free mammograms and clinical breast exams in their own communities. The vital program provides services to women who would not otherwise seek a screening mammogram.

Avon Breast Health Outreach Program

Denise Navarrete, TMC breast health and education program coordinator

 

The fund’s national advisory board selected The TMC Breast Health and Education Program as one of 56 new grant recipients nationwide in the 2017 cycle of Avon Breast Health Outreach Program grants. Programs were selected based on their ability to effectively reach underserved women in the communities they serve.

It is the nineteenth year that TMC has received funding from the Avon Breast Cancer Crusade to support its work on this important health issue, and in recognition of the program’s excellence.

Since May of 1998, the TMC Breast Health and Education Program has reached more than 50,000 women with information about the importance of early detection and has referred almost 7,000 women for mammograms and clinical breast exams.

The TMC Breast Health and Education Program helps ensure that all women have access to early detection information and options.

“We are proud that the Avon Breast Cancer Crusade shares our mission and has chosen to support our program. With these funds we will be able to reach women with breast cancer information and resources to Early detection saves lives at TMC Breast Center Avon Breast Cancer Crusade help overcome factors that keep them from practicing good breast health,” said Denise Navarrete, TMC breast health and education program coordinator.

For more information on the TMC Breast Health and Education Program at Tucson Medical Center please call (520) 324-1286. To learn more about the Avon Breast Health Outreach Program, visit www.avonbhop.org

Do you believe this Breast Cancer Treatment Myth? TMC One’s breast oncology surgeon weighs in on cancer diagnoses

Throughout the month of October, Breast Cancer Awareness Month, we tapped into the expertise of Dr. Michele Boyce Ley, TMC One’s  board-certified breast oncology surgeon and medical director of TMC’s Breast Health Program. We’ve shared information with you including how to assess your breast cancer risk, asked her to weigh in on breast cancer myths about breast screening including mammography and self-breast exams and had her tell us what to do – and consider – if you find a lump in your breast.

To round out this blog series, we asked her opinion on a story that was recently released by the Susan G. Komen organization titled: Debunking Five Common Myths About Breast Cancer Treatment.

We decided to focus on the three Dr. Boyce Ley thought would be the most meaningful.

Breast Cancer Treatment Myth #1

I don’t have time to get a second opinion because I must begin treatment as soon as possible.

BDP36480First – that second opinion issue. “Second opinions are important for a couple of reasons,” said Dr. Boyce Ley. “Maybe the physician you initially went to isn’t a breast specialist. Or maybe they’re just not a good fit for you. Women need to know that it’s OK to find another doctor! Don’t worry about offending your current doctor or the person who referred you to them. It’s your health. People need to feel empowered to get multiple opinions.” Dr. Boyce Ley added that second opinions are also great because perhaps the first time around, you didn’t quite understand all of the information. Or maybe one physician has a treatment option that another doctor didn’t offer you.

Second – how soon after diagnosis should treatment start? The National Breast and Cervical Center Early Detection Program guidelines recommend starting treatment within 60 days of being diagnosed. Dr. Boyce Ley said that timeframe is readily accepted by most people – that two months is the maximum amount of time a patient should wait before starting therapy. She added that most patients in Southern Arizona begin therapy within a month of being diagnosed. “I think this is really hard for patients,” she said. “They feel like it’s an emergency, but realistically, it takes years for the cancer to grow. A couple of weeks in the life of breast cancer doesn’t change the outcome. Even a patient with an aggressive cancer will usually start therapy within a week or two.”

Breast Cancer Treatment Myth #2

Everyone diagnosed with breast cancer dies from breast cancer or everyone diagnosed with breast cancer survives.

Dr. Boyce Ley stressed that breast cancer is not a death sentence. With modern treatment, an estimated 90 percent of women with early-stage breast cancer will go on to live five or more years after diagnosis without it recurring. Of course survival rates vary based on what stage the cancer is in and what kind of behavior the breast cancer has. According to the National Cancer Institute, there are about three million breast cancer survivors in the United States. However, more than 40,000 women and more than 400 men still die from breast cancer every year. The reality is that while most people will survive breast cancer, unfortunately some patients will not.

Breast Cancer Treatment Myth #3

Chemotherapy and radiation therapy are more harmful than helpful.

Decades of breast cancer research have proven that chemotherapy and radiation therapy saves lives. “We know that these are two things that contribute to better survival,” said Dr. Boyce Ley. “Historically, doctors have gone from giving no chemotherapy to giving too much chemotherapy and now we’re working hard to give patients just the right amount.”

She added that doctors these days have lots of ways to analyze a patient’s cancer to identify more clearly what treatment would benefit the patient. This allows a treatment plan to be tailored to that specific patient. “We have ways to identify which patients are going to benefit from which targeted therapies,” said Dr. Boyce Ley. “The same can be said for targeted radiation. We have the ability to target one part of the breast where the cancer is and avoid radiation damage to the heart and lungs. Those are things we didn’t have available to us 15 years ago.”

Dr. Boyce Ley is located at TMC One, 2424 N. Wyatt Drive #100, on the TMC campus. Call (520) 324-BRST (2778) to make an appointment.

To schedule a mammogram, call (520) 324-2075. For more information about our free mammogram program for uninsured women, call the TMC for Women Breast Center at
(520) 324-1286 to review qualifications and schedule an appointment.

You’ve found a lump in your breast. Now what?

WhattodoifyoufindalumpDr. Michele Boyce Ley, TMC One’s new board-certified breast oncology surgeon and medical director of TMC’s Breast Health Program, has shared her expertise with us over the past few weeks about how to assess your breast cancer risk. She also helped us clarify some myths about breast screening including mammography, while stressing the importance of being aware of changes in your body. Having a good gauge on what your breasts normally feel like will help you know when something isn’t quite right.

So – what if you find something?

1. Connect with your primary care physician

Dr. Boyce Ley said your best bet is to start with your primary care physician. Don’t have one? Chances are you’ll find one you totally connect with at TMC One. Your physician will typically order breast imaging. A mammogram and ultrasound can solve many questions without escalating it to a breast specialist.

2. Determine if it is time for a breast specialist

When should your first call be to a breast specialist? If you notice changes with your nipple or if your breast has suddenly changed color, size, shape or texture. Dr. Boyce Ley said she often sees women who, upon finding an abnormal mass in their breast, instantly jump to a worst case scenario – “who will take care of my kids when I die?” She advises women in this situation to keep this in mind: “Most of the time, it’s not going to be cancer,” said Dr. Boyce Ley, “but that still means you should pursue it. Even if you have an abnormal screening mammogram, the chance of finding a cancer is very small. A majority of the time, we may need to do further testing but oftentimes it turns out to be something benign like a cyst or overlapping breast tissue. Those are the two most common things we find.”

The take away message: Statistically, it’s unlikely that the mass you feel is going to be cancer.If it is cancer, it’s likely small and easily treatable.

3. Get a second opinion

If the initial imaging shows the mass is benign, but your physician recommends a biopsy, Dr. Boyce Ley said it’s not a bad idea to get a second opinion before getting a biopsy. Sometimes the recommendation to biopsy may differ from physician to physician and some things can be followed with imaging and exams. You may feel an urgency to get an answer but taking your time to make a good choice is important. However, Dr. Boyce Ley cautioned that if a biopsy is recommended for you, follow through with it because it could save your life.

4. Take a little time to assess and make a game plan

“So many women come in with ideas that they’ve gotten from their friends and neighbors instead of medical professionals. They’ve already decided that they’re dying or that they need a double mastectomy. As a breast surgeon, it can be very hard to unwind that thinking. Is it important to get into someone quickly? Yes. But breast cancer is not an emergency. A difference of one or two days – even a week – is not going to make a difference with your treatment. In the age of quick information that we live in, while it’s possible to find information easily, it’s not necessarily helpful.”  Dr. Boyce Ley gave this advice: “Get the facts. Figure out your options. And then come up with a game plan that’s best for YOU.”

Dr. Boyce Ley is accepting new patients!
She is located at TMC One, 2424 N. Wyatt Drive #100, on the TMC campus.
Call (520) 324-BRST (2778) to make an appointment.

To schedule a mammogram, call (520) 324-2075. For more information about our free mammogram program for uninsured women, call the TMC for Women Breast Center at
(520) 324-1286 to review qualifications and schedule an appointment.

Thinking pink for October and assessing your breast cancer risk

October is recognized as Breast Cancer Awareness month, and with so much information readily available under the “pink cloud,” we agree with you that sometimes it all can be overwhelming. So your grandma and your aunt had breast cancer – but your mom didn’t. Are you considered high breast cancer risk or not? What is the magic age for a mammogram these days – is it still 40? What’s this I hear about starting at age 35? And with all the attention about Angelina Jolie’s recent double mastectomy, is that really the only way to ensure that you never fall victim to this devastating disease? With an overload of information available at your fingertips about breast cancer, what’s the best way to dissect it all?

We sat down with TMC One’s new breast oncology surgeon Dr. Michele Boyce Ley. She’s a board-certified breast cancer surgeon and medical director of TMC’s Breast Health Program. Dr. Boyce Ley brings high-level, compassionate specialty care to TMC’s well established and respected program. We asked her to break down the most important things you should know about breast cancer and we’re going to share her thoughts in a new post each week throughout the month of October.

First up: that high-risk question.

As women, we are all at risk of getting breast cancer. Yes, men are also at risk. But simply being a woman is the number one risk factor. Others include:

∙ getting older
∙ family history
∙ not having children or having children after age 35
∙ receiving hormone replacement therapy
∙ obesity
∙ lack of exercise
∙ more than four alcoholic drinks a week

Let’s focus on that family history for a bit. Dr. Boyce Ley explains the key here is if multiple people from multiple generations in your family have been diagnosed, then you’re considered high-risk. “If your aunt had breast cancer when she was 65, for example, it’s probably not as important as if your mom had breast cancer at age 45,” she said.

Additionally, there are some easy-to-use scoring methods online to help you figure out if you’re high-risk or not. Dr. Boyce Ley is a fan of the bright pink website that offers a user-friendly tool. TheNational Cancer Institute also offers an online assessment. Still not sure? It’s best to get established with a breast specialist to assess your risk and what to do about it. A breast specialist can also help you figure out your breast density which oftentimes can be another risk factor.

Genetic testing is also an option, but proceed with caution. It’s not for everybody, and there are lots of caveats to it. Dr. Boyce Ley says it really needs to be done by a breast health specialist. Testing used to be limited to just testing for the BRCA 1 and 2 genes. Now there are numerous companies which offer genetic testing for up to 25 different markers. Certainly good information to have, but oftentimes it turns into a case of “We have this info. Now what do we do with it?”

While these mutations have been identified, it takes a highly trained team of clinicians to know how to interpret the results. Genetic testing can make a big difference in the treatment planning but it’s not a one-size-fits-all approach. “The testing can be helpful, but it’s not helpful in the same way for every person,” said Dr. Boyce Ley.

“I always tell my patients who want to pursue genetic testing this: Let’s think this through. If you get the testing done, and you get these results, what are you going to do about it? Your motivation might be to protect yourself or simply to help your children figure out their risk.”

Dr. Boyce Ley warns, however, that testing can have implications for an entire family. “Sometimes there is guilt associated with it if people realize they have passed this gene on to their kids. This isn’t like getting a blood test and finding out you have high cholesterol. It’s a bit more complex than that,” she said. That’s why it’s important to sit down and talk with an expert. Insurance coverage of genetic testing has gotten measurably better with the exception of Medicare, which is more restrictive in covering the cost.

Bottom line: Have a plan before you get genetic testing done.

Doctors continue to develop a better understanding about what characteristics constitute a high-risk patient, and there are an assortment of new drug therapies in the pipeline that work to reduce a patient’s risk. “Just because you’re identified as high-risk doesn’t necessarily mean you need an invasive procedure,” Dr. Boyce Ley said.

Something super simple you can do that isn’t talked about much? Exercise and manage your weight. “It’s been shown over and over again that maintaining a healthy weight and exercising more than four times a week reduces the risk of breast cancer. Those are things you don’t need to see a doctor for. They’re not easy, but they’re free!” she said.

Dr. Boyce Ley is located at TMC One, 2424 N. Wyatt Dr. #100, on the TMC campus.
Call (520) 324-BRST (2778) to make an appointment

TMC One welcomes breast oncology surgeon Dr. Michele Boyce Ley to guide prevention and treatment

Dr. Michele Boyce Ley Board-Certified, Breast Surgical Oncology Medical Director, TMC Breast Health Program

TMC One is expanding the scope of services available to you. We are thrilled to welcome Michele Boyce Ley, M.D., a board-certified breast cancer surgeon and medical director of TMC’s Breast Health Program. Dr. Boyce Ley brings high-level, compassionate specialty care to our well established and respected program. She is also fluent in Spanish.

Dr. Boyce Ley shares some insight into why she chose this field, what she thinks is the biggest misconception about breast cancer and how a string of profound experiences within her own family impacted how she treats each and every patient.

What is your background?

I was raised in Northern California and have lived in Tucson since 2000. I graduated from Northwestern University with a bachelor’s degree in molecular and cellular biology. I completed medical school at St. Louis University and moved to Tucson for my general surgery residency at the University of Arizona.

I completed a fellowship in breast surgical oncology at the University of California San Francisco, Carol Frank Buck Breast Care Center in 2006 before establishing a breast surgical oncology practice in Tucson. Most recently, I was the director of breast surgery at the University of Arizona and associate professor of surgery.

What inspired you to go into breast surgical oncology?

I was always interested in the biology of cancer. It is so incredibly complex on a cellular and molecular level. Additionally, when you add in the human element – that the disease is happening in a person who has a set of values, beliefs and an individual health status, it adds another layer of complexity. It is very rewarding to take all of these issues into account when helping a patient choose a therapeutic pathway.

How do you help primary care physicians care for their patients with breast cancer?

I like to communicate with referring physicians to inform them of what their patients’ treatment options are. A lot of the information I pass on is educational including information about new evaluation and treatment options as well as updates on recent research.

We hear a lot about breast cancer in the media. What do you think is the biggest misconception about it?

Everyone who is diagnosed with breast cancer, even if it is just pre-cancerous cells, worries that she will die from breast cancer. While there are about 45,000 deaths a year from breast cancer, the majority of patients with breast cancer have a 85-90 percent of a 10-year survival. This means that 10 years after diagnosis, 85-90 percent of these patients are still alive. There are certainly people who do not survive their disease, but these are primarily people in whom the breast cancer was diagnosed late, not properly treated or their particular type of cancer is extremely aggressive.

If a patient has not been diagnosed with breast cancer, but has it in her family history, do you recommend she get established with a specialist like yourself for regular checks/preventative care?

There is great interest in breast health to know your risk. The best way to assess your risk is to meet with a breast specialist to accurately take a history, estimate risk and develop a prevention plan. This plan usually includes regular breast exams, imaging and lifestyle modifications. Sometimes a prevention plan includes risk-reducing surgery or medications.

You’ve lived in Tucson for 15 years. Is there anything in regards to breast health/breast cancer prevention that you’ve found is unique in this part of the country?

One of my goals in returning to practice after my fellowship at UCSF was to raise the level of breast cancer care in Southern Arizona. This has certainly happened as immediate breast reconstruction and nipple-sparing mastectomies have become more commonplace. I hope that we continue to improve our access to routine breast care, breast health education and wellness education.

What interests you outside of work?

I love to cook up healthy meals and I like baking desserts – especially sugar-free ones! I have recently adopted a low-carbohydrate lifestyle that has been both a challenge and a reward. I have two children, Logan, 9, and Lauren, 4, who are bright and energetic. We try to spend time together when we’re not at school and work. My husband takes us camping and as a family, we enjoy adventuring in our time off!  It’s good for all of us to be outside and be unplugged. My other pastime is reading. My son and I have challenged each other to read 40 books this year. He’s ahead of me already! We are all looking forward to skiing this winter, as my daughter is ready to take lessons so that we can all hit the slopes together!

What has been your most valuable life experience that has impacted your medical career?

A few years ago, several of my family members were diagnosed with cancer in the same year. My father was diagnosed with leukemia and died after three years of incredibly difficult treatment. My aunt had a recurrence of her breast cancer and eventually passed away from it. Her daughter had a rare form of sarcoma and fortunately is doing well today. All three of my loved ones underwent intensive treatments over a varied amount of time. This was challenging for our family as we had family members who needed support in different parts of the country.

My father and my aunt were relatively young when they died at ages 64 and 62. My family and I felt robbed of the time we should have had with them and were saddened at the suffering they had to endure. Both my father and my aunt accepted hospice care, which was so good for them and our family. My father and my aunt did not want their lives to be defined by their cancer diagnoses. They wanted to live and be involved in the lives of their children and grandchildren. They saw beauty in every day they were given.

These experiences have changed the way I look at my life as well as how I see my patient’s lives. I know that not every treatment is necessary. I know that many treatments may have little benefit and incur risk of long-term effects. I also work to be more understanding of the whole picture of a patient’s life when faced with disease. They have families and pressures outside of their diagnosis that form their response to the illness. From a family perspective, it’s so wonderful to have a physician who “gets” you and sees you as a human – not just as a diagnosis.

How do you approach your relationship with your patients?

Patients are people with an illness, and in the case of breast cancer, these people don’t usually feel ill. I try to put my patients at ease initially to let them know that they will be cured with a little hard work. I often have to deliver news that is disappointing or surprising, so I try to be frank, yet gentle. I really enjoy getting to know my patients and their families. Regardless of our backgrounds, we are all people with feelings and personal challenges and triumphs.  I strive to make their experience of the breast cancer process a positive, triumphant part of their life.

Dr. Boyce Ley is accepting new patients! She is located at TMC One, 2424 N. Wyatt Dr. #100, on the TMC campus. Call (520) 324-BRST (2778) to make an appointment.

Just how dense are your breasts? Why keeping abreast of this indicator can help save your life

BreastDensityFlowerWhat kind of question is that?

In recent years it’s become the kind of question that can help health care providers identify breast cancer at earlier stages allowing them to treat women earlier with better results.

What are dense breasts?

The size of our breasts might be the only measurement we’ve thought about when it comes to “the girls,” so what on earth are dense breasts?  The density of breasts is a measurement of fatty tissue compared with fibroglandular tissue. The more fibrogladular tissue you have the more dense your breasts. On a mammogram, this dense tissue shows up as white areas. Levels 3 and 4 in the image below are what we describing as ‘dense breasts’ where more than 50% of the tissue is fibrogladular rather than fat.

Breast Density Categories from American College of  Radiology

Breast Density Categories from American College of Radiology

 

Why does knowing if you have dense breasts matter?

While having dense breasts is perfectly normal, increased density of fibroglandular tissue makes it difficult to interpret a mammogram. The dense tissue can mask a growth from view. As a result there is a slightly increased risk of not catching a tumor at an easily treatable stage. In younger women, who typically have denser breasts, an aggressive breast cancer may be hidden from detection by the dense fibrogladular tissue. There is also an increased risk of developing breast cancer in tissue that is dense. For women with extremely dense breasts there is a four to six times increase in the rate of breast cancer.

 

Eek! What if my breasts are dense? Am I going to get breast cancer and not know it because the mammogram was hard to interpret?

Knowing that you have dense breasts can help your care providers determine what is the best screening approach for you. Mammograms are still the primary way breast cancers are detected, but technology is changing rapidly. Digital mammograms have improved the ability to view breast tissue, and  3-D mammograms, also known as digital breast tomosynthesis, have further improved the ability of radiologists to assess dense breasts. There are additional methods that can be applied for women with dense breasts. Read the upcoming post for more information on tomosynthesis here in Tucson.

My breasts aren’t lumpy, I’m not worried.

Before you start trying to manually evaluate whether your breasts are dense (we still encourage monthly self-exams) or comparing them with friends and loved ones, the only way to assess the density of the breast is through mammography. Breast density refers to the appearance of the breasts on a mammogram rather than to breast size or firmness.  Your breasts may feel firm but not appear dense on a mammogram, or feel soft and appear extremely dense on the mammogram.

Once I have dense breasts will it always be that way? Does breast density change?

You may find that your breast density changes from one year’s mammogram to another for a variety of reasons – breast density is related to genetics, hormone levels and age  (all things you can’t control).

Oh no, not the ol’ mammogram!

If you’ve been putting off getting a mammogram, know you are not alone. More than half of Arizona’s women are not up to date on having a mammogram whether they have insurance or not. Perhaps it’s time to read this post about why there is nothing to fear from a mammogram. Whether you have insurance or not, it is time to schedule an appointment. Thanks to support from TMC Foundation, Susan G. Komen of Southern Arizona and an Avon grant many uninsured women can receive a free screening mammogram at TMC for Women.

photo 1 (7)

You’ve got mail!

Last year the Arizona State Legislature passed a law requiring that women whose breasts appear dense (More than 50% dense material – Levels 3 or 4 on the image above) on a mammogram be informed – typically this is done through the results letter sent to the patient – and to encourage them to talk with their health care provider to see whether additional screening is appropriate.

More information: Beyond the Basics – It’s Mammogram Time

Preventive Screening Helps Local Woman with Cancer Prevention

monica stopping breast cancer in it's tracksIn the 30 years that Monica Kealey has been a cosmetologist, she has supported a number of clients through bouts with cancer, whether lending a sympathetic ear or shaving their hair to give them more control over the hair loss that may accompany chemotherapy treatment.

She knows cancer can be a formidable opponent, so she’s been faithful to her No. 1 strategy to be her own best health care advocate: Routine screenings.

“Early detection is so important,” said the 53-year-old West Side resident, who has been going to the TMC for Women Breast Screening Center for annual mammograms for the past six years. “Like any other kind of health issue, your best chance of treatment is when you find something early.”

Monica, who is self-employed, found the clinic six years ago at a time she couldn’t afford to purchase insurance, but made too much to qualify for financial assistance programs. The TMC Breast Health and Education Program provides free screenings – 316 in 2013 – for uninsured women by using grant funding from the TMC Foundation and other community partners.

Even though Monica has since become insured, she stayed on at the clinic and received a call back from her April 2014 mammogram, asking for additional imaging after staff noticed a change from previous screenings. After more imaging, the doctor suggested a biopsy to rule out or confirm early signs of cancer.

The biopsy was painless and quick, with staff bringing her a warm blanket and keeping her adult daughter, waiting in the lobby, apprised of how the procedure was going. “It’s such a great team in there,” Kealey said. “I just felt very cared for – you don’t feel like you’re part of a cattle call. It’s very welcoming, but it’s also very efficient at the same time. You’re in, you’re out.”

Karen Narum, the women’s health care nurse practitioner who serves as a navigator at the Clinic, said she and her staff follow a simple rule: “We know the patients and their families are scared and anxious, so we treat them the way we would want to be treated.”

PhotoContestBFF

The staff called to check in on how she was holding up while waiting for an answer back on the biopsy, but Monica is a positive woman. “I know some people freak out when they hear the word ‘cancer,’ but I stayed positive and prepared myself that if I did have it, it would be something I’d have to deal with. But I think it’s really important to stay positive from the beginning and then, when you have the actual results, you move forward with a plan.”

Monica had a complex sclerosing lesion known as a radial scar. She was advised that it should be removed to prevent a possible malignancy from forming over time. Kealey did her research, wrote down a number of questions for the doctor, and was comfortable with the answers back. The surgery was over in 25 minutes and Kealey credits the surgeon, Dr. Kelly Favre, with such fine incisions that her healing was rapid. She missed just two days of work.

“I’m so thankful for the awesome team at the TMC Breast Center. They are a hidden treasure in Tucson,” Monica said, adding she shares the need for early detection when she can. “I have people in my chair tell me they’re in their 60s and they’ve never had a mammogram!” she said, noting their biggest concern is they think it will be painful. “Everybody is different, and sure, it might be a little tender, but the way I look at it, it’s over in just a few minutes and it could save your life.”

Although Monica now shares her experience, she kept it to herself initially. “I didn’t tell very many people about what I was going through because I didn’t want to hear horror stories about what happened to others. I knew I was going to have my own story – and I feel very fortunate.”

Make HerStory donation buttonMaking HerStory – Whether a woman is having her first child or a life-saving surgery, she deserves a welcoming and safe environment with state-of-the-art services and a caring touch. Making HerStory is the campaign for the new Joel M. Childers, M.D., Women’s Center to make this environment a reality at TMC for Women and in our community. 

TMC is committed to providing a lifetime of care For Women, About Women. Join us in Making HerStory

Breast cancer survivor: Care at TMC made a difference

breast cancer survivor shares her storyCyndi Dwyer is a practical woman. When she undertakes home improvement projects, she’s not afraid to hang dry wall and rewire the electricity and – in the case of her ongoing kitchen renovation – do dishes in the bathtub if need be.

So when she was diagnosed with breast cancer in October 2013, she cried once, when she told her husband, and that was the end of that. “I had cancer. It just needed to be taken care of. I didn’t see it as any different than when I had a torn rotator cuff. I just needed to get it fixed and move on with my life,” said Cyndi, 60, who administers the special education program at her high school.

It helped that she has been a devotee of annual mammograms and her previous one had been clean. And because the cancer was found in its early stages, she did not have to have radiation or chemotherapy and was able to start her reconstruction in the same surgery as her bilateral mastectomy.

Dwyer said the care at TMC helped her get through a trying time. Her family appreciated the ability to track her as she moved from pre-op, to surgery, to recovery, without having to wonder where she as in the process. She appreciated her surgeons, as well as the attentive, friendly staff, including the nurses who answered her call button promptly. She loved the fact that TMC features all private rooms. “There are some things your doctor will talk to you about that are personal. A curtain really doesn’t do the job.”

There was plenty of space for her family to visit, and the rooms themselves were relaxing and comfortable, she said. “I felt really well taken care of and I also felt kind of at home,” Dwyer said. “I wasn’t just another patient. They really acted like they cared.”

“No one wants a diagnosis of cancer, but at least the whole experience was positive. It was as good as it could get if you have to have cancer.”

Back at work and back at the gym, she’s hoping her kitchen is back soon, so she’ll be back to whipping up some of the creamy desserts she’s famous for.

But she’s also finding far more patience and is letting more things go that might have irritated or worried her previously. “Life’s too short. When you find out you have cancer, it is a clear reminder of that. Fortunately, my reminder was relatively easy to come through, but it is still a reminder that anything can happen at any minute, so you have to be grateful for what you have.”


Make HerStory donation buttonMaking HerStory – Whether a woman is having her first child or a life-saving surgery, she deserves a welcoming and safe environment with state-of-the-art services and a caring touch. Making HerStory is the campaign for the new Joel M. Childers, M.D., Women’s Center to make this environment a reality at TMC for Women and in our community. 

TMC is committed to providing a lifetime of care For Women, About Women. Join us in Making HerStory 

 

Surgery provides opportunity to build on 45 years of love – Breast Cancer Survivor Frances

FrancesBreastCancerSurvivorFrances Bustamante and her husband didn’t expect to spend their 45th wedding anniversary at Tucson Medical Center.

But it was also somehow fitting as well for the sweethearts who have been together since their days at Sunnyside High School: The lumpectomy that would remove breast cancer tissue would also help ensure the two have many more years together.

“I’m sure it saved my life,” said Frances, 64. “I’m lucky. I am really, really lucky and I am very aware of that.”

Fortunately, the South Side resident is a believer in preventive care. Her first cousin died of breast cancer in her 30s, the mother of an infant. The two were close, and the loss left a stamp. Aunts on both her maternal and paternal sides have survived breast cancer, so she knows the value of finding problems early.

Frances #breastcancer #survivorFrances has had call backs before on mammograms, since she has fibrous tissues, so she wasn’t particularly worried when she received the call for more images. This time, though, the images showed calcification that appeared to be a precursor to cancer. A biopsy confirmed it.

She credits staff at the TMC for Women Breast Center with being welcoming and friendly. A staff member kept her hand on Bustamante’s shoulder during the biopsy, which she found a soothing and compassionate gesture.

She said she found it comforting to know that technology now allows clinical staff to leave a marker or clip on the site of the biopsy, which gives a clear target for the surgeon, no matter if the initial site changes somewhat as it heals. The Center also provides wire localization, in which clinical staff using mammogram or ultrasound guidance, insert a wire as a guide to tissue that needs to be removed. This guides surgeons to the exact area and depth of the abnormality.

#breastcancer #survivor #TMCforWomenFrances’ outpatient surgery similarly went well, she said. “All in all, it was a good experience. I didn’t have any problems at all.”

And that’s a good thing, since she jokes she’s busier now in retirement than she was as a full-time office assistant. She splits her time between her 94-year-old father, who is still going strong, and her three grandchildren and the family pets. This year, she’ll be volunteering at their school library and helping students with literacy issues learn to read, while squeezing in a little time for her creative outlets of scrapbooking, needlepoint and making hand-made cards.

“I know there are no guarantees in life. Even though it’s gone, I could get it again, I suppose, but we’ll deal with it if that time comes. The important thing now is that I’m going to be here for the people I love.”

Surgery or surveillance, not a simple decision – a BRCA patient and physicians weigh in

Lisa and her daughters

Lisa and her daughters

Imagine you find out you have a mutation in something called the BRCA gene that means you face up to an 87% chance of developing breast cancer or ovarian cancer- a greater chance than a woman already diagnosed and treated with breast cancer has of a reoccurrence. What would you do?

Faced with that very decision, Lisa Rezende, considered her options:

1. Increase surveillance of her breast tissue via alternating MRI and mammograms every six months.

2. Have a prophylactic double mastectomy and ovary removal

3. Have prophylactic double mastectomy and reconstruction, and ovary removal.

Lisa, fortunate to have insurance that covered all the current options, was able to make a choice based on what she felt was best for her and her family. The thought that she could dramatically reduce the chance of developing breast cancer from upward to 87% to under 5%, and increase the chances that she could be there for her young daughters as they grew up was a deciding factor. The stress of waiting for results of the genetic test, and a mammogram after discovering that her mother carried the BRCA1 impressed on Lisa that this was not something that she wanted to face every six months.

Lisa is not alone. We talked with local plastic surgeon, Dr. Edward Eades and general surgeon, Dr. Vanessa Roeder, regarding the number of women undergoing this type of surgery here in Tucson. The physicians work together to help women with a breast cancer diagnosis or who have tested positive for a BRCA mutation as they consider mastectomy and reconstruction.  Over the past few years they have seen an increase in the number of women who are considering the prophylactic surgery and reconstruction, Dr. Eades explains the upswing in cases,

The rate limiting step has been the willingness of the insurance companies to pay for the BRCA testing…In the beginning, when the test came out, you had to have a really, really, strong family history or compelling reasons and it took forever to get it approved, but now it seems like it’s getting more common and the insurance companies are more willing to approve the testing.

Not a simple decision – Surgery or Surveillance

Dr. Roader and Dr. Eades

Dr. Roader and Dr. Eades

Dr. Eades points out that the decision to proceed with surgery following a positive BRCA gene screening isn’t simple. For an individual who carries the BRCA mutation it isn’t just a double mastectomy and reconstruction, but also ovary removal. Dr. Eades emphasizes that there are health consequences,

This is a new cadre of patients that has not been seen in surgical oncology previously – patients coming in and having cancer surgery, who don’t have cancer… And they’re much younger usually too. They have to struggle with when to do the mastectomy and when to have their ovaries taken out. When the ovaries are removed the women will go through menopause.  Some of them are young, they may not be married, or have kids and they may want to have children.

The physicians have to understand and explain a myriad of other complicating factors too. Dr. Roeder further explains,

BRCA is an extreme risk, not just a low risk, it’s not just twice as much as a woman sitting next to me that doesn’t have the gene mutation. It can be upwards to 87%, but just because you have the gene mutation does not mean that you’re going to get breast cancer, it just means you have a much higher risk. There are other things to take into account- the age of onset the family members who had the breast or ovarian cancer. Are there other illness that the patient has? You have to think about the risk to the patient. It’s a big surgery. There’s a lot of information that you have to let the patients know so that they can make the decision for themselves.

Double mastectomy doesn’t eliminate all chances of breast cancer

No matter how good we try to be when we’re doing a mastectomy we don’t get a 100% of the breast cells out period. We know that even with the best situations there is a risk of re-occurring or new developing breast cancer of about 4%. It’s important they realize that we’ve decreased their risk immensely, but we can’t make it zero.

– Dr. Roeder.

Dr. Eades shares that, while the risk isn’t eliminated completely, the women who have the double mastectomy state that they “gain tremendous relief and peace of mind. None regret having both sides removed and the reconstruction.”

What should patients consider when deciding whether to have a double mastectomy and possible reconstruction?

Dr. Roeder highlights the importance of being well-informed and it being the individual’s choice:

1. Patients need to decide whether it’s the right surgery for them. They need to be well-informed and make a decision based on that information.

2. The only reason to have reconstruction if they have a mastectomy is only because the patient wants it, not because a family member, not her husband, but because SHE wants it. Reconstruction is never just one surgery and it’s done. There is always more than one surgery, and there is increasing discomfort associated whether it is implants or if reconstructing with the patient’s own tissue. Any time you do implants you’re lifting up the pectorals muscle and when you do muscle work it hurts more. It’s worthwhile if YOU want it; it’s not worthwhile if you don’t.

3. Know the risks
It takes 2-3 months after the mastectomy for the tissue to become well profused, and healed well, to decrease the risk of the infection. Poor healing and skin loss are added risks.

Dr. Roeder stresses the importance of choosing a plastic surgeon and general surgeon who work as a team from the outset of a case to understand how to produce the best outcomes for their individual patients. The two surgeons have followed a different model than the norm where  a general surgeon completes a surgery and then turns the patient over to the plastic surgeon who then  inherits whatever choices were made by the previous surgeon – as well as any complications. Dr. Eades consults and meets with Dr. Roeder and the patient before the patient is even put under anesthesia. Dr. Eades then stays with Dr. Roeder as she performs the mastectomy. In turn, Dr. Roeder  stays with her colleague as Dr. Eades finishes the reconstruction.

“It’s not done in very many places because it’s not considered a good use of each other’s time,” Dr. Eades explained. “We end up spending a lot more time in surgery than we otherwise would, but it gives superior results. There’s no question it’s better for the patient.” You can read more about this unique collaboration here.

Lisa chose to proceed with the double mastectomy, reconstruction, and ovary removal. She stresses the importance of support from family and friends for women facing this decision whether they chose surgery or surveillance.  Having experienced post surgery complications  Lisa is particularly aware of the difficulties associated with surgery and emphasizes that this is a personal choice  – surgery or surveillance is a valid option, even for women with children.

Why is this important? A Family Discussion

While the media describes this type of breast cancer as rare, Eades disputes that characterization  “10% of all women with breast cancer seems like a lot to me…and they’re just the tip of the iceberg – their children are affected too.”

For Lisa being there for her daughters was part of her decision-making process for her own surgery. Women who know that they have one of the BRCA gene mutations, or other genetic predispositions to breast and ovarian cancer, must also consider how they will address it with their children and families.

Lisa is completely open with her 10 and 6-year-old and answers all their questions,

They know that their Nana and their great-grandma both had cancer.  They know I took a test that told me I would likely get cancer, but that I could have some operations that would make it much less likely.  The oldest child has asked if she could have it and I said she can get the test when she is grown up to find out, but it does not change anything right now.  Genetic counseling guidelines strongly discourage testing children for BRCA mutations, as surveillance would not start until 25 (unless there is a family history of breast cancer before that age.)  The recommendation is that they decide own their own when they are adults.

While Lisa has daughters, and the BRCA mutation appears to have been passed down the maternal line, it can be passed from father to daughter. Lisa encourages women to know not only the breast cancer history on their maternal side, but also paternal side.

At FORCE (Facing Our Risk of Cancer Empowered) meetings I have met several young women who grew up knowing that there was a BRCA mutation in the family and they say that is their normal.  So I guess it is my kids’ normal too.   It took awhile for me to wrap my head around the possibility that they have it, but the more years I live with it and the more young women I meet with BRCA mutations, the more I know that they will be fine.

Facing Our Risk of Cancer Empowered (FORCE)

Not only is Lisa sharing her story, but she is also actively involved with FORCE,  a non-profit dedicated to supporting those who are affected by hereditary breast and ovarian cancer.  Here Lisa volunteers her scientific and education background to translate scientific studies around BRCA mutations and other hereditary cancer conditions for the lay public.

FORCE is not just for families that carry BRCA1 or 2 mutations.  There are also members with other hereditary cancer syndromes (such a Lynch syndrome), as well as families with a strong history of breast or ovarian cancer but no known BRCA mutation.

FORCE‘s  toll free hotline number 1-866-288-RISK and their web helpline provide help in both English and Spanish.

“Know your genes” site with information on constructing a family tree and warning signs that your family might have an inherited cancer syndrome.

Want to know more?

You can find out more about how Dr. Eades and Dr. Roeder are using best practices and collaborating to achieve the best outcomes for women facing mastectomy whether they be from genetic or non-hereditary breast cancers here.

This is the second of two posts sharing the experience of a local woman with the BRCA1 mutation, the first is here.

You can read more personal stories of women facing breast cancer and the resources that TMC for Women Breast Center offers here.