By – Dr. Shruti Kainth, Senior Consultant, Obstetrics & Gynaecology, Cocoon Chandigarh
A breast cancer diagnosis when pregnant poses two vital questions at once: “What will happen to me?” and “What will happen to my baby?” These questions have more complex answers than one might think—and more positive outcomes, too. Scientific research has determined that pregnancy doesn’t necessarily stop cancer from being treated. Yet, time is always an essential factor in any decision made.Understanding the NumbersAccording to the National Cancer Institute in the US, the prevalence of breast cancer is about 1 out of 3,000 cases, and the age group where most of them happen is between 32 to 38 years. Another concept called “pregnancy associated breast cancer” refers to cases diagnosed with breast cancer during pregnancy, one year postpartum, and during lactation.Why Diagnosis Can Be DifficultThe process of pregnancy makes the breasts ready for nursing by increasing their size and tenderness. This tends to mask a lump, leading many women to think that the problem is related to hormone production. In addition, many women who are pregnant are below the age at which routine mammography is done.An abnormality should still be checked. The ultrasound examination comes first in the evaluation of an abnormal breast mass, and biopsy may be done even during pregnancy. Delivery should not be a pre-requisite for making a diagnosis.Treatment Follows Two TimelinesBoth the cancer’s behaviour and the pregnancy status should be taken into account. Surgery can be conducted during pregnancy; certain chemotherapies can be administered post-first trimester. Radiation is delayed until after birth, while hormone therapies and other systemic therapies are not recommended during pregnancy.Such a treatment plan should involve teamwork between oncologists and obstetricians. The main goal of treatment is to ensure that the mother is effectively treated without unnecessary risks to the fetus.What Research Says About the babyThere have been many studies on cancer during pregnancy and one particular study done by the New England Journal of Medicine in 2015 looked at 129 children conceived during maternal cancer against 129 controls and found that there was no significant cognitive, cardiac, or developmental problems in early childhood due to maternal cancer or treatment for it.Premature birth, however, did result in cognitive problems. This study included many cancers and cannot prove that all treatments are safe. Turning Evidence Into ReassuranceWhen it comes to family members, reassurance must be provided by way of an accurate diagnosis, individualized treatment plan, and an open discussion about uncertainties. Emotional support is key to complementing the medical side. The patient needs to walk out of the consultation knowing what her choices are.
