Baby And Breast Cancer: Now What?

On the same day that Amy Robach underwent a double mastectomy after being diagnosed with breast cancer on air, my friend Sara had a lumpectomy procedure for Stage 1 breast cancer. But unlike Robach, Sara had another factor that made the treatment plan much more complicated: she had discovered that she was pregnant the same week she learned that she had breast cancer. 

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How Often Are Women Diagnosed With Breast Cancer During Pregnancy?

Because age is a risk factor for some types of breast cancer, and because women are biologically limited to pregnancy before menopause, few women receive a diagnosis of breast cancer while they are pregnant. The American Cancer Society reports that, in every 3,000 pregnant women, 1 case of breast cancer will be diagnosed1. This low incidence likely reflects the fact that young women at high-risk will have developed a plan for both pregnancy and cancer treatment (like harvesting eggs in advance) or will have already undergone treatment (like prophylactic mastectomy) prior to getting pregnant.  Additionally, women without a family history may simply attribute unusual masses in their breasts during pregnancy to the many changes that typically occur in a woman’s body and postpone an appointment with her doctor until after giving birth. Yet with an increasing number of women postponing motherhood, physicians are anticipating that this situation may become more common, albeit remaining relatively rare.

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Breast Cancer Treatment During Pregnancy

Breast cancer treatment for a pregnant woman will depend on the size and location of the tumor, whether the cancer has disseminated into other areas of the body, the stage of the pregnancy, and the woman’s preferences. With these factors considered, your doctor may advise anything from standard treatments to delaying treatment for non-aggressive cancers until after the birth or terminating the pregnancy, particularly if urgent, aggressive treatment is needed to save your life.

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Surgical removal of part or all of the breast may be an option for a pregnant woman if the fetus would not be harmed by the anesthesia.  Breast-conserving surgery (BCS) may be discouraged for women in the first, second, or early part of the third trimester because BCS is followed by radiation treatment.  Women who are close to delivering may be considered for BCS because the radiation treatment could be delayed until after birth.

Chemotherapy is usually only considered during the second trimester. During the first trimester, it may increase miscarriage risk and compromise the fetus’s organ development. If given during the third trimester, the mother’s blood count may decrease thereby increasing bleeding and infection risk. In some cases, the obstetrician may be asked to induce the birth early to allow the mother to get treatment sooner.

Radiation, hormone therapy, and targeted therapy are typically avoided during pregnancy because of the possibility of harming the fetus. For example, hormone-therapy drugs like Tamoxifen, letrozole, exemestane, and anastrozole are not considered safe, potentially increasing the risk of birth defects. Targeted-therapy medications are similarly dangerous for the developing baby.

Don’t Be Afraid To Ask

It is important to press your doctor about any recommendations that make you feel uncomfortable.  “All of my doctors kept telling me to abort, but I just didn’t want to do that,” Sara told me. “[Another friend] asked her doctors and they admitted that, at least in my situation, it would be possible to ‘work around’ the pregnancy—to find other ways to treat the cancer. I can see how it would be so much more difficult to deal with from a medical perspective, but we really wanted this baby. Don’t feel bad asking the same question more than once until you are satisfied that it’s the only way.”

1American Cancer Society. Pregnancy and Breast Cancer.