At first, Mikaela Rix was not worried about the tiny lump in her breast. It felt like a frozen pea, and she assumed it was a benign cyst. A former Boston College lacrosse player, 26-year-old Mikaela assumed she was in perfect health. She became uneasy when the radiologist looked at the ultrasound and recommended a biopsy.
Over the next three days that May of 2019, Mikaela says she barely slept or ate — just stared at her phone awaiting the results. On the fourth day, the fears were confirmed: She had invasive ductal carcinoma, the most common form of breast cancer.
The diagnosis blindsided Mikaela. Suddenly she had to confront a bewildering array of medical decisions — not just about her cancer, but about her quality of life going forward.
Mikaela sprang into action. “I called my family to let them know the news,” she says. “After I hung up, I immediately reached out to Memorial Sloan Kettering to see how soon I could get in to see a surgeon.”
Mikaela was already familiar with MSK’s expertise. The previous year, she had helped her sister Marguerite get a second opinion at MSK when she developed ovarian cancer. Two weeks after Mikaela’s diagnosis, she was meeting with MSK surgeon Mary Gemignani to learn about her treatment options.
“It was definitely a strange time of life to be going through this,” Mikaela says. “You are in this no-man’s-land where you’re too old to be a kid, but you’re just figuring out how to be an adult and start ‘real’ life and your career.”
When Breast Cancer Strikes Before Age 45
Memorial Sloan Kettering Cancer Center’s program for young women with breast cancer is tailored specifically for people like Mikaela, who are forced to deal with a potentially lethal disease at an early age. The program, which focuses on women 45 and younger, guides patients through treatment while helping them manage their physical and emotional needs. In particular, it helps patients deal with the impact of breast cancer therapies on sexual health and fertility issues.
“Young women with breast cancer face unique challenges,” says Dr. Gemignani, who co-founded the program with MSK medical oncologist Shari Goldfarb. “We’ve treated so many young women and understand they need special services to help them get through treatment so they can recover and resume their lives.”
“I had a great connection with Dr. Gemignani during our first meeting,” Mikaela says. “She took the time to sit with me and my mom, dad, and boyfriend, and told us what tests I needed — mammograms, MRIs, biopsies, tests for tumor markers and genetic mutations — [so that I could] make an informed decision.”
The Team Approach to Treatment
The first decision Dr. Gemignani walked Mikaela through was what type of surgery she should have. Mikaela could have a lumpectomy followed by radiation, or she could undergo a single — or even a double — mastectomy. A lumpectomy is less invasive, involving removal of the tumor along with a rim of normal tissue surrounding it. A mastectomy removes the entire breast. Fortunately, the tumor was limited to one location and did not appear to have spread to the lymph nodes.
Still, like many patients, Mikaela wondered if having a more radical procedure would be more effective at stopping the cancer. But research has shown that lumpectomy is just as effective as mastectomy for most women with breast cancer like Mikaela’s.
“Because we have researched and treated so many women with breast cancer, we have the expertise to know when they don’t need radical surgery,” Dr. Gemignani says. Mikaela’s team of breast cancer experts confirmed her treatment plan. Dr. Gemignani removed Mikaela’s tumor in a one-hour operation at MSK’s Josie Robertson Surgery Center in Manhattan, doing a lumpectomy and a sentinel lymph node biopsy to ensure the cancer cells had not spread to the lymph nodes.
“It’s a beautiful, state-of-the art facility, very warm and welcoming like a hotel,” Mikaela says. “Dr. Gemignani did an amazing job. I have only one incision under my arm, so no scars on my breast. The recovery was very manageable in comparison to knee surgery I had in 2015. I was able to walk out of the hospital the same day.”
Mikaela had another major concern. In light of her younger sister’s ovarian cancer diagnosis the previous year, Mikaela and her doctors wondered if this family history meant she had inherited a mutation in one of the BRCA genes, which raises the risk of cancer returning. Fortunately, MSK genetic testing showed she did not have a BRCA mutation.
MSK sent Mikaela’s tumor to a laboratory for Oncotype DX testing, which analyzes genes in the tumor to determine the likelihood the cancer may return after surgery. Results from the Oncotype DX test, as well as tumor markers found, suggested Mikaela should have chemotherapy to reduce the risk of the cancer coming back. She met with Dr. Goldfarb, and again felt a close bond.
“She was very warm and made me feel comfortable with what I was about to go through,” Mikaela recalls. “She spent more than an hour sitting with me and my family answering questions and introducing me to her team.”
More Than Medicine: Treating the Whole Person
Dr. Goldfarb told Mikaela that the chemotherapy could affect her fertility. She recommended that Mikaela speak with an expert in MSK’s Cancer and Fertility Program, which considers patients’ medical and financial needs and suggests fertility doctors in the area who are experienced in helping people with cancer. Mikaela was able to undergo fertility treatments to freeze her eggs without jeopardizing her cancer therapy.
Under Dr. Goldfarb’s care, Mikaela started chemotherapy, receiving eight infusions over several months at the Evelyn Lauder Breast Center. After chemotherapy, she received radiation therapy from radiation oncologist Oren Cahlon to further reduce the risk of cancer returning.
Throughout her medical treatment, Mikaela also received psychological counseling from Wendy Lichtenthal, who specializes in helping breast cancer patients. “She was amazing,” Mikaela says. “It was very beneficial to have a third party to talk to about what I was going through and give another perspective apart from my family and friends who were intimately involved.”
Today, a year and a half after her final treatment, Mikaela is disease-free and is as active as ever. She is back at work as a trader at Morgan Stanley and is still involved in lacrosse, playing for the New York Athletic Club and coaching two youth teams, Tradition Lacrosse on Long Island and Ireland Lacrosse.
Giving Back and Lifting Up
Mikaela says her athlete mentality helped her deal with the disease and its aftermath. In light of everything they have been through together, Mikaela, Marguerite, and their youngest sister, Morgayne, started their own nonprofit, We Fight Like Girls (since renamed For All Who Fight) to raise money and awareness for breast cancer and ovarian cancer research. In the past year alone, they raised $70,000. In addition, in November a team of ten women from the organization will run the TCS New York City Marathon on behalf of Fred’s Team to raise money for MSK’s Young Women with Breast Cancer program. We Fight Like Girls will hold its Second Annual WFLG Walk in Long Beach, New York on October 16.
Mikaela wants to give back — and lift up — young women who’ve been diagnosed with breast cancer.
“For what was a not-so-great diagnosis to have in your 20s, I was very fortunate have the opportunity to be treated at MSK. I was able to take advantage of the incredible doctors and have access to many other resources MSK has to offer — counseling, social work, and fertility guidance,” Mikaela says. “There are so many treatments and cures that can help you to live a long, cancer-free life. It can be a long and arduous process, but you have to try to stay positive and stay the course.”
MSK’s Young Women with Breast Cancer Program has received generous support from the Manhasset Women’s Coalition Against Breast Cancer.