As a patient navigator, I met with young women who had just found out they had breast cancer. Some were pregnant and wanted to know if they could carry their babies to term if they had treatment while pregnant. Would the breast cancer hurt their babies?
Some of those who had a baby within the past year were angry that their doctors minimized their concerns over a breast lump, explaining it away by telling them they were too young for breast cancer. And now their cancers were advanced.
There were also women, still in their childbearing years, who wondered if they could become pregnant once treatment was over. Was it safe to get pregnant after breast cancer? Could doing so increase the chances of recurrence? Would chemo and /or radiation make them sterile? Would they need to harvest their eggs before beginning treatment? Could they afford such a procedure?
I would come away from these visits amazed by the courage and determination of these women. I couldn’t help but wonder how many women in the US face these same scenarios .
The National Cancer Institute ( NCI), www.cancer.gov, was an excellent resource as was the BreastCancer.org www.breastcancer.org, article on research data presented at the European Breast Cancer Symposium in 2010 in preparing this post.
According to NCI, Breast cancer is the most common cancer in pregnant and postpartum women, occurring in about 1 in 3,000 pregnant women.
Since the breasts of pregnant and lactating women are often tender and engorged it may be hard to detect masses. Delays in diagnoses are common, with an average reported delay of 5 to 15 months from the onset of symptoms. Because of this delay, cancers are typically detected at a later stage than in the non-pregnant population.
To err on the side of caution, pregnant and lactating women need to practice self-examination and undergo a breast examination as part of the routine prenatal examination by a doctor. If anything questionable is found, ultrasound and mammography may be used. With proper shielding, mammography poses little risk of radiation exposure to the fetus. Diagnosis may be safely accomplished with a fine-needle aspiration, core biopsy, or surgical biopsy under local anesthesia.
Surgery is recommended as the primary treatment of breast cancer in pregnant women. Since radiation in therapeutic doses may expose the fetus to potentially harmful scatter radiation, modified radical mastectomy is the treatment of choice.
Chemotherapy should not be given during the first trimester. Chemo given after the first trimester is generally not associated with a high risk of fetal malformation but may be associated with premature labor and fetal wastage. If considered necessary, chemotherapy may be given after the first trimester. Data on the immediate and long-term effects of chemotherapy on the fetus are limited.
Studies using adjuvant hormonal therapy alone or in combination with chemotherapy for breast cancer in pregnant women are also limited. No conclusion has been reached regarding these options. Radiation therapy, if indicated, should be withheld until after delivery since it may be harmful to the fetus at any stage of development.
Termination of pregnancy has not been shown to have any beneficial effect on breast cancer outcome and is not usually considered as a therapeutic option.
In the United States, there are about 400,000 breast cancer survivors younger than 45 years of age. Many of these women might want to have children. According to research data released at the 2010 European Breast Cancer Symposium (EBCC) Pregnancy Is Not a Hazard to Breast Cancer Survivors.
According to the American Cancer Society, there is a link between estrogen levels and the growth of breast cancer cells. Because of this, many doctors advise their patients to wait at least two years after completing treatment before trying to get pregnant. This gives doctors a chance to find any early signs of a recurrence. Women who are currently undergoing hormone therapy are also advised to talk to their doctors before becoming pregnant as some hormones could affect the growing baby.
If a woman is planning on having children after her cancer treatment, she needs to make this known to her physicians before beginning treatment. Her treatment team can then bring in a fertility expert for a consult and to be a part of ongoing care.
The American Cancer Society,www.cancer.org, Fertile Hope,www.fertilehope.org, BreastCancer.org,www,breastcancer.org, are all excellent resources for women thinking about pregnancy after breast cancer.