Coping With Pregnancy and Cancer
- Arlene Brown was diagnosed with triple-negative breast cancer after finding a lump in her breast while showering. She underwent chemotherapy while pregnant, delivered a healthy baby, and completed aggressive treatment. Now she’s cancer free.
- 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.
Brown, who works for a non-profit organization as a program officer and has chosen to share her story with WISHTV and Duke Health to offer other women hope.
Read More“Even though I went through the most horrific chemotherapy anybody has, it does not breach the placenta, which is still like magical to me,” Brown told WISHTV.
Doctors induced Brown when she was 35-weeks pregnant, allowing her to followthrough with more chemotherapy and begin immunotherapy just two weeks after welcoming her son Andrew into the world. She also had surgery and underwent radiation therapy for five weeks.
As per Duke Health, the surgery she underwent was a double mastectomy to remove her breast tissue and nearby lymph nodes. She also had breast reconstruction at the same time.
Now, she’s cancer free and sees her doctor every few months to check for cancer recurrence.
More Resources On Breast Cancer Risk
- A New Recommendation Adds To The List Of Drugs That Can Lower Breast Cancer Risk For Women With High Risk Of Developing The Disease
- All Hormonal Birth Control Increases Breast Cancer Risk, No Matter the Method, Study Says: Should You Stop Taking Yours?
- Breast Cancer Risk For Post Menopausal Women — Taking Hormones Can Increase Your Risk
- ‘A Real Milestone’: FDA Approves New After Surgery Treatment for High-Risk Early Breast Cancer
- Alcohol Can Increase the Risk of Developing Breast Cancer
- Exercise Can Lower Your Breast Cancer Risk
“I had gone back and forth on what I wanted to do when they explained the different options.I wanted a fast recovery to get back to my newborn. Because my surgeons worked together, it all worked in my favor. My new breasts look amazing,” Brown told Duke Health.
It has been two years since her diagnosis and she has no signs of cancer recurrence.
“Triple-negative breast cancer has a high risk of recurrence, and can come back as stage 4, which is why it is treated so aggressively,” her doctor, Duke medical oncologist Dr. Rani Bansal, said.
Brown, who was named after her aunt who passed away from triple-negative breast cancer and saw her sister battle the same disease, was at a higher risk of getting breast cancer because she has the BRCA-1, breast cancer gene mutation.
Women with an inherited BRCA gene mutation have a much higher risk of getting breast cancer, ovarian cancer, and cancer of the fallopian tubes.
Looking back on her cancer journey, Brown tells Duke Health it “seems like a near-distant memory. It happened, and we lived it, and I see the people at the front desk who greet you with kindness.”
“I’m glad to be on the other side, but it’s so nice to see friendly, welcoming faces that care about you. I am healing and I’m grateful,” she concluded.
Understanding Triple-Negative Breast Cancer
Triple-negative breast cancer is one of the most aggressive forms of the disease and makes up for approximately 20 percent of all breast cancers. The treatment approach varies from patient to patient and may include a combination of different treatments.
Early-stage triple-negative breast cancer (TNBC) treatments may use a combination of chemotherapy drugs.
Understanding Triple Negative Breast Cancer
For example, a CMF regimen is an abbreviation for combining chemotherapy drugs cyclophosphamide, methotrexate, and fluorouracil. AC stands for doxorubicin (Adriamycin) with cyclophosphamide, and ACT just indicates that a taxane drug is added to the regimen. Likewise, TC is an abbreviation for a regimen of Taxotere and cyclophosphamide.
RELATED: In Triple Negative Breast Cancer, New Drug Trodelvy Extends Life
In 2021, the FDA approved the immunotherapy drug pembrolizumab for the treatment of early-stage triple-negative breast cancer (TNBC). Pembrolizumab (Keytruda) is already used to treat other cancers, including melanoma and non-small cell lung cancer. Doctors heralded the FDA’s approval of pembrolizumab as a potentially paradigm-shifting advancement in breast cancer treatment.
RELATED: New Study Identifies Genes Linked to Increased Risk for Triple-Negative Breast Cancer
For patients with stage 2 or 3 TNBC, adding the immune-boosting medication pembrolizumab to combination chemotherapy before surgery increases chances of living free of breast cancer, explains oncologist Dr. Sylvia Adams, director of the Breast Cancer Center at NYU Langone’s Perlmutter Cancer Center.
She was one of several researchers involved with the pembrolizumab trials. “It changes the standard of care and should be discussed with all patients diagnosed with stage 2-3 TNBC,” she adds. “Yes, it’s a game-changer, though there is much more to be learned.”
RELATED: The First Immunotherapy Approved For Breast Cancer Hope For Triple Negative Breast Cancer
Until recently, researchers hadn’t had much success using the therapy to fight breast cancer. That’s changing now. The IMpassion130 trial showed for the first time that a combination of immunotherapy and chemotherapy had a significant effect in treating metastatic triple negative breast cancer. Triple negative breast cancer is an extremely aggressive form of the disease, so this discovery is important.
Dr. Sylvia Adams explains, “The question now becomes, is it only triple negative breast cancer that can benefit from immunotherapy, or are there other subtypes as well?
“If a tumor has the PD-L1 protein in it, that means there’s already an inflammatory response, that the patient’s immune system already recognized the tumor and was starting to work against it. The benefit of identifying such a strong biomarker in the triple negative subset will allow us to actually test for the presence and responsiveness to immunotherapy in other subtypes of breast cancer.”
Is My Cancer Really Triple-Negative?
Dr. Heather McArthur, Clinical Director of the Breast Cancer Program at Simmons Cancer Center at UT Southwestern Medical Center, has spoken with SurvivorNet on this relevant topic.
You might be told you have triple-negative breast cancer, that means that your cancer is not being fueled by any of the three main types of receptors: estrogen, progesterone nor the HER2 protein. But now you could be categorized as HER2 low instead of HER2 negative.
Breast cancer cells with higher-than-normal levels of HER2 are called HER2-positive, those with low levels of HER2 are (or were) called HER2 negative. Recently, however, researchers have looked to further expand this definition to include patients that have a minimal amount of HER2 expression but do not meet the classic definition for HER2-positive tumors. This group has been called HER2 “low” and is very important as it represents almost 50% of all patients with breast cancer.
This excitement stems from the fact that HER2-low breast cancers are targetable with a recently new FDA-approved Enhertu (Fam-trastuzumab deruxtecan-nxki). It appears that Enhertu is extremely effective for appropriate patients and can greatly improve their quality of life and help them live longer.
Therefore, it is exceedingly important to discuss with your physician about your HER2 status.
BRCA Gene Mutations and Breast Cancer
In understanding how women’s risk of breast cancer is heightened if the disease is hereditary, it’s important to understand the role BRCA gene mutations play in breast cancer risk, and what these gene mutations actually are.
For starters, BRCA is two genes (BRCA1 and BRCA2). According to the National Cancer Institute, BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2) are genes that produce proteins that work to repair damaged DNA.
The BRCA genes are sometimes referred to as tumor suppressor genes since changes, or mutations, in these genes can lead to cancer.
Everyone is born with two copies of each of the BRCA genes, one inherited from each parent. If either parent carries a BRCA gene mutation, there’s a 50-50 chance the child will carry it as well.
When BRCA1 or BRCA2 have certain mutations, or changes, men and women are at a higher risk level for several cancers, most notably breast and ovarian cancer in women.
According to the National Cancer Institute, 55 to 72 percent of women who inherit a harmful BRCA1 variant will get breast cancer by the time they reach 70 to 80 years old. Similarly, 45 to 69 percent of women who inherit a harmful BRCA2 variant will get breast cancer by that same age.
The percentage of women in the general population who will get breast cancer in their lifetime? About 13 percent.
“If a woman has one of these mutations the genetic BRCA1 and (BRCA)2 mutations, it puts her at basically the highest quantifiable risk for getting breast cancer,” Dr. Elisa Port, a surgical oncologist at Mount Sinai, told SurvivorNet. “We typically say between the 60 (percent) and 80 percent range.”
When Cancer Runs in the Family: Survivor Amy Armstrong On The Importance of Genetic Testing
If you have a family history of cancer, genetic testing could be one way for you to find out if you have harmful genetic mutations that increase your risk of developing certain cancers. Ask your doctor if genetic testing is right for you.
Dr. Port explained, “We now feel that casting a wider net with genetic testing is probably very prudent because finding out that one has a cancer predisposition gene can definitely change their course, their risk for cancer and what they might want to do about it.”
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.”
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.
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.
What You Need to Know About Survivorship
Whether you’re beginning your journey into survivorship or are a seasoned survivor, you’ll quickly learn that it’s a term with many layers. At its simplest, ‘survivorship’ signifies the state of living beyond a challenging event or diagnosis, such as cancer. More specifically, it marks the period after treatment where a patient goes from merely surviving to thriving, as they navigate their newfound lease on life.
It’s important to remember that survivorship isn’t just an end state – it’s a continuous journey. It begins the moment a person is diagnosed with a significant health condition and continues throughout their life. You might hear people say things like, “from the moment of diagnosis, you become a survivor.”
It’s a powerful sentiment that reflects the courage and resilience involved in battling a serious illness.
Being a survivor also means redefining your life while coping with the aftermath of disease and its treatment. This phase might include the challenge of dealing with physical and emotional changes, attending regular check-ups, the fear of recurrence, or the need for long-term medication. Despite these hurdles, many survivors find unique strength, growth, and transformation during this time.
Survivorship is much more than just the absence of disease—it’s a new stage of life, a rite of passage. Your journey might not have been one you would have chosen, but through it, you’ll uncover a greater understanding of yourself and what you’re capable of. Each person’s survivorship journey is unique, and how you choose to travel is entirely up to you.
Remember—navigating this new terrain called ‘Survivorship’. It might be challenging, but remember, you’re not alone. There are ample resources and support systems designed to help you along the way.
Continued Medical Care
Don’t lose sight of the importance of continued medical care – always keep your follow-up appointments and adhere to any healthcare recommendations.
Remember, embracing these coping strategies can help you navigate your way into survivorship with greater ease and renewed energy. Just remember – slow and steady wins the race! You’ve overcome huge hurdles, it’s okay to take this new stage of your life at your own pace.
Resilient learning to overcome any obstacle
Additionally, health checkups are an integral part of maintaining wellness and spotting potential health issues early. This holds true for everyone, but even more so for a person who’s in the throes of survivorship.
One of the main reasons you’ll want to maintain routine health checks is to monitor for recurrence. While the hope is always for complete recovery, there’s a possibility of the disease returning—even with successful treatment. Regular checkups allow you to keep a vigilant eye on the situation, leading to early detection and treatment if any problem emerges.
Screening For Breast Cancer
Contributing: SurvivorNet Staff
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