Alexandra (Ali) Butler was living in Wisconsin when her husband gave her a hug and felt a lump in her armpit. Fortunately, the breast cancer was caught early. In 2021, the 34-year-old mom with three young girls had a double mastectomy and completed several rounds of chemotherapy. After treatment, the Butlers moved to Raleigh to be closer to her siblings. Then she discovered another lump. New to North Carolina, Butler went online and found the Duke Women’s Cancer Center Raleigh. “I trusted Duke,” she said. “This is where I need to be.”
Forging a Connection with Medical Oncologist
A week after her 36th birthday in October 2023, Butler felt a golf ball-sized lump in her armpit while shaving. “It was so big,” she remembered thinking. “How did I miss this?”
Having had a male oncologist in Wisconsin, Butler searched the internet for a local female oncologist with good reviews. She found Rani Bansal, MD, a breast cancer specialist who saw patients at the Duke Women’s Cancer Center Raleigh at that time. “That’s where I wanted to go,” she said.
Right away, Butler felt a connection with Dr. Bansal. “She’s my age. I knew she felt for me that I had to go through this all again. I felt that she wanted to get me healthy because I had life to live.”
Butler also liked that Dr. Bansal paid close attention to her symptoms. “I have juvenile rheumatoid arthritis,” Butler said, which made her cancer treatment more complex. “She was very attentive to how I was feeling right from the start. She talked to me like I’m a real person.”
More Aggressive Breast Cancer the Second Time
Testing confirmed Butler didn’t have genetic mutations that would predispose her family to cancer. And this time, the type of cancer Butler had was different. The first time, it was stage 1, estrogen receptor positive, HER2 negative, which is very treatable. The second time it was triple-negative, a more aggressive type of cancer.
Having two types of breast cancer occurs in less than 15% of cases, said Dr. Bansal. “We don’t know why breast cancer comes back in some patients and not others. But we do know that breast cancer tends to be more aggressive in our younger patients, and we know that it can present with a higher grade of disease and higher stage, meaning lymph node involvement.”
Because her cancer was aggressive, Butler was given an aggressive treatment regimen. She had 16 rounds of chemotherapy, radiation therapy, and surgery. The treatment wreaked havoc with her arthritis, causing crippling joint pain, and she experienced a severe allergic reaction. But the nurses and Dr. Bansal were right there for her.
So were Duke’s rheumatologists, who helped Dr. Bansal manage Butler’s care during her treatment. “One of the side effects of immunotherapy is inflammatory arthritis, which worsened significantly,” said Dr. Bansal. “They worked closely with us to make sure she received the right treatment for her arthritis.”
Cancer Diagnosis Made Life Sweeter
Today, Butler is doing great. She’s on preventive medication for the next five years; her hair is growing back, and she’s started working again. The joint pain has finally diminished, and she can go for runs again. While the radiation therapy damaged her implants, she’s since had one removed, and the scar tissue scraped out. “I’m still a little wonky, but everything is hopefully cancer-free. I’ll take that over symmetrical breasts,” she said.
Butler appreciates all the positive things that resulted from her experience. “When you are sick, you see such a good side of people. It was heartwarming to see how many people wanted to make your life better. Although it’s such a hard thing to go through--you get this cancer diagnosis and think life is over--it has made life sweeter. I appreciate so many more things that I took for granted beforehand. It shows you the best of humanity.”
