Pregnancy and Breast Cancer Treatment

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. 

CHEMOTHERAPY
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. 

SURGERY 
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. 

• DO NOT use target therapy, hormone therapy, or radiation therapy during your pregnancy as part of your treatment. 
• Stop breastfeeding or do not start breastfeeding if you are going through treatments.
• Pregnancy can make it harder to treat, diagnose, or even find breast cancer. 
• If you already have breast cancer while pregnant, the changes in hormones that happen during pregnancy can cause your tumors to grow. 
• Getting a mammogram during pregnancy isn't commonly used, as the radiation used during the procedure is very dangerous to the baby. Plus, they are usually not effective on women under 40, as the breast tissues is too firm for the radiation to pass through to get any clear results. 
• A woman's breast thickens during pregnancy making it harder to find any lumps. It is very important to continue regular self-breast exams and to have your doctor continue breast exams throughout your pregnancy. If you have any concerns, they need to be brought to your doctor right away. 

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. 

• There is still hope.
• Breast cancer itself does not hurt or harm the baby.
• Getting breast cancer while you're pregnant is not very common.
• Being pregnant doesn't cause breast cancer.

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.