Vital Signs

I Know That’s Cancer

Episode Summary

Dr. Deborah Axelrod spent her career treating women for breast cancer. Then, she found a lump in her own breast. Hear how this experience did - and didn’t - change her as a physician.

Episode Transcription

Season 1 Episode 4 - I Know That’s Cancer

Featured: Dr. Deborah Axelrod, MD

Narration: Maggi van Dorn

Dr. Deborah Axelrod: So in 2001, it was March, I think. I went to get a massage. After the massage I took a shower and I felt a little lump in my breast. And I went and I got a sonogram and I looked at the sonogram and I knew what it was. And I called my husband and I said: It's cancer. I'm looking at the scan. I know that's cancer. My name is Deborah Axelrod and I am a breast surgeon. I'm also the Director of Community Education and Outreach and Clinical Breast Services and Programs at NYU Langone. And I've been at NYU Langone for about 16 years. My primary role is to treat women who have breast cancer.


Maggi van Dorn: Dr. Axelrod is just one of the estimated 3.1 million women in the U.S. who have had breast cancer. But she's one of the very few who's devoted her entire career to helping patients overcome the disease. So how has this changed her as a doctor?


DA: You know, you'd think I would be real softy with patients having had breast cancer, but I think it gave me, maybe a little bit different view of what it was like. 


MVD: And what can she tell us about a cure? 


DA: I think it's just a matter of time before we find a cure for breast cancer. And in the meanwhile, people are living a lot longer. 


MVD: From SiriusXM and NYU Langone Health, This is Vital Signs, where medicine is made personal. I'm your host, Maggi van Dorn.


DA: You know, I never wanted to be a doctor. When I was in college, I was a chemistry major, but I was also a film minor. I liked to go to the movies and that was a fantastic respite for me being a science major.

MVD: At first, Dr Axelrod thought she wanted to be a scientist, but while working in the lab, she saw the impact her research had on people's lives.

DA: It had to do with working with patients and I liked that we were trying to answer a question that ultimately would benefit people. And ultimately it helped me transition from wanting to be a scientist to wanting to be a clinician.


MVD: From there, she decided to attend medical school at Tel Aviv University, a program that was recognized by New York state, but that would allow her to learn with people from all over the world.


DA: I worked on the West Bank, I worked with Israeli soldiers, Georgians, and I remember working with Arabs. I worked with Russians and people from all sorts of places that you can only communicate with your hands. I was a very eager student. I would be the first one in, you know, wanting to be part of the surgery and the last one out. That's what I tell everyone, you know, be eager. Be motivated. And show people that you want to give them a hand.


MVD: After medical school, Dr. Axelrod returned to the States. To the world-renowned Cleveland Clinic where she specialized in breast disease.


DA: And at that time at the Cleveland Clinic, they were doing a lot of partial mastectomies or lumpectomies where you didn't have to remove the whole breast. We would remove the tumor with some normal surrounding tissue and radiate, versus mastectomy where you'd remove the entire breast.


MVD: This was revolutionary. Because as Dr. Axelrod says, the default solution had been a total mastectomy plus radiation. But the surgeons she studied under were developing procedures that were far less invasive. As a result, breast cancer patients now had greater options, but those options raise new questions.


DA: I mean that's really the quintessential question that people like to ask when they're diagnosed with breast cancer. You know, if I have a lumpectomy, meaning if I save my breasts and just have a lump out versus a mastectomy, will I do any worse? These people that are coming are scared, they're frightened, they don't know what to expect. They want someone to reassure them. And most of the time, you know, most people survive their breast cancer, they don't die of of their breast cancer. And so I think reassurance is, is really important for a patient.


DA: So in 2001, it was March, I think. I was out in Park City with my husband and a few friends. They all went skiing. I went to get a massage. But I went and I got something called Rolfing, which is a really deep fascial massage. And I left after the massage, and I went back and I took a shower, and I put my finger where I felt most of the massage was very vigorous and I felt a little lump in my breast. And when I got back to work, I, you know, had my colleague do a needle, a fine needle aspiration. And they said, you know, this looks benign, but you know, there's a lot of calcium. And I had just had my mammogram, uh, a few months ago. So I said, you know, let's just look at it a little bit more. And she agreed. And I went and I had a core biopsy, a thicker biopsy, because this was really not specific.


DA: You can't tell on a clinical exam always what something is. So I went for further testing and I went and I got a sonogram, and then they did a biopsy on the spot and I looked at the sonogram and I knew what it was. And I called my husband and I said, you know, Noel, it's cancer. I mean, they didn't even send the cells yet. It wasn’t even, I said, this is cancer. And he said no it's not. You're just, that's in your head. I said, it's not in my head. I'm looking at the scan. I know that's cancer.

MVD: It was then that Dr. Axelrod had to make the same decision that had confronted each of her patients.


DA: The knee jerk reaction is, take my breasts off, take them off. You know, I don't, I don't need my breasts. 

MVD: But after her initial reaction, Dr. Axelrod began to think like a breast surgeon. 

DA: I actually talked to my boss at the time, who's the chair of surgery, who said, well, what would you tell a patient? And I thought about it and I said, well, I mean, if I were my patient, I would say a lumpectomy should be just as good, should produce the same kind of results. I didn't have any real family history of anything that would be significant to think that I would have an inherited mutation that would have really propelled me to want to take my breasts off. So I ultimately decided, you know, that I would have a lumpectomy.


MVD: The decision to choose one surgery over another was only the start of managing her cancer diagnosis. What came next was learning how to live with the news.


DA: When I was first diagnosed, I mean there were a million things that went through my head. I really felt like I needed an operator's manual. I felt like my body had failed me. It really didn't. But I really felt like it had failed me. I had always been very good about talking to people about how to talk to their kids, well, how am I going to talk to my own kids? I always felt, because I, I had a woman who I really respected who said to me, well, I told my kid when he was very, very busy and he was engaged in something that he liked. I told him that I had breast cancer and he looked up and said, are you going to be okay? And I said, yep. And he put his head back down and I said, well, you know, I really like that because you know, a nine and eleven year old, they want to know that their mother's going to be okay, that their room is not going to change and that their friends are going to stay the same. So I tried to do the same thing. And I remember they were cannonballing into the pool and I, you know, when they got out of the pool, I said, listen guys, I just want to tell you something. And I told him that I had breast cancer.


DA: I thought that they were having fun in the pool and that they wouldn't continue to ask me anything. And instead they, oh, they really let me have it. You know, what are you going to do? What kind of surgery are you going to do? I said, well, I don't know. And my son said, well, you can't take your breasts because then you're not going to be my mommy anymore. I’m  like, no, that's not true. And you know that's not true.


DA: The interesting thing, which I still do, and I still use this as a coping mechanism, and I tell patients this: You can only think about your disease several times a day. In the beginning you could think about it quite frequently. But towards the end where you've been out of treatment, you really should be thinking about it less and less. I tell people, because this is what I followed. You know the Escher like the crazy diagrams of Escher? So I said, think of yourself, of your body, as like an Escher piece of art and you have a little room somewhere. You have to pick out that room and you have a key. You have to hide the key. You can only visit that room a few times a day. Maybe more so when you're first diagnosed. I always like to have the room in my brain like in my head, and I always put the key in my big toe, Cause I felt like if I wanted to think about it, I really have to journey up there. I would go down, I would get the key and go all the way up. You know, I would imagine, you know, traveling through my body, I would go up to my brain, my head, I would unlock the room. And then I would open the room, I would go in and I would close it.


DA: Lots of times I would just cry. And I would visit the room several times a day and then I couldn't visit it because I was a mom of young kids and I couldn't be distracted. So I would lock the room and then I would go do whatever I had to do. And I found myself visiting the room less and less and less. I think that's a very good mechanism of coping that really worked because otherwise it can be all-consuming. You cannot let that happen. If you become so paralyzed by that, you'll never move forward.


MVD: This strategy not only helped her manage her emotional life, it also enabled her to continue her work.


DA: I had the surgery, ultimately I had a lumpectomy and one of those lymph node biopsies and I had radiation. I worked through my radiation. So I would see patients and then go and get radiated. It was like totally weird, but it was fine, and it worked for me. I also had chemotherapy before the radiation and that was also, you know, you have to take off a day or so. But I really tried to push myself because I felt when I was working it was good cause I can concentrate on work and then when I was home I could be with the kids. And I really, again, tried to have these boundaries.


MVD: So how does this experience change her as a person and as a doctor?


DA: You know, you'd think I would be real softy with patients having had breast cancer. But I think it gave me maybe a little bit different view of what it was like. I think I got a little tougher because I wanted to put things in perspective. Instead of saying, let me tell you that you are going to be fine, I had to give them a little bit more tough love. I can say to someone, you're going to be 100% fine. You know people like to ask that question, can you promise that I'm going to be okay. Frankly, the only way that you know you're going to be okay after breast cancer if you die of something else. But you know, if you look at the statistics, far more people get breast cancer than die of breast cancer and why would you be any special person that you would succumb to the disease. 


MVD: At NYU Langone’s Perlmutter Cancer Center, every cancer is treated differently. This is called personalized medicine because treatment is based on the unique genetics of each person and their disease.


DA: We're able to look at the signature of the tumor - to the genes and the proteins. You know, all that juicy stuff in a tumor is very good to look at because it can help predict how that person's going to behave. So I've been using those tests routinely since 2003 in particular instances, not everyone. But it can help decide whether or not chemotherapy is going to be beneficial or maybe what you thought chemotherapy would be beneficial, where it won't, where it won't help, we shouldn't offer it. Where maybe just anti-hormonal therapy would be indicated. You know, when I started my practice it was in ‘88, and in ‘88 everyone with over a one centimeter cancer had chemotherapy. Obviously we are so far along with being able to understand the different type of breast cancers. There are many, many different types of breast cancer and so that's where we're headed.

DA: I think it's just a matter of time before we find a cure for breast cancer. And in the meanwhile people are living a lot longer. We have so many survivors, and with that, that's like, I think our new challenge also is to figure out how people who have aged with cancer can live full, healthy lives. It's not like you got breast cancer and you're not around anymore. So they survive, but they got, you know, brittle bones, they got coronary disease. They were obese. They went into menopause, they couldn't have babies. Nobody ever talked to them about fertility, so at least now we are focusing on survivorship.


MVD: And just as personalized medicine helps her treat patients, Dr. Axlerod also sees it as paving the way for a cure.


DA: I think that we are going to find a cure for breast cancer because I think the cure will come from the laboratory. It's going to come from understanding the different signatures of breast cancer. It's going to come from the investigators that are working on looking at the different types of proteins. We are understanding so much more on a molecular level, a cellular level, and that's what personalized medicine is all about. I think the cure is out there, and I think that it's only a matter of a short period of time before we understand that.


MVD: It feels daunting to speak about a cure for any kind of cancer. But when it comes to breast cancer, we're getting close. And it's not just one cure, it's many. Dr. Axelrod is on the forefront of this battle, customizing treatment to each individual patient. And not only is she keeping them alive, she's helping them achieve greater quality of life long after breast cancer. Along the way, her patients have helped her, too. And together with her friends, family, and colleagues, they've made Dr. Axelrod who she is today.


DA: I feel I'm just about the luckiest person in the world. I'm really lucky. I'm lucky with my kids. I'm lucky with my husband. I'm lucky with my relationships. I'm very lucky with my patients. I have very good relationships with, I would say 99% of my patients. I have had a practice for three decades. I've learned a lot, you know, from the patients a lot. A lot.


MVD: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Julie Kanfer, Rob Schulte and Keith King with sound design by Jim Bilodeau and writing from Julie Kanfer. SiriusXM’s executive producers are Beth Ameen and me, Maggie van Dorn in partnership with Allison Clair and Jim Mandler at NYU Langone Health. Don't miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone, tune in to Doctor Radio on SiriusXM channel 110 or listen any anytime on the SiriusXM app. For the Vital Signs podcast, I’m Maggie van Dorn. Join us next time as we bring you the stories of medicine made personal.