Cracking the Code: Unlocking Breast Health Secrets with a Radiologist

Welcome back to another episode of A Couple of Rad Techs Podcast! I'm your host, Chaundria Singleton, and today we have a very special guest joining us. We are thrilled to welcome Dr. Stacy Smith Foley MD, a radiologist specializing in breast health. 

In this episode, Dr. Foley shares valuable insights about breast health and the importance of patient-centric care. From discussing the complexities of breast MRI to the role of family history and dense breast tissue, Dr. Foley provides invaluable information that everyone should know. We also dive into the importance of advocacy, connecting with radiologists, and debunking myths surrounding mammograms and breast cancer. You won't want to miss this episode filled with knowledge, personal anecdotes, and a special surprise about a unique resource that our guest has encountered. So grab a cup of coffee, sit back, and enjoy this enlightening conversation about breast health on A Couple of Rad Techs Podcast!

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Transcript

1:41

Okay. Welcome everyone to our live event. I am Shondria Singleton. I am the host of a couple of Rad Tech's podcast, And I am a radiologic technologist. I'm also registered in mammography and MRI, CT, and X-ray. But my passion is for all radiology fields, and that is what we're talking about today. We are actually going to interview Someone that is in the radiology field, but they're not a technologist. They are one of our radiologists who are doctors that specialize in Being able to diagnose all of those beautiful images that us technologists are taking every day, all day, and this is who we turn to to interpret this for all the physicians. And today, our guest is Stacy Smith Foley. She is a radiologist, and I'm gonna let her introduce because she does a much better job of it than I do. So welcome to our program. Thank you so much for having me, Shondria. As you mentioned, I am a diagnostic radiologist. I'm fellowship trained in breast imaging, And I've been in practice for almost 17 years. I have practiced in a variety of clinical settings from Private practice to hospital based, and I currently practice at a community cancer center that's a non profit organization. Oh, that's rather interesting. I talked a little bit about that with one of the mammographers that I had, so I would love to touch on that later, when I do ask you more about, that community based program. So what led you actually into as a radiologist. What made you choose radiology? That's a great question. I'm a very analytical person. And when it came to that point you needed to decide what you wanted to be when you grew up. Of course, I wrote a pro con list. And I wrote down the things that I enjoyed, in the practice of medicine. And the things that I really enjoyed were difficult cases, challenges. I actually really enjoyed procedures, and I liked the variety of things. And I decided that, You know, I I I landed on 3 things, ophthalmology, urology, and radiology, and I tried them all in sequence. I didn't like touching eyeballs. I don't mind male patients, but I really enjoy taking care of women. And so radiology was the natural fit. And from the outset, I knew that I would go into breast radiology. Yeah. I'm just so cited because when I started in radiology, the in 21 years ago, the facilities I worked in, which were much Mostly teaching facilities in the Atlanta area, and I didn't run across a lot of female radiologists. And I'm just blown away Over time, how many more women are in the field? And it just what have you seen the growth as far as especially women in radiology? Have you seen the growth? And what what's your take on it? I have seen the growth, but I think we're still behind. Like, if you look Overall, at the percentages of men and women in the field of radiology, there are still quite a few more men than there are women. But If you look at, subspecialties like pediatrics and breast radiology, those fields, particularly breast radiology, tend to be dominated Right. By women Yeah. Which is kind of exciting that we have, you know, we have a place where, we can really make a difference in where our voice is heard and appreciated. Yeah. And kinda to stay on that topic, what advice would you maybe share with those firing to follow a similar career path because I think radiology when I tell my patients, most of my patients say and I'm sure you hear this all the time. My doctor sent me here for this exam. My doctor's gonna read it. And I make sure I let them know, no. We have radiologists. That's who reads the exams. Your doctors are allowing them to read them as well. I want to, like, bring awareness to that as well. How would you encourage or any advice you would give to other other people, women and men, who are looking at radiology or haven't even thought about it? Well, I think it's a fantastic field. I recently had a patient who is a 4th medical student. And I asked her, have you decided what field you're going into? And she said she hadn't really. And I said, well, have you ever considered radiology? It's a fantastic field. You know, we get to see the the coolest cases from every subspecialty. We get to make a huge impact on the diagnosis and the treatment. And we we we're kind of like this wonderful communicator between The patient and the clinician. We're we're kind of the glue that binds everything. So I know some people think that radiologists sit in a dark room and, that they, you know, don't ever talk to patients. But in breast radiology, you do. Yes. You do. I find that, I remember doing my 1st MRI breast biopsy when things started to really come over to MRI, and I was just blown away, and that's what moved me to take a national certification in in mammography because I just wanted to learn more. I was like, to be able to do these MRIs and do them justice this because it just it just blew my mind what all went into looking at the breast. Because when the radiologist Just wanted to do the breast MRIs they had. We had to pull the mammograms. We had to, you know, find out their history. They filled out certain forms. It had to be after their cycle. It couldn't be during this time. I I was just so intrigued. And I just wonder through your career, Have you had any experiences, any challenges, or any key moments that really have led you to the current place you're at in radiology? Well, I'm an Arkansas native, and I have you know, I trained, did my residency in In Knoxville, Tennessee, my fellowship in Seattle and came home to my home state, but not to my home area and practiced for 10 years in Northwest Arkansas. And from there, I went to Tulsa and then Greenville, South Carolina. And then I had this opportunity. I got a phone call the Friday before Labor Day weekend from the CEO of my organization, it was a cold call. And I remember getting in the car to travel with my family for the weekend saying, I got this call from this weird guy about coming back to Arkansas. And I, you know, I came for the the visit, And I really wasn't that interested in the position. But for me, the the key moment was Accepting the challenge and the opportunity to start a program from the ground up, which gave me a huge platform in a voice to be able to do breast radiology in a very patient centric fashion. What would what do you mean by that? Explain that part to us. So everything about our breast center is patient focused. We've tried to identify every potential barrier and then break those barriers down. If the barrier is it's You have to park far away and you have to walk really far. Well, we have dedicated parking spots. We have a fairly luxurious waiting room where You can charge your phone. Like, we've got chargers built into the furniture, and the furniture is accommodating for people of all bodies and abilities. You know, we we designed the seating because some people are gonna come in in a wheelchair. Yeah. Right? And you need to to have that in mind. We have fresh flowers in our lobby every week, and they are always hydrangeas and Hot pink roses, which are my favorite. There was a period of time during the pandemic when we didn't get to have the flowers, and Everybody was disappointed. Yeah. So we had to bring the flowers back. But it's just a it's a small breast center, But it's almost boutique like, you know, we have really soft waffle weave robes. The dressing rooms are personal. It's 1 person in the dressing room. We have video monitor boards that give patients information while they're waiting. We offer risk assessment and genetic testing, so we really, you know, go a step beyond just doing a mammogram. Yeah. Right? We're trying to provide a personal recommendation for each patient and help guide them in their decisions about their breast health. That's so important because I know I was 24 when I had my 1st mammogram. I found a lump. My breast cancer is really, really heavy in my family, on my grandmother's side. And it was scary. I was even though I was not scared, I was scared. And I had been in the field for a few years, but I was nervous. Nervous about the exam, nervous about what the results would be, but then I was like, oh, this is really comfortable. It's that environment, I felt really comfortable. I was it was warm, but it wasn't as nice as what you're describing. I need to come take a trip to Arkansas. But I think We'd love to have you. Yes. That I I think that that is a trip that I'm gonna have to take because I think people need to see what the inside of a mammography facility looks like, especially one dedicated to patients. Because sometimes you can become just a number. I've been to those places where, you know, they're just rolling them in, rolling them out, you know, trying to get it done, and that's great. But sometimes, I just like that special That special feeling and having a breast doctor. I am a big advocate on that because I had never had a breast doctor before until recently. And could you explain Just a little more, because I wanna go over to dense breast as well, because I saw a TikTok that you guys did about myths and all of this. I do wanna talk about that because you all teach. You have a good time because you have a partner in this. You're not alone. I I do. Yes. I have an amazing colleague, doctor Yara Robertson. She is a fellowship trained breast oncology surgeon, and she's actually our director of surgical oncology here at our institution. She joined us from Atlanta. She was practicing in Atlanta for probably about a decade, and she was very involved in the community there, and she's just that type of person. She's got a lot of energy. She's got a lot of, Excitement and a lot of passion for her patients just like I do. Yes. The first time she came and interviewed, she said, I like you, but I'm not coming. I was like, okay. It was nice to meet you. And then, you know, she came. Then she came. You won her over. Well, you guys are a good match. You guys, if you haven't seen her tick their TikToks, please go follow them because Not only are you a good match. Their personalities, I will feel very comfortable, like, just from the TikToks going there and saying this is gonna be my these are gonna be my doctors. You know, and that is really important to people. Like I was saying, when I was going through my thing, and I've had 2 other lumps since then. Just recently last year, turned out to be nothing again, but it's still fearful every time. You know? You're not looking forward to those things. So I just imagine other women, and I do younger and younger women every day who have positive breast cancers. Yes. I haven't had any men personally, but you talk a lot about that as well. So I do wanna talk about that. But I do wanna talk about dense breasts because Sure. I never knew I I never really knew what to call my breasts, but, You know, a lot of women now that us women are talking in the streets about our breast more, which we need to do, A lot of women have dense breasts. And our does our diet affect that, or is it genetic? Tell us more. It's a combination of all of those factors. It's hormonal. It's genetic. It's Somewhat related to your body mass index. And the most recent data shows well, we've known for a while that having dense breast tissue was an independent risk factor. But the most recent studies show that if you continue to have dense breast tissue beyond menopause, you are at a greater risk. And we haven't been talking about that as much as we should. You know, a lot of the older ladies, they're getting their mammogram every year, and then we make this recommendation about ultrasound when they have dense tissue, and they say, oh, that's not necessary. I don't need to have that. Well, you do. Mhmm. You know, I in the last month, I've diagnosed a woman in her mid sixties. She had the ultrasound to complement her screening mammogram, and we found a small mass that turned out to be a low grade lobular cancer. It would have been difficult to diagnose at this juncture with the mammogram alone. Wow. That's interesting. Very interesting. So for our for our what women might have dense Is it a group of women? How would they know? What are some things that Well, I think the most important thing is You can't tell whether or not you have dense tissue just by feeling by doing your self exam. Your doctor can't tell you. When your doctor does the exam, they can't tell you if they have dense breast tissue. The radiologist is the only person who can tell you whether or not you have dense tissue. It's based on the composition of the tissue on the image. How much of the tissue is glandular white on the mammogram relative to how much of the tissue is adipose fatty tissue that's dark on the mammogram. And since breast cancer typically is white Mhmm. You're looking for something white in a background of white Yeah. It's more difficult. So that's the challenge of mammography when it comes to dense breasts. Yes. So the optimal would be the ultrasound. Could you explain that a little bit, the benefits of the ultrasound versus because people have it in their head. I gotta get a mammogram. Gotta get they just don't get that part. So could you explain that for us? Well and you do have to get a mammogram. Right? You can't skip the mammogram. There are some people who think, oh, I can skip the mammogram and just go straight to ultrasound. The mammogram will find some cancers that the ultrasound might miss. They complement each other. But on average, the mammogram finds between 5 to 7 cancers per 1,000 women screen. When we add in ultrasound, we find up to an additional 5 cancers per 1,000 women. So It's not a huge increase in cancer detection, but it's an increase in cancer detection. And the cancers that we find on ultrasound tend to be invasive, not DCIS. You know? We we find more DCIS, you know, in introductal cancer that hasn't invaded the tissue yet, so low grade, we tend to find that more on mammograms than we do on ultrasound. Interesting. Wow. Okay. So this is I am I'm I'm in school too, you guys. I'm learning as well. This is why we have radiologists, and I I'm glad you're here because As a person with dense breasts, and I'm trying to learn more myself because this is new to me. I just got a breast doctor who's really helping me to understand, and I thought I was really on top of stuff when it came to my breast health, but I'm learning even more. And what shows as women, especially now that I'm getting older, Learning my body feels like I'm starting over. And that's I I become even more passionate now about women really, really learning your bodies because you start to go into that perimenopause and your body is, like, totally different. So how does your breast tissue really change, as you age? Because We're talking about women in their twenties, then thirties, then forties, and fifties, and now sixties. So for some women, as they go through menopause and their hormones drop, the density of their tissue becomes less over time. But there's a subset of women that continue to have dense tissue. Taking hormone therapy will Promote that. You know? You will continue to have more dense tissue if you are taking hormone replacement therapy, but there are some women that aren't taking hormone replacement therapy that still have dense tissue. I I think of the dense tissue as like a biomarker. Mhmm. You know? We know it's an independent risk factor. It's just a data point that we need to take into consideration. And depending on where you live, there's more and more awareness about the need to supplement with Sound. And it varies from state to state whether or not insurance covers it, you know, if you have any out of pocket cost. Unfortunately, I'm hearing that some people get pushed back. Yeah. When their doctor has ordered an ultrasound, the radiologists, some places are pushing back and not wanting to do it. I do think there's a little bit of a challenge with breast density because In general, it's someone's opinion. It's the radiologist's opinion. But there is software available now that quantifies the measurement and, you know, the computer aided detection is not perfect, but it's pretty good. The software that we're using is pretty good, and and I kind of like having that data point. There are some women who come in and they'll say, oh, My tissue is so dense. I have to have a ultrasound, and I have to say, no, ma'am. Your tissue is not dense. You don't need the ultrasound. You can have it, but you don't necessarily need it because of the density of your tissue. And I can show them the quantifiable measurement. See, it's giving you a category b. Your tissue's scattered. Oh, boy. There's so much to this. Yeah. It's It's like an onion. It's got a lot of layers. Yeah. But we love that, you know, the passion you have for it and the education. And Is it something personal? You know, like, for me, mine is family history. You know, many doctors, they've just seen it. And as a woman, You're just passionate about it because you've seen it. Well, I am. My grandmother had breast cancer. She had Postmenopausal breast cancer in her eighties, and I think her breast cancer was probably missed. There was an opportunity to make the diagnosis and maybe in that biopsy, they didn't get an adequate sample. And if a short time After that, she had a 2nd biopsy that ended up with a diagnosis of breast cancer. And where she lived, this was many years ago. Right. The surgeon wasn't considering doing a sentinel node biopsy on her Even though she had invasive cancer, and it was a grade 2 invasive ductal cancer. And I I was in training. I was a resident. I picked up the phone and I called the surgeon and we had a conversation and he said, well, that's one way to do it. And that's what he ended up doing. He, like, he wanted to remove her breast. Oh, yeah. And she had a small cancer. In the small breast, she didn't need that extensive surgery. She didn't need to be deformed in that way. She Died a couple years later from other causes, you know, but it is very personal for me From that standpoint, I, like you, have dense tissue and am trying to do a better job about taking care of myself, So I made sure that I had my ultrasound last year, and I had 16 cysts. Oh, wow. I was shocked. I could barely see 1 of them on my mammogram. Like, I would have called myself back because there was 1 area that I was like, I probably would have called myself back for that 1 area, But not 16. Yeah. I mean, it just really, really brought the importance of supplemental screening home for me, and And I use myself as an example when patients are terrified that they have a cyst in their breast. I I, You know, explain what assist is and how it forms and that it's not gonna harm you. But I also say you have 1. I have 16. Right. I'm not losing any sleep. I think you're gonna be okay. You know, that's so relatable, and it's so funny that you said, I woulda called myself back for a while. Oh, for sure. You know, that is so good because I think like you said, many people think radiologists are just locked up in a in a dark room, And I I just love my radiologist. I have really good relationships at the facilities. I traveled for years. I've worked at several facilities, And I just feel like the connection should be there with your doctors because you're you're next to them. You're that you're telling that patient a lot of information before they meet the radiologist. And you have to know the radiologist, and I think patients should understand that it's not their doctor. It is another doctor, that really cares about them and is going to be interpreting something very important for them. So your breast center, I I would love to know. Like, you'd spoke a little bit about it, but what are the mission and the goals? What made you guys form a business like this? Our institution is patient centered but cancer focused. So we're nonprofit. We're we're multidisciplinary. It started as a collaboration between medical oncology and radiation oncology. But once they merged, they found that their patients had special needs, And they ventured out to offer services and service lines that met the special needs of their patients. For example, we have dentistry. We have a dental clinic. Because patients with head and neck cancer and all of that extensive treatment, They have dental issues. Now I benefit from that because I can walk upstairs and get my teeth cleaned twice a year by a very lovely dentist and a hygienist that palpates my lymph nodes very thoroughly because she deals with head and neck cancer. That's just one example, but but that's Kind of our business model. You know, we're we're relatively small. This particular location, we have 2 m m o units, And we have 1 ultrasound suite, and our patients get an MRI on a three t magnet. And we probably do 4 or 5, breast MRIs a day. They run the scanner 7 days a week, 12 hours a day. Wow. And and we have 4 locations for mammography services. Our our organization has many many locations. Mhmm. But we offer mammography services Four locations. 3 are comprehensive, and then 1 is just a screening location. That's amazing because, honestly, My cousin passed away of cancer back in the eighties at 32, and 5 of my mom's aunts passed away, in the eighties seventies of breast cancer. So I really and then another cousin passed away there. So I never really saw people who had issues after surviving, cancer. My mom's sister survived it, breast cancer, and she's the only person in my family ever survived breast cancer. And I have a friend that had breast cancer. She had treatment, and she lost all of her teeth from the treatment that she had. And we talk all the time, and she's like, I'm so tired of these smoothies. And when you said that your facility does patient, You know, patient focused care. That truly is because I learn a lot from my friends who have survived it, the different things that they struggle with, and it's things I woulda never ever thought about. And I think many of us don't think about that. We just say, oh, they survived. But there are certain things people have to live with after surviving, and you guys are providing that for them. Dental work. We are trying. We also have a lymphedema clinic. Like, we started a lymphedema clinic in the middle of the pandemic. We launched a breast specific tumor board that was accredited, and it's virtual in the middle of the pandemic, and we still host it virtually 2 times a month. I love it. I love it. I mean, you I see why you're so passionate. You focus with a company that's passionate, and your TikToks are just amazing. We just need a tour on the TikTok next time of the of the facilities. We definitely need a tour. Yeah. If you look back at the best friends forever TikTok account, there is a little bit of a tour. One time when doctor Robertson got her mammogram, she did, like, a little video with music behind it, like, Her experience of getting her mammogram. Okay. I'm gonna have to look. You it's you know? In the archives. It's kinda weird. Okay. Yeah. We have to we have to make that a a top little one they can tap on because people need to know this is an amazing resource. I I don't think I've ever seen anything out there like it, And, it's really patient focused, and that that really touches my heart. And I'm sure many, many people pre appreciate what you guys are doing. But just a little bit because I talked to a mammography tech last week on my podcast, and she was talking about how they celebrate during the month of October. I do wanna ask you. How do you guys educate your patients and keep them beyond October excited about breast health? What are some things that you do, as far as Educating patients, creating excitement around, just excited as you are. How do you do that? Well, I will say during the month of October, we host an annual event called mammo's and muffins, and we use it as an opportunity to have outreach. We open our clinics on a Saturday. So each of our 4 locations is offering mammogram appointments on a Saturday during the month of tober to make getting a mammogram more accessible to patients. We have done a lot of media locally to to, you know, bring it to the forefront. And we've had a tremendous response. Last year was the 1st year we did it. And for all of those patients, they get a muffin when they come and have their mammogram. We have these totally cute little containers that the muffins come in. I bet the muffins are great. The muffins are very tasty. We have a bistro on-site, and our executive chef and his team actually Make the muffins every morning for the, you know, celebration. Wait. You guys have a chef there too? We do. We have a little cafe that it's incredible. They I feel like they make things from scratch. Like, I had Chicken and vegetable soup today that had so much great flavor. And they, you know, they do a couple things. They, like, do a sandwich and then an entree, and then there's some prepared salads and a soup. It's So it's not like a hugely extensive menu, but it varies. Of course, there are fan favorites. I think cowboy baked potato. It's like a baked potato with shredded pork and cheese and onions. Like, that one's very popular. Oh, yeah. Well, that is I tell you guys have gone beyond what I even expected, and and I think more people should know. So definitely, we're gonna follow you on TikTok, but I do love that recent TikTok you did. Could you talk about some of those myths that people have and debunk them for us before we close out tonight? Well, sure. You know, there's a lot of misinformation on the Internet, and I have seen so many posts about Putting your phone in your bra and getting breast cancer from keeping your phone in your bra. Number 1, don't put your phone in your bra. Like, that's uncomfortable. That's sweaty. It's gonna chafe. Yeah. But it it is not known to cause breast cancer. Okay. There you go. We to our knowledge, there's no way that the phone is causing breast cancer. One of the huge myths we hear all the time when we recommend a biopsy, a lot of patients are are having concerns that if we do the biopsy, that biopsy will spread the cancer. That is simply not true. You the the tumor cells would have to have a blood supply to continue to grow. And in the case of breast cancer, we don't seed the tract. You know, having a needle biopsy is the safest way to make the diagnosis. It's the least invasive. It's the least costly, and it's it's very safe, and we've been doing it for decades. I've been doing it almost for decades. Right. Nice. Okay. Well, that debunks some myths there, and those are really popular ones because I've heard all both of those before. Because I remember having my my phone. I don't have much to hold it up, but I was grocery shopping, and I had all kind of stuff in my hands. And the lady came to me and said, you shouldn't have that there. And I was like, I don't think that's true. So I'm glad I was right. That is not true. I think the biggest one is that mammograms cause breast cancer, And that is not true. Yeah. You could have a mammogram every year of your life for from the time you're 40 to into your nineties. And the amount of radiation, the cumulative dose over your lifetime is not gonna cause breast cancer. You know, I think in this day and age, there's been a lot of confusion around the time frame, like, when women should get a mammogram and how frequently they should get a mammogram, And the guidelines have gone back and forth over the last maybe 5 to 7 years, and it's created a tremendous amount of Confusion. I think some women think that they're in the clear after a certain age. They don't need to get a mammogram, but, like, the oldest woman I'm currently taking care of is 98. Wow. I mean, I have a good handful of ladies who are in their nineties with breast cancer, and they don't all have low grade, slow growing cancers. Some of them have more aggressive cancers. So I have a little saying, if you have breasts and you have birthdays, you have risk. So get your mammogram. Yes. So what is the youngest age? Because how do women know? I I know many women that have not even been to a gynecologist, into their twenties into their mid twenties. So what what recommendation do you have for women who maybe say, well, I'm not old enough to get a mammogram? Well, I think you need to know your family history. And by the time you are 25, I would Strongly encourage you to have an in-depth conversation with your doctor or your nurse practitioner around your family history. The goal of setting that deadline by 25 is we wanna identify those people who have these strong family histories who may potentially carry a gene mutation. We have accessible testing, and if we test people early, We can monitor them more closely and detect a change potentially before they develop a breast cancer. We've created a whole new category of patients called previvors. They don't even ever get breast cancer because maybe they choose to have a prophylactic mastectomy or they choose to take a low dose of tamoxifen to reduce their risk. But that 25, that is the new recommendation from the American College of Radiology that came out in this in the spring of this year that and and the reason That we're really focused on that is we've got disparities in care. We know it. Yeah. We know we have disparities. We know that women of color are more likely to die of their breast cancer. They're more likely to have more aggressive disease. They're more likely to have a gene mutation. Mhmm. And you and I both know they're more likely to not be taken seriously. Yeah. So we need to advocate for all of them. Right? And we need to encourage them to advocate for themselves by having that conversation with their doctor. Yes. That is a perfect way to end this Conversation. I want to thank you so much for coming to my podcast and sharing all of your knowledge and your personality with us Because it's important for women to take care of themselves and especially take care of their breast, and it's important for men. We I would love to have you back, and maybe we could touch more on men and your Your your TikTok business partner, your director, maybe if she would be interested in coming back, I would love to have both of you on to speak more about what you what you talk about, especially with men and women when it comes to breast health. So thank you again for being a a honored guest and just so knowledgeable and down to earth. Well, thank you for having me, Shondra. This was a great conversation. Yes. Thank you, and thank you all for listening to a couple of Rad Tech's podcast. Be sure to check the link for