Breast Cancer: What Happens If You're Pregnant?
A diagnosis of breast cancer is always traumatic for a woman, but even more so if it coincides with a pregnancy. Fortunately, the combination is relatively rare, occurring in approximately three out of every 10,000 pregnancies.
Regardless of whether or not she is pregnant, the decision about which is the most appropriate treatment option is a personal one. Pregnant women have the same treatment issues as any other woman facing breast cancer, but the fact that they are pregnant may affect their choice of therapy.
For a large number of patients, the traditional mastectomy has been replaced with the more breast conserving lumpectomy, plus chemotherapy and radiation, when appropriate. While some literature has stated that a mastectomy should still be the treatment of choice for a pregnant woman because of the contraindications of radiation, Steven Edge, MD, chief of the breast surgery department at Roswell Park Cancer Institute in Buffalo, New York, disagrees.
"This has been shown not to be true because radiation therapy is generally delayed after surgery, until chemotherapy is completed," he says. "In general, chemotherapy is administered first, and the radiation is not given until chemo is done. A typical breast cancer patient is not given radiation until four to six months after surgery." By this time, he points out, most women will have delivered their baby and can then safely receive radiation therapy.
Chemotherapy does carry a risk to the fetus during the first trimester, and if needed after surgery, it is an issue that a woman needs to discuss with her doctor. "Once a woman is out of (her) first trimester and well into their second trimester, chemotherapy can be administered which is effective and safe for both mother and fetus," says Edge. "The majority of women with breast cancer during pregnancy can have appropriate therapy".
Terminating a pregnancy does not seem to have any effect on the outcome of the breast cancer, but the decision to continue the pregnancy or not, may depend on other factors. If the fetus is in the very early stages of development and the cancer is advanced, for example, treatment options will be severely limited. Overall, it is a very personal decision, based upon circumstances and individual belief systems.
The survival of pregnant women with breast cancer may be worse than in nonpregnant women at all stages, but this may be due to difficulty or a delay in diagnosis. "Generally, if you look at it stage to stage, pregnant women tend to do as well as anyone else," says Edge. "However, if you look at women who are pregnant, their cancers do tend to be a little bit larger. This is due to a number of reasons. Cancer is harder to detect in younger women to begin with, and women who are pregnant are also usually not in the age range where they are getting mammograms regularly. Pregnancy itself, may make it harder to detect as well".
For the majority of breast cancer survivors, having a baby will not affect survival or have an adverse effect on the fetus. Some doctors recommend that a woman should wait a few years before trying to get pregnant, so that a recurrence may be more easily detected - and this may affect a couple's decision about parenthood.
"There is a large body of evidence which says that pregnancy subsequent to breast cancer does not increase the risk," says Edge. "But everyone who has cancer must understand that there is a chance that their cancer will recur, but it's a personal decision they have to make on their own. However, they can make that decision confident that they are not altering their risk".
Edge does warn that a woman should not get pregnant while receiving therapy, such as chemotherapy or radiation, because of the adverse effects on the growing fetus. "A woman should not assume that chemotherapy or radiation is making them temporarily infertile and they should use appropriate contraception while receiving therapy."
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