The Future of Breast Cancer Detection Dr. Stacy Smith Foley Explains

Episode Overview

Episode Topic: In this episode of Skeleton Crew – The Rad Tech Show host Jennifer Callahan welcomes Dr. Stacy Smith Foley, a fellowship-trained breast radiologist from CARTI, a comprehensive cancer center in Arkansas. Together, they delve into the intricacies of breast health, mammograms, and the evolving field of breast imaging. Dr. Foley shares her journey into breast radiology and discusses the latest advancements in technology, including 3D mammography and AI tools that enhance diagnostic accuracy. The conversation also highlights CARTI’s commitment to providing holistic cancer care, including their innovative Bridge program, which supports patients through their cancer journey and beyond.

Lessons You’ll Learn: Listeners will gain valuable insights into the field of breast imaging, including the importance of regular mammograms starting at age 40, and the role of advanced technologies like 3D mammography and AI in early cancer detection. Dr. Foley also discusses the significance of breast density in cancer risk and the need for supplemental screening for women with dense breast tissue. The episode emphasizes the importance of comprehensive care, including psychological and emotional support for patients, which is crucial in helping them navigate their cancer journey.

About Our Guests: Dr. Stacy Smith Foley is a highly experienced breast radiologist with a deep passion for patient care. With extensive training that includes a fellowship in breast imaging at the Fred Hutch Cancer Center in Seattle, Dr. Foley has dedicated her career to advancing breast cancer detection and treatment. Currently serving at CARTI in Arkansas, she has been instrumental in launching key programs like 3D mammography and the Bridge program, which offers holistic support to cancer patients. Dr. Foley is also an active advocate for patient education, using platforms like TikTok to dispel myths and provide accurate information on breast health.

Topics Covered: This episode covers a wide range of topics related to breast imaging and cancer care. Key discussions include the evolution of mammography from film to digital and 3D imaging, the role of AI in improving diagnostic accuracy, and the impact of breast density on cancer detection. Dr. Foley also talks about the new breast screening guidelines, emphasizing the importance of starting mammograms at age 40 and the need for annual screenings. Additionally, the episode explores CARTI’s comprehensive approach to cancer care, including the integration of support services like counseling and nutritional guidance, which are crucial for patient well-being during and after treatment.

Our Guest: Breast Health Innovations Insights from Dr. Stacy Smith Foley

Episode Transcript

Jennifer Callahan: Hey, everybody, welcome back to another episode of The Skeleton Crew. I’m your host, Jenn Callahan, and today I have with me a great guest. It’s Doctor Stacy Smith Foley, and she is joining me from a great center that’s out in Arkansas called CARTI. And she’s here to talk to us today about mammograms and, you know, breast health and breast imaging and everything that goes along with that field there. So Stacy, thank you for being with me today. Tonight where I am.

 Stacy Smith: Well, thank you so much for having me, Jen.

Jennifer Callahan: My pleasure. So I gave just a little bit background of yourself, but let you handle the, you know, the ins and outs of your career and kind of maybe how you ended up with Car-T. And then we’ll talk about Car-T itself.

 Stacy Smith: Sure. I’m a fellowship trained breast radiologist. When I was a senior in medical school, I had to decide what field of medicine I was going to select, and I made a very analytical I made a pro con list, and it came down to the things that I really liked were procedures, analytical endeavors. but I also still liked patient care. So I was a little bit conflicted when I decided to become a radiologist, because a lot of people think that radiologists don’t have direct patient care. However, in breast imaging, you can have all the direct patient care you can handle. Because, you know, as a breast imager, I’m talking to diagnostic patients and I’m performing procedures. And, you know, radiology just seemed to tick all of the boxes.

 Stacy Smith: And even from the outset, I knew that I would ultimately go into breast imaging. You know, just as I started my residency, I knew that’s where I would end up. I went to medical school here in Arkansas, at the University of Arkansas for Medical Sciences, and I did my diagnostic radiology residency in Knoxville, Tennessee, at University of Tennessee. And then I did a full year of fellowship as a dedicated breast imager. So at full 12 months in Seattle at the Fred Hutch Cancer Center, in association with the Seattle Cancer Care Alliance and the University of Washington. And from there I made my way back to Arkansas, which is my home state, and I was in practice in Northwest Arkansas for about ten years. I spent a short amount of time in Tulsa, Oklahoma, home in Tulsa in Tulsa, Oklahoma, where I actually launched the first 3D mammography program in that area. And then I landed in Greenville, South Carolina, for a short stint. And I’ve been back home in Arkansas and central Arkansas, which really is my home for the last five years. So five years ago, in June 2019, we started the breast center here at CARTI.

Jennifer Callahan: And so before Stacy and I started speaking, I unfortunately I did call it Cardi and she said, it’s not Cardi like Cardi B, it’s CARTI. So just a little, for anyone who like, does, you know, look into this further afterwards. as CARTI and she gave me a little blurb behind it that it used to be for radiation therapy, but now they are basically write all things cancer.

Jennifer Callahan: Um, and you’re specializing within breast cancer specifically?

 Stacy Smith: Yes. So we’re all things cancer. We’re a nonprofit, community based cancer center that’s multidisciplinary. And we have multiple different locations across our state. But I am at the flagship, you know, I’m at the main center here in little Rock, Arkansas, and we even have our own outpatient surgery center. So we’re able to provide comprehensive cancer care for our patients and even continue to care for them as they’ve completed their cancer journey and they move on to survivorship. We have a whole new service of support services for patients called the bridge, where we’re offering therapy, nutritional support, massage therapy, exercise, just all of the things that patients really need to help them through this difficult journey.

Jennifer Callahan: Do you find, I mean, you might not possibly know this, but do you feel that most patients that are going through treatment with Car-T, that they do actually follow through with the bridge. That’s to say therapy. But you know, the continuing services while the bridge is new.

 Stacy Smith: So, you know, we just recently launched the bridge. I think there’s a lot of excitement about and I’m actually very excited to be able to, you know, have that resource to recommend to my patients because I’ve always said when the bra comes off, it all comes out.

 Stacy Smith: You know, patients are in a vulnerable state when they come to the breast center, and they oftentimes share very difficult things with me. And it’s I feel very reassured to know that, you know, there’s a psychologist, there’s a team of psychologists here, but I refer them to I have had a pattern of patients coming into my practice where their spouse was a patient, their spouse had cancer, and so they were coming here for their appointments and their treatments with their spouse, and then maybe they lost their spouse. And sometimes then it’s hard to come here. It’s very emotional when they’re coming, even when it’s just for a screening. because it just brings up a lot for them. And so oftentimes they share things like that with me. And we have a chaplain on staff. We’re able to offer grief counseling, uh, and all of the types of, you know, support that cancer patients need.

Jennifer Callahan: And that’s that’s a great thing to have offered to them. because, you know, you find some people who possibly know that, you know, services like that would benefit them, but they don’t necessarily maybe have the stamina to do the research, you know, into finding a therapist for themselves or a chaplain or, you know, someone that they can talk to about their grief that, you know, they don’t. Let’s just say that they don’t want to do the work for it, but it’s just kind of easier not to and kind of sit with your feelings.

Jennifer Callahan: But here, you know, Katya is offering this saying, we already have, we’ve already done this work for you. And here, you know, maybe here’s three names, three doctors that we have that you can call, you know, and that you don’t have to do the extra legwork or, and, you know, just a weight lifted off of a patient or even a family member of a patient.

 Stacy Smith: And to have it all consolidated in one location, that’s beautiful. You know, I think if you had time, if you have looked at our website, one of the things that’s different about CARTI is it is a beautiful space, like the campus is beautiful. We have a grand piano in the lobby, and somebody comes in and plays live music five days a week for a few hours in the middle of the day. Like sometimes we even have, you know, flutists or violinists. And in the winter we have these fireplaces that are going. So it’s like it’s just a different type of environment.  It’s a comfortable space. It’s a space for healing.

Jennifer Callahan: Right. Inviting almost.

 Stacy Smith: Yeah.

Jennifer Callahan: All right. So let’s talk then about, you know, breast imaging. And maybe from the time of when you started in your fellowship and decided that you wanted to do that. And you know, we’re currently now have you seen like leaps and bounds in changes of imaging itself. And then, you know, we were talking previously about guidelines as well.

 Stacy Smith: Well holy smokes. I mean when I was a resident they still had film screen mammography with all of that QA and the pickoff and, you know, thumbprints on images that were artifacts that could get a patient called back. By the time I was a senior resident, we were transitioning to digital mammography. So it was, you know, there were two different types of there was computed mammography, and then there was digital. And I think we might have had computed in the beginning. So it was a it was a digital image. We were no longer looking at the mammogram on a film. We were looking at the images on a monitor. And when I when I came out of fellowship at that time, the percentage of facilities that were quote unquote, all digital was less than 10% across the nation. And that was in in 2006. So, you know, around, you know, 2011, we saw the advent of digital breast chemosynthesis. And in the beginning, there were a lot of discussions at meetings like, you know, is this does this really benefit patients? There were there were discussions that maybe we couldn’t see calcifications as well. And so that was something that kind of held me back from jumping into that technology, because I’m really good at finding I’m a Spect finder, you know, I’m good at finding calcifications. And I didn’t want to miss the opportunity to make an early diagnosis if the technology prevented that. So, you know, I was in private practice at the time in a practice where we had to purchase the equipment ourselves as our business.

 Stacy Smith: And so we did not just jump right into Tolo. We knew that we were missing cancers because of dense tissue, like even back in 2013, you know, 2011, 2013. In my practice, we were very aware that the patients that we failed were the patients that had genetic predispositions and those who had extreme breast density. And so we were very early adopters of whole breast ultrasound screening. And we we embraced new technology called sonosnet. It was a articulating arm that, you know, worked with your ultrasound transducer, and it allowed the technologist basically to take sin loops of the entire breast and you watch them back like a movie. So I have long felt that learning that technique, like learning like adopting that technology. Some of that sometimes those exams would take like 5 to 10 minutes to review. But looking for that blip of the abnormality coming in and out of focus, it’s almost like it prepared me for Tolo. Okay? Because when you’re looking at a Tomo stack, you’re looking for that thing that shouldn’t be there, like that thing that disrupts the flow. And so we didn’t, you know, in our practice at the time, we didn’t get tomosynthesis, uh, in our technology until about 2016.

Jennifer Callahan: And just to clarify, for those who are listening and just for myself. Tomosynthesis is kind of what you would say in lay terms is like 3D imaging.

 Stacy Smith: Yeah. 3d tomography. I think what a lot of people, even people in the field of radiology who don’t do mammography, but they don’t realize is tomosynthesis is almost like taking a mini CT of the breast where you’re taking all these different slices, and then they’re put together with computer software to generate, you know, an image. In our practice, we no longer do the combo mode where you take two images. You know, when when I started the practice here in 2019, we went full in with high res 3D. And so from the very get go, we started doing the technique that reduces the radiation by 40% because the newest software and the newest equipment, the quality of the images is so good, you don’t need that extra picture and that extra radiation. But, you know, in the five years since we started this practice, I’ve seen definite improvement. The advances that I, you know, so many different AI platforms coming in, another kind of technological advance that we were very early adopters of was something an ultrasound called shear wave elastography that can help you discriminate between benign and malignant lesions. Okay. I find I speak about that a lot because I find it to be a useful tool. And it’s nice to show like different like blood flow to, to something like how would it differentiate the two. It shows stiffness. So it shows in a color map. It shows areas that are more stiff than the tissue that surrounds it. So it’s not just how stiff it is, but it’s also the pattern.

 Stacy Smith: You know, like normal breast tissue is homogeneous and soft versus a malignant lesion that’s heterogeneous and stiffened. Okay. All right. So then it shows the edges of that. And that saves a patient from having to have a biopsy done of the area. Yeah it can actually. So when you’re in mammography we have the bi-rads categories. And if we have a lesion that we’re on the fence like does this need to be biopsied or can it be followed. Sometimes you know, the added advanced tool of the elastography gives us more data to say, no, this one needs to be biopsied. Or, you know, I feel really confident that this isn’t breast cancer and I think it would be safe to follow it.

Jennifer Callahan: So it helps you it helps you upgrade the cancers that you might have a delay in the diagnosis.

 Stacy Smith: Because you’re just following them. And then it helps you downgrade some of the benign lesions. So you don’t have to biopsy as many benign lesions. Okay.

Jennifer Callahan: And now you’re discussing about you know, so many different AI platforms out there. And Stacy and I were speaking about this before we started recording.

Jennifer Callahan: Is that something that CARTI uses at all to help with, especially for the the dense breast imaging?

 Stacy Smith: So yes, we do have an AI platform that we use a couple of different AI tools. Okay. We have an AI tool that does automatic breast density assessment.

 Stacy Smith: Now some of those there’s there’s lots of software that does that. And you know I think in the beginning I was resistant to that, you know, additional software package because I felt like I’m a I’m a pretty good breast radiologist. I know, you know, I know which breast is dense and which breast isn’t dense, but I find that it helps support the decision that I’m making when I’m looking at the image. And now that we have new regulations around breast density notification that are going to be across the country in the fall, I think it’s even more important to be consistent with that. You know, one software, AI software that’s a breast density assessment. But then we have a computer aided detection tool as well that, you know, helps tag areas that are more suspicious. It even puts into an order of importance which cases you should maybe look at first and even tells you like, how is this going to be a fairly straightforward case before you open it? Or is it going to be a more complicated case?

Jennifer Callahan: And the great thing about all the AI tools that are offered out there is that at the end of the day, the radiologist has the final say, you know, so you know, you can take what they’re suggesting, you know, and like you said, sometimes it you know, it helps you and to like to reaffirm what you already feel or for you to be like, no, I don’t believe that.

Jennifer Callahan: That’s it. I feel like with so many AI things coming out with computers and stuff, you know, people are like, oh, you know, like technologists and radiologists, you know, one day they’ll be obsolete and, you know,

 Stacy Smith: Not only not be obsolete because you else can perform the biopsy. You know, we’re the only ones who can perform the biopsy, and we’re the only one who can hold the patient’s hand and talk them through the process. So, you know, I just I, I see these things as tools in our toolbox, right, to help us be better at what we do. And maybe they take them they help us make a more confident decision so that we can spend more time with the patient communicating directly.  so let’s continue on with, you know, things that have been changing. Uh, you were talking to me before and I also too saw all your, uh, LinkedIn that you had shared about the breast screening guidelines changing.

Jennifer Callahan: So currently right now what it’s age 40 that is suggested that you should have a breast 19. Are they changing? You know that they’re lowering the age at this point.

 Stacy Smith: So if you go back several years, you will find that the United States Preventive Services Task Force really muddied the waters and made things so confusing for patients when they changed. They are the ones who changed the guidelines. The rest of us have always had the guideline that, you know, like anyone who has any focused, you know, practical medical application in the breast cancer field, we have always recommended that average risk women start screening at age 40 and that they screen yearly.

Jennifer Callahan: But the Preventive Services Task Force changed that some years ago. And they said, oh, women can start at 50 and they can go every other year, and then they can stop at 75. And, you know, the result of that has been that more women are presenting well, more women are skipping their mammogram. And of course, Covid didn’t help that at all. Right. You know, I think if we give people an excuse, they’ll use any excuse not to get their mammogram. But I think the result of that is we are finding that women are coming in with more advanced disease because they didn’t start screening earlier. The data is also showing that it’s not just breast cancer, it’s all cancers that even younger people, younger people are getting breast cancer or people are getting breast, not just breast cancer, but people are getting cancer at a younger age. So because people are getting a cancer at a younger age, we do have to adjust the guidelines. So the task force did a good thing. They realigned, they course corrected with the rest of us. They’re now recommending that average risk. Women start at age 40, but they continue to recommend every other year, which is not adequate. A woman’s mammogram can change dramatically in 12 months. And, you know, so can her health. So I still think it’s very important that women screen every year.

 Stacy Smith: They had said that women can stop screening at age 75, but the data says that a woman continues to have a risk of breast cancer as long as she’s living. If we look at the curve, the curve kind of plateaus when a woman is between the ages of 80 and 90. But it’s not because her risk for developing breast cancer decreases. It’s because women in that age range start dying from other worlds. That makes sense, right? So, you know, I have what I call my collection of my Golden Girls, and they have something that one really important thing in common, they have all come to me. These are like women. I’m diagnosed with breast cancer between the ages 80 and 95. Wow. What they have in common is people stopped telling them to get a mammogram, and even told them that they didn’t need to get a mammogram when they were otherwise healthy. So when they came to me feeling a lump in their breast, they had a larger cancer, a more advanced cancer, a more aggressive cancer. So if they had been screening on a yearly basis and they had been screening continuously, their cancer could have been detected at an earlier stage for sure.

Jennifer Callahan: But you wonder why. I mean, why the recommendation is to stop at 75. Like you said, I mean, you’re it doesn’t mean that you still can’t develop some type of disease that, you know, I mean, is it because the life expectancy.

Jennifer Callahan: Is maybe at.

Jennifer Callahan: That.

Jennifer Callahan: That around.

Jennifer Callahan: That.

 Stacy Smith: Age.

Jennifer Callahan: Life expectancy.

Jennifer Callahan: Of an.

 Stacy Smith: Otherwise healthy 75 year old is that to 15 years. So, you know, like even if you looked into the guidelines based on life expectancy, that that guideline was if you have less than five years to live. Now, obviously you have to put this into the context of the individual patient. If you have a patient with severe dementia who doesn’t really know what’s going on, and it’s going to be like physically challenging and or mentally challenging for her to have a breast exam. You know, in her life expectancy is less than five years, then maybe that’s the patient who doesn’t need to get a mammogram. But my mom’s 75 and she’s very vibrant and she better get her mammogram or I will be all over her case for her. And she does. She gets her mammogram every year. She’s a very consistent patient.

Jennifer Callahan: That’s good. So for women who do have, you know, kind of like genetic markers or, you know, it’s it’s in their family history. Should they actually have screenings done sooner than age 40?

 Stacy Smith: They should. And there are a few things that the task force really missed the opportunity to deal with. You know, one of those is family history and genetic predisposition. The Society of Breast Imagers actually recommend that all women have a conversation with their primary care provider by their 25th birthday, right, so that they can discuss their family history. And the goal with that is so we can identify those women who are at the greatest risk, and we can start screening them sooner.  And we can offer them options like genetic testing. If, you know genetic genetic mutations only account for about 5 to 10% of breast cancers. But those patients have the highest personal risk. So we really do need to find them. You know we need to start screening them early because when they do get cancer, it tends to be more aggressive. It tends to be, you know, triple negative, much harder to treat. And it tends to grow quickly. So, you know, for those women when they’ve had that risk assessment by the age of 25, if they’re found to have this elevated lifetime risk, we can start doing MRI on them between the ages of 25 and 30 and then maybe add mammograms in at age 30. I have what I call the ten year rule of thumb. So, you know, whatever your family history is, you should start you should consider starting to do screening tests about ten years before the age the youngest person was diagnosed. So if your mother was diagnosed with breast cancer at age 40, you know, we would want you to start getting your mammograms at age 30.

Jennifer Callahan: That’s smart. It makes a lot of sense because the mother who possibly had it, at what, age 40? You know, maybe she didn’t catch it until, you know, it’s more advanced. So to follow the ten year guideline, you can catch it quick.

 Stacy Smith: Another thing the task force failed on is they really didn’t address 3D mammography. We have so much data that shows that 3D mammography does two things that are, you know, very rare for a screening test. So the tomosynthesis, the 3D mammograms, it we find more cancers, but we also have fewer false positives. So we call fewer women back unnecessarily because we can determine with the 3D image that that’s just a normal tissue.

Jennifer Callahan: Is that not something that’s normally used? I hate to say that, you know, as a X-ray technologist, I don’t know the ins and outs of mammography and, you know, the different screenings that, you know, or I should say, maybe the different types of imaging used for it. I mean, I’ve heard of 3D breast imaging, but I’ve seen like, you know, like we offer that here at this location. And I kind of would have assumed that at this point that that’s just something across the board that’s offered to patients. But is it still.

 Stacy Smith: It’s not offered universally? I would say probably the majority of the mammography units across the country do have 3D capabilities, but not all patients. You know, you still have some centers that have some older equipment that’s viable. And so maybe they don’t. Not all of their mammo units offer 3D, so they may have to triage.

Jennifer Callahan: So uh, centers that do have it though, say for instance like carton, you know, you have 3D imaging. That’s just every patient receives that type of imaging.

 Stacy Smith: It’s standard of care here. Yeah. That’s not universally true. That’s you. You just can’t expect that. If you want to make sure that you’re getting a 3D mammogram, you need to be asking that question. Okay, gotcha.

Jennifer Callahan: So even for like places that do have it, they just might not offer it to you. That’s right.

 Stacy Smith: Because not all of their mammogram units may have the capability.

Jennifer Callahan: Right okay. Maybe they reserve that for patients who have dense issue or.

 Stacy Smith: Are patients with dense tissue.  Which is another area that the task force failed. So the task force said nothing about women with dense tissue and supplemental screening. And we know the data is robust, that women who have dense tissue have an increased risk of developing breast cancer, and that that is an independent risk factor. And the only way to mitigate that risk is with supplemental screening and the options for supplemental screening. You know, the most available options for supplemental screening are ultrasound and MRI.

Jennifer Callahan: Um, and now when you were saying for patients who would start having screenings done earlier that you would suggest starting with MRI, is it just for the radiation portion itself that it’s somewhat.

 Stacy Smith: For the radiation. But, you know, the MRI is our best test of that. This test is detecting breast cancer. So if a patient has a defined, elevated risk of 20% or greater lifetime, then the MRI is the best test. I’d want to start with the best test.

Jennifer Callahan: So much information I’m sure flying around, uh, you know, for radiologists and even technologists, you know, as a technologist myself, I know that we’re required to do continuing education every two years. is it the same for radiologists, you know, with all the new information that’s out there for breast imaging and, you know, all the different types of equipment and I and I’m sure sometimes your guy’s head just, like, explodes.

 Stacy Smith: Well, if if you’re a board certified and you’re maintaining your certification, your maintenance and certification, we’re required to have 25 hours each year in radiology specifically. And they do. They can do an audit. And what they’re looking for is, you know, have you had 75 hours over the last three years? There are lots of good options these days. You know, some sometimes it’s industry sponsored webinars that are available free of charge. You know, I still I favor the in-person meetings. I really enjoy attending the Society of Breast Imagers meeting when I can. I try to go most years because it’s just such an uplifting opportunity to be with my colleagues, you know, to be with people who are like minded and who are as passionate about the field of breast imaging and breast cancer detection.

Jennifer Callahan: So speaking of being passionate and, you know, sharing the word of breast imaging, and I don’t really know how else to go into this, but Stacy and I were talking earlier about how she is a TikToker, not to even be funny about it, but, you know, just to put the good information out there for patients who, you know, you might feel uneasy about it or you’re unsure of exactly what you’re doing. But as Stacy, just explained what we were saying earlier about, you know, your three different videos that you’re doing and, you know, she’s kind of a sensation at this point in the world of breast imaging.

 Stacy Smith: We’re not really a sensation, but my surgical colleague and I, doctor Gary Robertson, we have a collaborative TikTok account that is Breast Friends, the number four. And, uh, and that’s forever. And we’ve been making TikToks over the last three, at least three years. And the reason we started making TikToks is we found that that is where people were seeking information. Yeah. And we looked at some of the information that was available in so much of the information was misinformation, myths. There’s a lot of information out there warning women, telling them not to get mammograms. I had a patient recently that refused the mammogram, and this is why she told me I’m going to quote, because they’ve been banned in Switzerland because they’re so dangerous. Apparently that’s a thing. That’s a big myth on the internet out there. But we started this collaborative TikTok account, the social media engagement with patients to try to best the myths, to try to provide great, you know, good advice, to educate patients, to give them recommendations, and also to kind of show our personalities and to make it a little less scary. It’s kind of scary thinking that, oh, I’m going to go get my mammogram at the cancer center. Right. Like that is a scary word. But if it’s I’m going to go get my mammogram at Cathi with Doctor Smith. Bailey, she does those cute TikToks. She seems so fun. You know that it’s more approachable. 

Jennifer Callahan: The one that I saw that they just put up recently. Oh no. So much. She did share that it hit a good amount of views. But just, you know, basically explaining when you’re going in for your mammogram, you know, what you should and should not do and, you know, how to prepare yourself adequately, which I mean, as a technologist from x ray, uh, the first part of it was, what should you wear? Should you wear a dress or should you wear a two piece outfit? And I feel the same way that you know, how you explain it, that you should wear the two piece so you can just take your shirt off instead of having to take your whole dress off. And I kind of feel the same way about, you know, as technologists, you know, for a patient who’s coming in for just a quick chest x ray, you know, but they have this, like, elaborate bra and there’s all these necklaces on it, you know, for simple things like that, that can just easily break it down for a patient who, you know, is going out for the day. And, you know, maybe you don’t have to look your best and wear your prettiest dress, you know, to go in something that’s more easily to take off, to prepare yourself for your imaging. do you want to share any more about about that video, about, you know, how else to prepare to come in?

 Stacy Smith: Well, I think one of the other things that we reminded patients is we don’t want them to wear deodorant or lotion because it can create an artifact that could mimic calcifications and could maybe cause the patient to be called back unnecessarily. The other things we touched on were that if you experience a lot of discomfort with your mammogram, you can take a couple of over-the-counter pain relievers, you know, 30 to 45 minutes before your exam. And that might help with some of that, discomfort that some women associate with getting the mammogram. I would say pain and fear are the two things that prevent women from getting mammograms or a and for the the women who are younger, who still have their menstrual cycles, you know, I would recommend that you not schedule your mammogram at the same time as your menstrual cycle. You’re going to be more sensitive in that timeframe. And so the mammogram might be a little more uncomfortable.

Jennifer Callahan: And that was a good one. I did see that at towards the end. I mean, it makes a lot of sense that and it’s just simple things that you don’t necessarily as a patient think about. But I mean, definitely leading up for the 1 to 2 weeks prior to, to your cycle that, you know, your breasts might be tender and, you know, you don’t really want to being squished between something. So, I mean, that’s that’s I feel like that’s a huge recommendation that many might not have even thought about that.

 Stacy Smith: I would also say the caveat to that is there’s no perfect time. It’s kind of like Nike with the sneakers. Just do it. Yeah, it’s better to do it and not do it, you know, and it being an imperfect time then to put it off and to not get it done.

Jennifer Callahan: Um, I find it interesting that, uh, how you had said that deodorant, uh, which I did know that deodorant shouldn’t be worn for it, but I have to say that I did not know that lotions was one of something that you should not have on prior going to your mammogram.

 Stacy Smith: Lotion and talcum powder. one of the things that can create what I would call a crazy artifact on the mammogram is, you know, some women will have a lot of issue with, like, moisture and yeast, but below their breasts. And sometimes they’ll use ointments that, you know, like A and D ointment or like Boudreaux’s paste. Those types of things and those types of ointments have silica in them, which creates a crazy artifact and makes it look like they have crazy calcifications in their breasts. And they don’t. It’s an ointment. And, you know, like the clinical strength deodorant. I mean, that stuff is that it’s it’s semi-permanent. It gets in the pores and it’s hard to get out. So if you use that kind of deodorant and it’s caused a problem on your mammogram in the past, you might want to like, not use it for about a week leading up to your mammograms. Oh, wow.

Jennifer Callahan: Maybe even, like exfoliate that area. Maybe it would help.

Jennifer Callahan: Not a good idea.

 Stacy Smith: Yeah.

 Stacy Smith: Bad idea. But. But if you’re using that and or that Boudreaux’s paste, you know, for the moisture issue, I mean, sometimes we’ll have those people come back in a few weeks, like stop using it and come back in a few weeks. Now, one of the things that can happen if a woman is having irritation under her breath, she could have a skin tear when she has her mammogram. And it’s not tragic, but it’s really uncomfortable. It’s uncomfortable enough, like, can you imagine the worst paper cut you’ve ever had? But it’s under your breast like it’s again, it’s not tragic. You can usually put some Vaseline on it to make, you know, to to keep it, to help it heal and to make it a little more comfortable. But if if that does happen when you take a shower after your mammogram, it’s like shocking because it’s so just imagined, like the worst paper cut of your life under your breast. Yeah. so if we we have a question on our questionnaire, we ask women, have you ever had a skin tear? Because we want to know that in advance. And if they have, if we’ve ever had a patient that has had a skin tear in the past, we notate that. So we’ll be mindful of it. But there’s some things that we can do. We have these coverlets that can go on the mammography machine. That’s a barrier between the machine and the patient’s breast. And so in the summer when women are hot and sticky and there’s, you know, a greater likelihood of that skin tear. And so we’re we try to use the coverlets really all the time. But those are some things that we think about when we’re we’re bringing the patient, when they’re bringing the patient back and they’re going to go ahead and perform the exam.

Jennifer Callahan: Would you find that maybe.

Jennifer Callahan: Patients.

Jennifer Callahan: Who maybe with thinner skin or like at the like, possibly older patients who have.

 Stacy Smith: Patients who have heavy, pendulous breasts are more likely to get a skin tear as well? Yeah.

Jennifer Callahan: That sounds extremely uncomfortable. I couldn’t imagine that. I think I don’t I don’t have large pendulous breasts. So looking forward, uh, you know, with CARTI and the bridge and everything, any other great developing news, you know, for the center.

 Stacy Smith: For the center? well, I think we’ll be opening our fifth location in the next in the next year, which will bring mammography services to South Arkansas, where they’re sorely needed.

Jennifer Callahan: That’s good.

 Stacy Smith: So that that’s something exciting that’s on the horizon. we just we’ve, just got in another three Tesla MRI unit at one of our locations in North Little Rock. And so we’ve opened up breast MRI at that site. So we now have three sites that are offering breast MRI. And we we have a high risk clinic with a nurse practitioner and genetic counselors. So patients can self-refer so they can have that risk assessment and they can learn if they’re at a higher risk, they can undergo genetic testing. And then they can they can be seen in that clinic and they help manage their recommendations for screenings even beyond breast cancer. But having more locations to offer MRI is definitely a benefit because that’s a bottleneck. You know, I said in the beginning that it was, you know, it’s the best test. And some people might ask, well, why don’t we do that on everybody? There just starts there’s not enough equipment for us to for that to be the standard screening test. And so because we had we we do have a high population of the high risk patients. It’s been a bottleneck in our practice. So we’re excited that we’ll have more opportunities for patients to get their MRI. Right.

Jennifer Callahan: And like you said, you know, with the new location where it’s where it’s coming, that there’s not much imaging centers, you know, it’s something that you kind of take for granted sometimes, at least for myself, that, you know, I live in the Philadelphia area and it’s so heavily populated and I feel like there’s imaging centers everywhere. And we have like three large health systems that, you know, are just vastly you know, I feel like if you need an appointment, you can probably get an appointment as long as you’re willing to drive me be an extra like 30 minutes or so, you can probably easily get an appointment within like a, you know, a week, two weeks or so. And it’s something that I hate to say that at least myself, you know, takes for granted for living in the type of area that I do. You don’t think about patients who or people that live in areas that are less populated, you know, that services like that aren’t easily accessible. The goal, right.

 Stacy Smith: Is a very rural state. Yeah. You know, we have a concentration of our population in central Arkansas and Little Rock and in northwest Arkansas, in Fayetteville, Bentonville. but otherwise we’re kind of spread out. And so it’s not uncommon for a patient to drive 90 miles each way to come and see me, or to drive 2 to 3 hours each way for their mammogram, because there aren’t quality services or specialists available to them. So one of the missions of CTI has been to bring care to patients in their community, because we know that patients, they they do better there. They get through their journey better when they’re able to stay in their community, and they’re able to be supported by their friends and family locally.

Jennifer Callahan: So we’re just on site there then. I mean are they considered outwardly.  Okay.

 Stacy Smith: Yeah. So, you know, we have the outreach site in Pine Bluff, Arkansas, which patients who are less advantaged to some extent, you know, it’s it’s a completely different demographic, definitely at risk patients, but it’s a smaller center than the big cartel cancer center in Little Rock. But we have a breast radiologist on site there. We have 3D mammography. We have ultrasound. We have we have MRI there. And we offer stereotactic ultrasound MRI biopsies. So it’s it’s comprehensive care in our community. Right.

Jennifer Callahan: That’s that’s great. It’s amazing. Party seems like an amazing place you know for for patients, you know past present future and even the families like you how you had said that, you know, so many people encompass in in care for the patients, you know. So thank you so much, Stacy. I really appreciate you being with me tonight. Everybody, this is Doctor Stacy Smith. Boley I’m talking to us about everything breast imaging and the great car ty out there in Arkansas.

 Stacy Smith: Thanks, Jen.

Jennifer Callahan: All right. All right everybody, we’ll see you next week. Uh, make sure you check us out on YouTube, Spotify and Apple Podcasts. So. All right. We’ll see you later.

Jennifer Callahan: You’ve been watching.Jennifer Callahan: The Skeleton Crew, brought to you by X-ray tech. Org on the next episode, join us to explore the present and the future of the Rad Tech career and the field of radiology