Breast cancer treatment frequently follows a straightforward pattern; the tumor is removed by a surgeon, and to minimize the risk of recurrence, patients are then given chemotherapy and/or radiation.
But what happens when cancer is discovered in a woman three months’ pregnant?
“It’s a little complicated. We need to reduce the risk of breast cancer recurrence without harming the developing fetus,” said University of Minnesota Cancer Care Medical Oncologist Douglas Yee, MD, who is also the director of the Masonic Cancer Center, University of Minnesota.
Radiation, some forms of chemotherapy and even the anesthesia used during breast cancer surgery can be dangerous for a fetus. On the other hand, waiting months to start treatment may increase medical risks for an expecting mother.
Fortunately, medicine has advanced by leaps and bounds, Yee said.
“Women facing cancer during pregnancy have a much greater chance of complete recovery—with no impact on their unborn child—than they did only a few years ago,” Yee said. And that’s especially fortunate because the problem is growing. Breast cancer is now discovered in about one out of every 3,000 pregnant women. As more women choose to have children later in life, doctors expect that ratio will continue to rise.
Oncologists now understand that two of the medicines used in chemotherapy—Adriamycin (doxorubicin) and Cytoxan (cyclophosphamide)—appear to have no effect on the rate of birth defects or miscarriage when used in the second or third trimester, Yee said. Thus, doctors can use those medicines to “buy a little time,” by stopping the tumor’s spread while the mother is pregnant. By spacing out her chemotherapy treatments, they can also postpone the date of surgery until the baby is born.
Sometimes, the postponement produces an even better outcome, Yee said.
“Occasionally, when chemotherapy is given before surgery, the surgeon finds absolutely no evidence of a tumor anymore in the removed breast tissue. The chemotherapy has eliminated it completely. There are a number of clinical trials going on now based around the idea that we can get more of these complete pathologic responses from chemotherapy alone,” Yee said.
Chemotherapy given before surgery allows many women to have a lumpectomy instead of a mastectomy, Yee said. In addition, there are now a range of medical options for controlling nausea and the other infamous side effects of chemotherapy.
Yee and the oncology team also work very closely with our Maternal-Fetal Medicine Center specialists to ensure the best possible care of both the pregnant woman and her developing fetus, according to Maternal-Fetal Medicine Physician Jessica Nyholm, MD.
When a pregnant patient is diagnosed with cancer, she is referred to the Maternal-Fetal Medicine Clinic and meets with care providers who will discuss the potential risks associated with cancer treatment on the pregnancy and developing fetus. Together, the patient and care team will develop a care plan for the pregnancy to ensure the best possible outcomes for both the mother and her unborn baby, Nyholm said.
“We follow pregnant women with cancer in our clinic and work closely with the oncology providers throughout the pregnancy and together determine the optimal timing of delivery for both the mother and her baby,” Nyholm said.
Yee take pains to point out that the disease treatment is still no walk in the park. Among other things, many new mothers receiving radiation or chemotherapy are incapable of breast feeding, Yee said. Still, Yee emphasized that women have much better treatment options now than they did decades ago—and outcomes continue to improve.