Alexis Lieberman, MD, and her partner Ilene wept as they sat in her Philadelphia doctor’s office. It was April 2007, and the 42-year-old pediatrician had just learned she had breast cancer.
“My surgeon told me the cancer was right behind the nipple,” Alexis says. “Right away she said, ‘Well, since it’s right behind the nipple, you might want to get a mastectomy.’”
A lumpectomy requires removing the cancer with a small margin, or rim, of healthy breast tissue. At the time, lumpectomy wasn’t offered for individuals with a tumor right behind the nipple, since it would have been difficult to get a good-looking result. (Advances in surgery allow lumpectomy in many such cases today.)
Alexis didn’t want a mastectomy. She began researching other options, relying on her medical knowledge as she did so.
Designing Her Own Treatment
After getting over the initial shock, Alexis hit the books. She read every study she could get her hands on, including a case study that focused on her specific situation.
The study looked at 15 women who had a tumor removed from behind the nipple and areola, the dark area around the nipple. The surgeons were able to remove all the cancer during lumpectomy, allowing the women to retain feeling in their breast. A majority of the women reported being happy with the outcome.
“After reading that study, I became convinced there was no reason for a mastectomy, since the cancer in my breast wasn’t in the areola, it was behind the nipple. I didn’t see the benefit from it,” Alexis says.
While she researched, a colleague referred Alexis to a surgical oncologist at another facility. Alexis met the surgeon, and told him she didn’t want a mastectomy. She learned he was one of the co-authors of the 2004 case study.
The new doctor agreed a mastectomy wasn’t necessary, but he still recommended removing the areola, meaning Alexis would still lose her nipple and her areola. Alexis did not want that, either, so she resumed research.
She and the surgeon eventually agreed on a lumpectomy and removing part of the nipple. Her doctor successfully removed all the cancer during the surgery, allowing Alexis to keep her areola.
“As a doctor, I knew that I was going to be offered what was standard,” she says. “If I wanted what was best for me, I had to do the research. [My treatment] was scientific. It was based on good data.”
After surgery, Alexis took the chemotherapy medicines docetaxel (Taxotere) and carboplatin with the targeted therapy trastuzumab (Herceptin). Following chemotherapy, she had a then-experimental radiation treatment where she received radiation twice a day for a week instead of once a day for several weeks.
Strengthened by Community
While Alexis designed much of her treatment on her own, she relied on others to help during her recovery.
Not only did Ilene stay awake at night when Alexis needed to vent, but she also balanced caring for Alexis with caring for the couple’s four-year-old daughter, Michaela, as well as caring for the house throughout this tumultuous period.
“She’s a particularly calm, even-tempered person, so she handled it way better than I ever would have,” Alexis says.
Ilene didn’t always do it alone: Friends and community members pitched in as often as possible. They’d help with doing laundry, caring for Michaela, bringing the family food and even setting up a schedule to keep Alexis company during her chemotherapy sessions. They also took turns staying on call when Alexis needed emotional support.
By the time Michaela entered kindergarten in fall 2007, Alexis was in the last few months of treatment. On Dec. 1, 2007, she and Ilene held a party to thank friends and the community for their support.
“There was a living room full of people who had gone through this with us and felt ownership of it,” Alexis says. “One of the blessings of this experience was noticing that people like to help you and want to help you.”