Receiving the news that you have breast cancer is difficult and life-changing information. But, what happens if you're pregnant and receive this news?
Being diagnosed with breast cancer is the last thing you want to deal with, let alone when you have the happy news that you're pregnant. There is still such a stigma connected to breast cancer that it only happens later in life, and after menopause. But, as we've mentioned in previous blogs, breast cancer doesn't discriminate. It doesn't pay attention to age or sex. Women and men at all stages of life are vulnerable and susceptible to breast cancer, and that includes pregnant mothers. Being pregnant and expecting a child should always be a time of joy and happiness, but a diagnosis of breast cancer changes all of that. What does this mean for you and the baby? How will this change your treatments? What will the next nine months of pregnancy look like? This will be a delicate and complicated journey, one you need to plan very carefully with your obstetrician and your oncologist. You need to be very well informed about your choices and options, and to choose what path is best for you and your baby. These decisions and the treatments need to focus on not just getting rid of or treating your cancer. They also need to be chosen to keep your baby safe and healthy as well. This limits and changes what kind of treatment options are available to you and when exactly you can receive them throughout your three trimesters.
The positive news is that yes, as a pregnant woman, you treat your breast cancer. The tricky part is deciding what route you can safely go to protect your baby and still conquer your cancer. This all depends on a handful of factors. They include how healthy you are overall, how far along you are in your pregnancy if the cancer has started to spread and if it has where it has spread to, the size of your cancerous tumor, and where that tumor is located. For a pregnant woman, two of the safest options are surgery and chemotherapy, while radiation and other hormonal therapy treatments are recommended to be avoided until after you've delivered.
This treatment is safe for babies in the second or third trimester, but not in the first. In the first trimester, some of the most important development and growth occurs, and chemo can seriously interfere in that process. It also runs a higher risk of losing the baby if chemo is used during this time as well. Many of you might be skeptical that chemo is safe at any stage of pregnancy, but studies have shown that when using certain chemo drugs like cyclophosphamide and doxorubicin during the last two trimesters of pregnancy is safe. They don't have the risk of birth defects, health problems, or loss of the baby. The only risk studies have found is the risk of an early delivery. If you do decide or need to have surgery during this time, you will be deciding between a mastectomy or a lumpectomy, with follow up treatments of chemo recommended for the second trimester or later. If your diagnosis comes during your final trimester of pregnancy, chemo is usually recommended after the birth of your child. After week 35 of your pregnancy (out of a total of 40) chemo is no longer recommended. Chemo at this point can bring on early delivery, and it also lowers the mother's blood cell count. This lowered cell count can lead to dangerous issues during birth including infection and serious bleeding. Deciding to delay chemo until after the birth allows the mother's blood cell count to return to a healthy level, so the birth can be as safe as possible.
This is one of the safest routes for a pregnant woman to take while battling a cancer diagnosis. It is the safest to do at any trimester, and you don't have to delay it unless your obstetrician recommends otherwise. Mastectomies are generally the most preferred surgery for a pregnant woman. You can have a lumpectomy, removing just the breast tissue that contains cancer, but it does come with a few risks. A lumpectomy generally requires radiation to follow up that surgery, and radiation is not safe for the baby. But, putting off radiation for the mother, if it is needed, is very dangerous and could increase the risk in cancer returning. The only time a lumpectomy is usually recommended with radiation is if the cancer is found during the third trimester. If the surgery is performed close to the due date of the baby or very shortly after, very small wait time or no wait time at all is placed on the recommended radiation treatments. The removal of a lymph node, or possibly a few, are also needed during surgery. There are two different types of lymph node surgeries, one, in particular, being safer than the other. The removal of lymph nodes under your arm called an auxiliary lymph node dissection, which removes multiple lymph nodes, is the first choice. The second is called a sentinel lymph node biopsy. This uses a small amount of blue dye and radioactive tracers that pick out the nodes that could contain cancer. The blue dye and radioactive tracers come with heavy concerns since radiation is very bad for the baby. This treatment, although it may help with removing fewer lymph nodes, is not recommended during pregnancy. It is recommended to happen after pregnancy or late in your trimesters and without the use of the dye.
TREATMENTS AND THINGS TO AVOID
During your pregnancy, there are some treatments and situations you will need to keep you and your baby safe. Keep these in mind as you move forward. Also listed are a few difficult situations that you might have to face, too.
THINGS TO REMEMBER
During this time, you already have a lot on your plate and a lot on your mind. We wanted to leave you with some closing thoughts to remember as you begin this process.
We know and understand the difficulties you are facing during this time. It is unique, scary, and full of unknowns. We want to help you celebrate the joy of your pregnancy, all while helping you conquer your cancer. If you have any concerns or worries, please don't hesitate to reach out to us. We are here to answer your questions, guide you through this process, and discuss any concerns you might have. Know you are never alone, and there is always hope.
Taking the confusion out and adding the zinc to your sunscreen...
We have all been told at least once the miracle ingredient we need to add to our skin care regimen… SUNSCREEN! SUNSCREEN! SUNSCREEN!
I, like many of us from my “era”, worshiped the sun as a teenager. I cringe when I think about life-guarding 10 hour shifts covered in baby oil; and how every spring break and summer started with a 3rd degree burn. If the SPF in my tropical tanning oil was higher than a 4, and didn’t smell like Hawaii, it wasn’t going in my pool bag.
Turning 40 exposed all those years of abusing my skin with emerging hyper-pigmentation, dark spots, and broken capillaries. Now, the one item that I won't leave the house without is a BROAD SPECTRUM sunscreen with Zinc. Zinc sits on the top of the skin and starts protecting you immediately when applied. Broad spectrum SPF refers to sunscreens that protect the skin from both UVA and UVB rays. Even with a high SPF (sun protection factor), if a sunscreen isn’t broad spectrum, you won’t be protected from UVA rays. It’s important to protect from both types of UV rays because they damage your skin differently. Here is a short breakdown:
work! If these reasons don’t persuade you, let the coral reefs be a reason to use an environmentally safe zinc based sunscreen. Chemically based sunscreens break down coral, causing it to lose its nutrients, turn ghostly white or bleach and often die or become unable to reproduce.
Now, you probably envision zinc sunscreen from the eighties… the white gooey stuff more suitable for the circus… well, here’s a welcome update! My all time favorite , ELTA MD sunscreens, are mixed with 9% transparent zinc oxide.
You don't have to worry about a clown like or chalky finish, and it's water-resistant up to 80 minutes, passing the test of beach waves and summer runs. The Elta MD UV Clear Broad Spectrum SPF 46 is a fantastic option for your face—particularly if you have oily skin, as the infusion of lactic acid simultaneously kills lingering breakouts, while reducing shine. The formula is also rich in hyaluronic acid, so you won't have to pile on the moisturizer beforehand, and the side of niacinamide can help to fade existing sun damage. The tinted version is like magic, it seamlessly blends into almost anyone’s skin, acting either as a light foundation or the perfect primer!
As far as the rest of your body goes, Elta MD has a full line of products, including a Sport Sunscreen, to protect you and your family...all containing zinc! On a side note, for those of us who began protecting ourselves a little later in life, there is an option to help reverse some of that hyper-pigmentation and those broken capillaries from our previous sun goddess days. My newest treatment obsession, Laser Genesis, uses micro-pulses of laser energy to diminish the signs of vascular facial redness and stubborn brown spots. Added bonus…Laser Genesis also improves the appearance of fine lines and wrinkles with collagen remodeling! The Breast Place is excited to offer packages of this no down time laser treatment, as well as many other skin rejuvenation packages personalized for your individual needs at your free skin consultation. Call me anytime at The Breast Place, extension 203!
We are very proud that The Breast Place has been a trusted breast health resource in our community. During this challenging time, we are putting your safety and wellness as well as that of our patient care team first. That being said, we thought a few helpful hints along the way would continue to bring our community together during this time of social distancing.
A patient asked this morning how to address the red patches and eczema inflamed on her skin with all the handwashing. Then one of our team members showed her blotchy, cracked hands as an example.
So what do we do when we have to wash our hands over and over and/or apply sanitizer again and again?
When you are washing your hands to avoid a disease, the last thing you want is to make them so raw that that there is breakage in the skin so that a bacterial or fungal infection develops. Cracks that form on skin can increase your risk of contracting infections through the fissures and also lead to conditions such as eczema.
We cannot stop washing our hands (health professionals are doing it up to 100 times a day) and guidance from the Centers for Disease Control and Prevention (CDC) says people should scrub their hands for at least 20 seconds. Don’t you remember your kindergarten teacher telling you to sing a full rendition of Happy Birthday while washing, to get through the 20 seconds? Those rules still apply today!
Here are some helpful hints to care for your skin after washing your hands:
Alcohol-based hand sanitizers, which kill the microbes on skin without removing any debris, irritate hands less than soap. We suggest using hand sanitizers when it makes the most sense, like after touching a door handle or another surface that might carry germs, instead of repeatedly washing your hands. However, keep in mind that sanitizer kills 6%0 of what soap kills, including surface debris. It does not replace washing your hands correctly.
Take preventative measures to moisturize your hands after washing them will help. Hand soap should also gentle and fragrance-free – remember, you are not washing dishes!
Once you’ve washed your hands for at least 20 seconds (Happy Birthday to you, Happy Birthday to you…you know the drill!), pat them dry rather than rubbing them. Leave just a small amount of dampness and then moisturize to lock in the water.
Immediately use a hand cream to seal in the moisture. Among the many kinds of moisturizers, hand creams are better than body lotion because they are more nourishing. Body lotions, which are primarily water-based, can further dry out skin because the water evaporates while creams, which are often oil-based, will begin moisturizing and protecting washed hands.
We recommend applying thick hand creams at nighttime to give your skin a rest. Put on a pair of cotton gloves or even socks!! For a few hours before bed, or even overnight, you will hydrate and replenish the skin, gearing up to fight the COVID-19 another day.
*Remember, if your skin is sensitive to harsh chemicals, you should handle cleaning supplies like Clorox wipes while wearing gloves.