Second opinions, survival rates and treatment options: 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 new 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 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.

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.”

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.

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 accepting new patients! She is located at 2625 N. Craycroft Rd #201. 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?

Dr. 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?

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.

BDP36503When 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.

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.

“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 2625 N Craycroft Rd #201.
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.

Screening and mammography myths – what’s your “normal?”

BDP36471We are continuing our weekly blog series with Dr. Michele Boyce Ley, TMC One’s new board-certified breast oncology surgeon and medical director of TMC’s Breast Health Program. Last week she shared with us highly valuable information about how to figure out if you’re really at high risk for breast cancer or not.

This week we’re focusing on how to sort out truths vs. myths when it comes to screening and mammography.

As women, we’re told to do our self-breast exam “when we pay our rent.” Or “on the same day every month as our birthday.” There are even apps to remind you. Most of us know we should do them. But the reality is, we don’t.

Are self-exams encouraged? And should you really be doing them? “Absolutely,” said Dr. Boyce Ley. “We want women to become really self-aware when it comes to their breast health. We want them to do monthly self-exams so that they become familiar with what their normal is. If they do regular checks and know what their breasts feel like, it’s easier to discover when something feels out of the ordinary. If you’re aware of it, you can monitor it and get in to see a breast specialist if necessary. When it comes to self-exams, it’s best to do it the first week after your menstrual cycle.”

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

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

Dr. Boyce Ley explained that there is chatter in the medical world that monthly self-exams may cause unnecessary imaging and biopsies. One of the many challenges, she explained, is that while there are a lot of risk factors we know about, there are also a lot of risk factors we don’t know about. It can be difficult to definitively decide that a 35-year-old, for example, should have a mammogram. “That’s when it’s appropriate for that patient to see a breast specialist,” she said. “If you’ve tried to figure out if you’re considered high risk or not, and you’re still unsure, or if you just need guidance to sort it all out, have a breast specialist help you,” she said. If a woman is identified as high risk, then imaging starts earlier.

▪ What about the risk of being exposed to so much radiation during a mammogram?

It may be recommended that younger people who are identified as high risk get mammograms every other year instead of annually at first. Or perhaps your doctor wants to combine a mammogram with an MRI. “Generally, radiation risks aren’t any higher than they were with regular film screen mammograms from 15 years ago,” said Dr. Boyce Ley. “MRI is a test without any radiation.”

▪ There are 2D and 3D mammograms. How do I figure out which kind I need?

Film screen mammography is a thing of the past. These days, all mammography is done digitally. A 2D, or standard mammogram, captures all of the layers of the breast tissue stacked on top of each other. During a 3D mammogram, the x-ray camera rotates around the breast, getting a picture of multiple layers of the breast. Those layers can then be separated out for an even more precise view. For a majority of patients, standard digital mammography is still very good. Doctors have found, however, that for all patients, especially those with dense breasts, 3D mammography allows them to do fewer call backs. That means that there is a smaller chance that you’d have to be called back in for a follow-up mammogram or ultrasound. “The detection rate for cancer is higher with 3D mammography, as it allows us to find more small cancers,” explained Dr. Boyce Ley. “The downside is it can cost more.”

At TMC’s Breast Center, both 2D and 3D mammography is performed. If you’re considering a 3D mammogram, be sure to check with your insurance first to see what it covers.

▪ I have breast implants. Do I have to do anything differently?

No. The screening recommendations are the same. Dr. Boyce Ley said that implants can distort the breast tissue. In some cases, implants can make it easier to find a lump by feeling the breast tissue during a monthly self-exam. On the flipside, in some cases, it may make it harder to find a lump by imaging since the breast tissue is being pushed around by the implant. It can be difficult to visualize all the breast tissue since the implant often distorts it.

▪ Does where I get screened matter?

Yes, according to Dr. Boyce Ley. Before you schedule your mammogram, do your research. Ask if your scan is going to be reviewed by a breast imaging specialist or radiologist with a specific focus who is able to give you an accurate interpretation. “You want to have your breast imaging read by someone who almost exclusively does mammographic imaging,” said Dr. Boyce Ley. “There are so many changes in technology and what we learn about the breast. It’s important to have someone who is highly experienced.”

Dr. Boyce Ley recommends asking a few questions when you call to schedule your appointment. Ask things like, “Can you tell me about your radiologist? Can I look them up online? Are they fellowship trained in breast imaging or are they a general radiologist? What percentage of their time do they read mammograms?”

At TMC’s Breast Center, all of our radiologists are trained as general radiologists and then receive specialized training in breast imaging. Additionally, our lead radiologist, Dr. Matthew Bell, as well as Dr. Shayna Klein are both fellowship trained in breast imaging. All of our radiologists must keep their training current, so you can be confident that if you get a mammogram at TMC, it’s being read by clinicians who are specially trained in reading mammograms.

Dr. Boyce Ley is accepting new patients!
She is located at 2625 N. Craycroft Rd #201.
Call (520) 324-BRST (2778) to make an appointment.

To schedule a mammogram, call (520) 324-2075.

Spread the word about when to have your first screening mammogram and the FREE screening mammograms for uninsured women by entering our TMC for Women photo contest. Snap a picture of you and your BFF and enter for a chance at a fabulous prize.   http://woobox.com/chcztiPhotoContestBFF

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

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 2625 N. Craycroft Rd #201.
Call (520) 324-BRST (2778) to make an appointment.


Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461