Treating Breast Cancers in Pregnant Women
It is always important to catch breast cancers in their early stages but it is even more important to find them in their early stages in women who are expecting a baby. Stage I or Stage II breast cancers are usually treated with surgery, since chemotherapy or hormone therapy could cause difficulties for the baby. If surgery is performed in the first or second trimester, it will be a mastectomy because a lumpectomy requires radiation as a complementary therapy, and radiation will not be effective if it is delayed for too long. If the surgery is performed in the third trimester, a lumpectomy becomes an option since birth is near and radiation therapy can begin after a short time. Nearby lymph nodes may be removed during surgery as well, in case the cancer had begun to spread.
When breast cancers are caught early, they can be treated in much the same way regardless of whether or not a woman is pregnant. Lumpectomies and mastectomies are considered fairly safe during pregnancy, however anesthesia may be risky for the baby during certain stages of pregnancy, so timing can be important. It is not necessary for an expectant mother with early stage cancer to consider abortion, since this procedure will do nothing to increase her chances of survival.
If the cancer is not caught until Stage III or IV, the situation is much more complicated. Surgery is usually not enough to get all the cancer in these cases, so chemotherapy becomes a necessity if a treatment regime is going to have a chance of success. Doctors will hold off on chemotherapy until after the first trimester but even then the baby will be put at risk by exposure to these powerful chemicals. Surgery performed as soon as possible followed by immediate radiation therapy could also be helpful to pregnant women with advanced breast cancer; but this kind of treatment would necessitate an ending of the pregnancy.
Women in advanced stages of breast cancer have lower odds of survival in any case, and the choice to forego chemotherapy and radiation in these cases is the course of action that many women have chosen to take. Of course, when a woman finds herself in this position, there really are no good options available.
Mastectomy is sometimes a better choice for pregnant women, as it makes it less likely that radiation will be needed afterwards. Your doctor, surgeon, and anesthesiologist can help you decide which options are best for you and your baby.
If chemotherapy is needed after surgery, it is usually postponed until after the 1st trimester. In the first trimester most of the baby's internal organs are developing, and chemo is believed to be a lot more risky during this time. Some studies have shown that certain chemo drugs given during the 2nd and 3rd trimester do not raise the risk of birth defects or stillbirths, however the long term effects of these drugs on the child are not known. In addition, chemo is generally not given in the last 3-4 weeks of pregnancy, as it can decrease the mother's blood cell count, raising the risk of certain complications during birth. In some cases, when the woman is in her third trimester, it may be possible to delay chemo until after the baby is born, and the birth may be induced so that treatment can begin as soon as possible.
If the cancer is already in an advanced stage (III or IV) when detected, treatment options are more limited, and the mother may have to consider aborting the pregnancy to increase the chances of her own survival. Radiation therapy is usually needed for advanced cancer, and the high doses used can harm the fetus during any stage of pregnancy. Hormone therapy is another treatment that may be used, and is also considered risky for the baby.
Awareness is the Key
As important as it normally is to detect breast cancer in its early stages, it is doubly important to detect this disease in its early stages when it occurs in women who are carrying a child. When breast cancers are found early, they can be successfully treated without putting the baby at risk. Clinical exams during prenatal visits, breast self-exams performed regularly at home, and immediate biopsy if anything anomalous is found should all be a part of the normal medical routine of a woman who is expecting a baby. As long as women and doctors are aware that breast cancer can and does affect pregnant women, there is no reason why these cancers cannot be caught in their early stages in almost every instance.
Breastfeeding During Breast Cancer
There is no evidence that breastfeeding will harm your baby if you have breast cancer. It is also believed that breastfeeding does not affect the progression of the cancer. However, if you are undergoing breast cancer treatment, it is likely that you will be asked to not breastfeed during this time.
If you stop breastfeeding (or don't start), this will reduce blood flow to your breasts, making them smaller, which can be advantageous during surgery. Stopping will also reduce your chances of infection, and will make it less likely that breast milk will be a problem during surgery or biopsy.
If you are receiving chemotherapy or hormone therapy, it is essential that you not breastfeed. These chemicals can pass into the breast milk and harm the baby.
Pregnancy after Surviving Breast Cancer
Many women are able to become pregnant after breast cancer, though some cancer treatments, such as chemo, can affect a woman's fertility. You should not try to become pregnant while you are on hormone therapy, as there is some evidence that this treatment can cause birth defects.
Some studies have shown that pregnancy does not increase the likelihood that the cancer will recur, however, there is clear evidence that estrogen levels affect the growth of breast cancer cells. For this reason, many doctors still advise women to wait at least two years before becoming pregnant. This allows time for an early relapse to be detected and treated.
A woman's history of breast cancer is not believed to cause any problems for her future babies.
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