Coping With Pregnancy and Cancer
- Laura Hudson, a 34-year-old mom, was diagnosed with an aggressive form of breast cancer when she was nine months pregnant with her daughter. Now she’s urging others to get screening for cancer and be your own advocate, as she credits finding a lump in her right breast and seeking medical advice right away for helping her get diagnosed.
- Pregnancy-associated breast Cancer is rare. According to the American Cancer Society, a woman is diagnosed with breast cancer “about once in every 3,000 pregnancies.” It mainly affects pregnant women in their 30s.
- Detecting breast cancer so tricky while pregnant is that the breast changes in appearance. These changes can easily be masked by the body’s natural response to pregnancy; thus, diagnoses usually come after the cancer has reached advanced stages.
- Surgery is often the first line of treatment for pregnancy-associated breast cancer. Chemotherapy can be administered in most cases during pregnancy. After giving birth, additional treatments may begin, such as radiation or hormone therapy.
Now, cancer-free and celebrating their daughter’s first birthday, Hudson is sharing her cancer journey as she credits her diagnosis from following her gut “instinct” about a lump she found in her breast, which her doctor initially dubbed as “most likely to do with pregnancy.”
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Within the next 14 days, the scan results revealed she had an aggressive form of cancer and a mammogram showed the mass to have grown at a fast rate.
She told PA News, “They wanted to make sure we could get the baby out, and then start treatment ASAP to try and shrink it before having any surgery. It was grade three, so quite aggressive.”
After her daughter was born, Hudson was able to enjoy some time with her daughter before starting chemotherapy, and then a mastectomy, reconstruction of her right breast, and 15 radiotherapy sessions.
Now, cancer-free, Hudson takes a drug called Tamoxifen [a selective estrogen receptor modulator, which means it works to prevent estrogen from helping cancer cells to grow] to prevent cancer recurrence.
What is Tamoxifen for Breast Cancer?
She has also chosen to get her other breast surgically removed next year as a preventative measure.
Hudson, who works as a lawyer, also told the news agency, “We don’t know what this means for having more children in the future, but we are so lucky to have had Aurora – other women are not so lucky.
“I’m now entirely focused on recovery and my future with Sam and Aurora. There’s so much I want to do, and I’m looking forward to what’s next.”
In another interview with BBC Manchester Radio, Hudson is incredibly grateful for following her “instincts” to get the lump in her breast checked.
She admitted, “I don’t know where I’d be if I hadn’t … The big message to women is make sure you get it checked.”
Coping With Pregnancy-Associated Breast Cancer
The American Cancer Society notes that treating breast cancer in pregnant women mirrors that for non-pregnant women – cure the cancer or control it and minimize the risk of spread. However, protecting the fetus makes treatment more challenging.
Research published in Obstetrics and Gynecology says women most impacted by pregnancy-associated breast cancer (PABC) are in their 30s.
Most women with PABC are found to have a “painless mass in the breast or thickening of the skin of the breast.”
As noted earlier, researchers say a diagnosis usually comes after the cancer has matured because “pregnancy-induced breast changes, such as engorgement, often make it difficult to discern a concerning breast mass from a normal breast in a pregnant woman.”
Surgery with modified radical mastectomy (lumpectomy) is often the first line of treatment for pregnant women facing breast cancer. After giving birth, radiation and hormone therapy may be treatment options.
Helping Patients With Fertility Resources
After the first trimester, chemotherapy may be used for adjuvant treatment following surgery.
“The majority of chemotherapeutic agents, including taxanes and vinorelbine, were safe for use during the second and third trimesters,” the researchers said in their report.
It’s important to note since the number of women diagnosed with breast cancer is so rare, limited research exists.
More on Cancer During Pregnancy
The American Cancer Society says in addition to breast cancer, other types of cancer pregnant women may experience include:
- Melanoma
- Leukemia
- Cervical cancer
- Thyroid cancer
- Ovarian cancer
- Colon cancer
- Lymphoma
Remember, during pregnancy, the body undergoes several changes making cancer-related changes harder to detect. Still, some things to be watchful for include:
- Hormone levels change during pregnancy, which causes breasts to become larger, lumpy, and/or tender.
- Rectal bleeding could possibly be due to benign hemorrhoids, a common occurrence during pregnancy, or from colon or rectal cancer.
- Feeling tired could be from pregnancy weight gain or from low red blood cell counts (anemia), which can be seen in leukemias and lymphomas or during pregnancy.
- As the fetus and uterus grow throughout pregnancy, ovarian tumors get more difficult to detect.
Staying current on all of your health and cancer-related screenings will help you manage your cancer risk.
How Cancer Treatments Impact Fertility
Chemotherapy can destroy eggs in your ovaries. This can make it impossible or difficult to get pregnant later. Whether or not chemotherapy makes you infertile depends on the drug type and age since your egg supply decreases with age.
“The risk is greater the older you are,” reproductive endocrinologist Dr. Jaime Knopman told SurvivorNet.
“If you’re 39 and you get chemo that’s toxic to the ovaries, it’s most likely to make you menopausal. But, if you’re 29, your ovaries may recover because they have a higher baseline supply,” Dr. Knopman continued.
Radiation to the pelvis can also destroy eggs. It can damage the uterus, too. Surgery to your ovaries or uterus can hurt fertility as well.
Meanwhile, endocrine or hormone therapy may block or suppress essential fertility hormones and may prevent a woman from getting pregnant. This infertility may be temporary or permanent, depending on the type and length of treatment.
If you have a treatment that includes infertility as a possible side effect, your doctor won’t be able to tell you whether you will have this side effect. That’s why you should discuss your options for fertility preservation before starting treatment.
WATCH: How chemotherapy affects fertility.
Research shows that women who have fertility preserved before breast cancer treatment are more than twice as likely to give birth after treatment than those who don’t take fertility-preserving measures.
Most women preserve their fertility before cancer treatment by freezing their eggs or embryos.
After you finish your cancer treatment, a doctor specializing in reproductive medicine can implant one or more embryos in your uterus or the uterus of a surrogate with the hope that it will result in pregnancy.
If you freeze eggs only before treatment, a fertility specialist can use sperm and eggs to create embryos in vitro and transfer them to your uterus.
When freezing eggs or embryos is not an option, doctors may try these approaches:
- Ovarian tissue freezing is an experimental approach for girls who haven’t yet reached puberty and don’t have mature eggs or for women who must begin treatment immediately and don’t have time to harvest eggs.
- Ovarian suppression prevents the eggs from maturing so they cannot be damaged during treatment.
- For women getting radiation to the pelvis, Ovarian transposition moves the ovaries out of the line of treatment.
In addition to preserving eggs or embryos, positive research has shown that women with early-stage hormone-receptor (HR) positive breast cancer were able to safely pause endocrine therapy (ET) to try to get pregnant, and they did not have worse short-term recurrence rates than people who did not stop endocrine therapy.
The Importance of Breast Cancer Screening
Screening for breast cancer is normally done through a mammogram, which looks for lumps in the breast tissue and signs of cancer.
While there is some disagreement about the exact age a woman should start getting mammograms, doctors generally agree it should happen in their 40s.
The American Cancer Society (ACS) suggests women should begin annual mammogram screenings for breast cancer at age 45 if they are at average risk for breast cancer.
However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) now says that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives.
WATCH: Mammograms are still the best tool for detecting breast cancer.
The ACS also advises:
- Women aged 40-44 have the option to start screening with a mammogram every year
- Women aged 55 and older can switch to a mammogram every other year
- Women aged 55 and older could also choose to continue yearly mammograms
For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, a genetic mutation known to increase risk of breast cancer such as a BRCA gene mutation or a medical history including chest radiation therapy before the age of 30.
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Don’t delay speaking with your doctor to make sure you are staying on top of your breast health.
Leading Experts Urge Us to Be Proactive
“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care,” National Cancer Institute Chief of Surgery Steven Rosenberg told us in a previous interview, “because finding a doctor who is up to the latest of information is important.”
As we highlight in several areas of SurvivorNet, highly respected doctors sometimes disagree on the right course of treatment, and advances in genetics and immunotherapy are creating new options. Also, in some instances the specific course of treatment is not clear cut. That’s even more reason why understanding the potential approaches to your disease is crucial.
At the National Cancer Institute, there is a patient referral service that will “guide patients to the right group depending on their disease state so that they can gain access to these new experimental treatments,” Rosenberg says.
Cancer Research Legend Urges Patients to Get Multiple Opinions
Furthermore, getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon that is recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.
Other reasons to get a second opinion include:
- To see a doctor who has more experience treating your type of cancer
- You have a rare type of cancer
- There are several ways to treat your cancer
- You feel like your doctor isn’t listening to you, or isn’t giving you good advice
- You have trouble understanding your doctor
- You don’t like the treatment your doctor is recommending, or you’re worried about its possible side effects
- Your insurance company wants you to get another medical opinion
- Your cancer isn’t improving on your current treatment
RELATED: Be Pushy, Be Your Own Advocate, Says Leading Expert
Bottom line, being proactive about your health could be a matter of life or death. Learn as much as you can from as many experts as you can, so that you know that you did your best to take control of your health.
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
