Breast Cancer During Pregnancy

Approximately 1 in every 3,000 pregnant women are diagnosed with gestational breast cancer or pregnancy-associated breast cancer during pregnancy, in the first postpartum year or any time during lactation.

While all cancers are daunting, gestational breast cancer is particularly ominous because there are two patients — the mother and her baby.

Doctors used to think that unless aggressive treatment began immediately, the mother wouldn’t survive to see her baby grow up. Fortunately, in recent years there have been tremendous advancements in treatment, which means the future for pregnant women and their babies is more optimistic than ever.

Richard Waldman, MD, an Ob-Gyn in Syracuse, New York and an Every Mother Counts’ Medical Advisory Board member says, “It’s a terrifying diagnosis, and it’s rare, but we think it’s becoming more common. Women are getting pregnant later in life and that’s when we see breast cancer risks going up.”

The National Cancer Institute says that while only 1 in 227 women age 30 will be diagnosed with breast cancer, incidences increase to 1 in 68 by 40 — an age when many women today are choosing to become pregnant.

Even though diagnosis rates among pregnant women are rising, treatment options are less dire than they used to be. Physicians used to delay cancer treatment until post-delivery to avoid inflicting fetal harm. A recent study published in the New England Journal of Medicine is putting those fears to rest.

Researchers indicate that prenatal exposure to cancer, with or without treatment, doesn’t impair the cognitive, cardiac or general development of children in early childhood. They do, however, tend to be born earlier and smaller than babies of mothers without cancer.

Waldman says, “Most people don’t realize that once the organs are formed in the first trimester, they’re formed. Most drugs taken after the first trimester won’t affect development. Chemo drugs do affect babies and do affect nutrition but it doesn’t affect them nearly the way we thought it did.”

Current treatment options for pregnant women may include surgery (biopsy, mastectomy or lumpectomy) during any phase of her pregnancy and, when it’s necessary, chemotherapy during her second and third trimesters. Radiation treatment is usually delayed until after delivery to prevent fetal exposure though the NEJM study mentioned above indicates that even radiation can be a safe option in some cases.

Waldman states, “Nobody wants to have or treat breast cancer during pregnancy. It’s an emotional nightmare but we’re in better shape than we used to be. We used to think we couldn’t treat the patient unless we aborted the pregnancy. Now we have many treatment options that don’t necessarily require termination. We also used to think that a woman’s prognosis was much worse because of her pregnancy, but the latest research says outcomes for women diagnosed during pregnancy are no worse than for non-pregnant women.”

Thankfully, death rates from breast cancer have been declining for decades, but for many women, the emotional impact is still the worst part of the cancer experience.

Waldman says, “I can’t imagine it, really. When you’re diagnosed with breast cancer, you think you’re going to die. It takes all the joy and dreams for the future out of a pregnancy and leaves it with tremendous fear… all kinds of fears. It takes a while to understand that most incidences of breast cancer are treatable and curable, as much as we can say what a cure is. Breast cancer is not the disease it used to be though it takes a while for most patients before they start to trust that they can live.”

What about breastfeeding? Some women can breastfeed following a breast cancer diagnosis, but many can’t. It depends on the extent of her cancer and treatment, how much breast tissue is damaged during surgery and radiation and whether or not she’s taking drugs that could pass through her breast milk or impact milk production.

For women facing breast cancer along with pregnancy and motherhood, it’s reassuring to know that many more women can now expect to survive and raise their babies.

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