Alexea

My name is Alexea, but on social media and since very publicly sharing my breast cancer diagnosis and treatment journey, I have become better known as “Dr. Alexea”.  I am a 39 year old mother, triple board certified Internist, Pediatrician and Infectious Disease physician, speaker, author and coach.  Recently, I have added breast cancer survivor and thriver and PALB2 mutant to that list.  I was diagnosed with Stage 3a invasive lobular carcinoma of the right breast on April 3rd 2018.  My breast cancer diagnosis was far from typical and the search and concerns for development of my breast cancer began 2+ years prior to my diagnosis, for my doctors anyway.  For me, breast cancer was something that had been on my mind since the age of 20. I attended a speaking engagement hosted by a campus sorority and the speaker was a young woman named Katrina Lewis who was living with Stage IV metastatic breast cancer.  She wasdiagnosed with breast cancer years after discovering a lump in her breast.  She had been repeatedly dismissed by her health care providers who stated that she was too young to have breast cancer.  A story I still hear from young women almost 20 years later.

Despite an increasing prevalence of breast cancer, women of all ages, myself included, often experience delays in the diagnosis and treatment of their breast disease. Katrina would eventually succumb to her disease but I will be forever grateful of her mission to educate young women about their risk for breast cancer, the need for breast self awareness and her encouragement to perform self breast examinations. 

The lasting impact of her story remains with me.  I immediately began performing monthly self breast exams and knew my girls so well that I would find a lump in my own left breast within the following year and I was in hot pursuit of answers.  Getting definitive answers as an uninsured 21 year old med school bound college graduate was not easy.  I was navigating a transition from undergrad in Tennessee to medical school in New York City.  In between, I would spend 6 weeks of that summer helping care for my grandfather who was actively dying from inadequately treated metastatic prostate cancer.  I was fearful that my lump might offer me the same fate and just like Katrina, I was repeatedly dismissed as being too young to have breast cancer.  The pebble I found in the lower quadrant of my left breast quickly turned into a pea and then a marble and then a painful amorphous blob that by the time it was removed a year later was over 5 cm in size.  It took several months from the time I found it to be diagnosed by ultrasound with a fibroadenoma and this was confirmed on surgical pathology when it was removed a year later.  To me, it was a sign of things to come though my providers dismissed it as a fluke.

I would remain symptom free for almost a decade and a half, but I continued to examine my breasts regularly.  I found another lump in my left breast at 35 years of age that prompted a work up which included a mammogram and breast ultrasound.  I was given a brief and false sense of relief when I was told that the mass appeared to be a fibroadenoma in a preliminary report.  Days later, my primary care doctor would sit me down in her office and inform me of BIRADS 4 results.  This meant that the findings were concerning and could not conclusively rule out cancer.  In fact, the findings were concerning enough to warrant immediate biopsy. The biopsy results showed LCIS, a precancerous change that led my breast surgeon to perform a lumpectomy. The pathology revealed 3 types of abnormal cells which informed my breast surgeon and oncologist that I was at high risk for breast cancer.  This led to two years of preventive therapy with tamoxifen and quarterly breast cancer screenings with alternating mammograms with ultrasounds and breast MRIs. 

I am deep sighing as I type this because despite our advances in medical sciences, increasing understanding of risks, and ability to test for genetic predisposition to cancer, many young women are still denied diagnostic testing and genetic testing for this disease, myself included!  I requested a prophylactic bilateral mastectomy after multiple scares with abnormal imaging and biopsies but I was told that it was “too radical”.  Figuring a genetic mutation would win me the surgery, I then requested testing for cancer gene mutations.  I was told that I was not a candidate for such testing based on my family medical history.

Over this time I had multiple biopsies, lumpectomies and cancer scares.  I had gotten so used to the exam, image, biopsy, wait routine that when I first got called back for abnormal MRI results, I figured that they’d just find more of the same precancerous cells.  I knew when it was time to have my MRI guided biopsy that this time was different because I could see my cancer on the screen across the room.  It was staring me right in the face.  This was a mass, a tumor, not the vague schmutz that could only be picked up by the trained eye that had been seen on prior occasions.  Anyone could see this, yet it had evaded the detection of the mammogram and breast ultrasounds, something that I now know 15 to 20 percent of all breast cancers do.  After the agonizing procedure, I waited 5 days for the call.  I knew, but all the while I hoped.  I hoped that they would tell me something different, something other than breast cancer. 

My breast cancer treatment consisted of bilateral mastectomies with immediate reconstruction and chemotherapy.  After completing chemotherapy on September 12th 2018, I began 25 doses of radiation therapy which I completed on November 15^th, and I am now on hormone suppression therapy.