Up Close with Dr. Alejandra Perez: ‘Every day I go home with a great feeling of accomplishment’
Alejandra Perez, M.D., joined Sylvester Comprehensive Cancer Center earlier this year as Medical Director of the Broward Breast Oncology Group. She is triple board-certified in internal medicine, hematology and oncology and has published more than 20 scientific papers and abstracts on breast cancer. Perez leads a multidisciplinary team of breast cancer experts at Sylvester at Plantation with the goal of continuing to grow the breast cancer program in Broward County. By addressing each aspect of breast cancer care, including clinical trials, precision treatments, breast cancer plastic and reconstruction surgical services, she and her team strive to address the physical, emotional, spiritual and nutritional needs of breast cancer patients.
What do you think are promising developments in the breast cancer treatment and research areas?
The next generation of promising advances are in precision medicine, looking at the genome of the patient and their tumors. The factors we used historically to determine treatment, for example tumor size and nodal involvement, are considered, but the actionable mutations found will drive the treatment choices. The technical advances in the laboratory that map the genome now can deliver the answers in days, and if there is a drug in place that can target the specific mutation, the patient has a good chance that the disease can be managed. Another area of research that is evolving is reengineering the immune system to make it work against cancer. The concept is inviting to patients who have always longed for an approach other than a cytotoxic therapy. Understanding the immune system and extrapolating select types of cells that could be redirected or enriched to identify the cellular discord are areas of interest to the bench scientist, the oncologist and the patients.
What makes Sylvester unique?
Sylvester is one of the few institutions that offer the full spectrum of services for those with cancer. From the scientific think tank located at the downtown campus to the bench-to-bedside approach with their cadre of esteemed researchers, we unfold the exciting medical approaches of tomorrow. No longer applying broad-based approaches to cancer, Sylvester doctors are entering a new world where we can direct the therapy to the area of dysfunction or invasion. The patients are savvy, they follow the science and expect us to have not only access but a good knowledge of the mechanism of action of a new molecule or technology. This work serves the entire community even if they never enter the Sylvester doors. Sylvester’s intellectual property is shared openly through clinical trials, so that all can gain access. Within that same institution, Sylvester has migrated from downtown to the community setting where 80 percent of cancer patients are treated, in close proximity to their loved ones and households. The satellite centers in Plantation, Deerfield Beach, Kendall, Coral Springs and Hollywood deliver the best that medicine has to offer, yet the care is delivered in beautiful surroundings, nestled into the communities, staffed with board-certified oncologists, and every amenity a cancer patient could need, including onsite psychologists, exercise physiologists, nutritional counseling, physical therapy and even integrative services like acupuncture.
How did you end up being a breast cancer doctor?
Throughout my training, I was always taken back by the magnitude of the disease, which affects one in eight women. Seeing the impact of the disease not only on the patient but on her family as well was something that drew me in. Witnessing how the disease has changed from one primarily occurring in older women into a disease that also affects younger people has alarmed and motivated me. I began to imagine how challenging and rewarding it would be to spend my life working to find a cure. And, even more important, how to get a woman through the disease with all we have to offer in terms of treatment and research. How to help her find her new self after the treatment is complete. Breast cancer treatment can rob a woman of everything she holds dear – her body image, her resolve, her work, her loving relationships. I work each day to restore what the disease has taken and to remind each woman of her value, contribution, beauty and strength, and to give her what she needs to feel whole again.
What part of your job do you find challenging?
Breast medical oncology is fascinating and every case is challenging. When you think about how each individual is unique, with rare carbon copies, breast cancer is the same. No two cases are alike. The measure of a good breast cancer program involves many disciplines to ensure the patients have access to the skillset of the entire team. Medical oncology is just one component but we are also the gatekeeper, empowered to assemble the recommendations of the breast and reconstruction surgeon, breast radiologist, the pathologist, radiation oncologist, geneticist, fertility expert, etc., to determine the best approach. The drugs to combine, the sequencing of the therapies, the extent of the surgeries, the influence of the genetic profile all fall to medical oncology to sort and deliver. After the medical decisions are made, we begin to unravel the details of the person who is afflicted with the diagnosis, which of course is an art form. We consider the culture from which they come, their belief systems, we work to gain their trust and educate them at the level they can best understand. We must consider their work and family obligations, not to mention the fiscal impact of the disease and treatment. Appreciating the role they play in the family unit and the degree of emotional support they derive from their environment helps ascertain how we can best support the family. The aftermath of the diagnosis and interventions are the challenges; how do you learn to love your new self, how can you demonstrate your feelings to others when you don’t understand them yourself? Where do you find the strength and motivation to rejoin the workforce, where do you go to find the person you were before the breast cancer? The job is daunting, the challenges immense, the opportunity is precious. There is no greater job than to save a life, to return a mom to her children, to tell a loving husband that his wife is going to be okay. Challenging yes, but also a privilege.
What motivates you?
It’s hard to believe but I can’t wait to get to work each day. I love what I do, who I work with, and what we as a team stand for. I was raised to believe that it is a privilege to work and I still follow that principle. The days are long, the work pulls at every heartstring but on my way home I am happy to have given my best and, hopefully, have given my patients what they need. I have a real love for the interpersonal relationships I form with my patients and their families, hoping to fix their world that has fallen apart, while bringing them back to health with a new appreciation for each day and an opportunity to share it with those they hold dear.
Can you give an example of when you drove home at night and thought “this was a great day”?
Every life saved is a triumph and every consoled and cared-for patient is a step in the right direction. When you get invited to your patient’s daughter’s graduation with a special note thanking you for making it possible for mom to be there, you know you had a great day. When you get a card from your patient on her birthday thanking you for another year, you know you had a great day. When you get a surprise visit from your patient to show you her beautiful baby, delivered after getting through chemotherapy, you know you had a good day. Every day I go home with a great feeling of accomplishment. I know I have done something good for someone in need.