The unthinkable: Breast cancer during pregnancy

October 25, 1999
Web posted at: 4:10 PM EDT (2010 GMT)

In this story: Rare situation on the rise Therapeutic abortion: The jury's still out Second chance? RELATEDS

By Rochelle Jones

(WebMD) -- Marion Kistler, 34, and her husband, Philip, 33, were thrilled last December when they discovered that their efforts to start a family had finally succeeded. But their excitement turned to despair in late May when Marion slipped a bar of soap over her left breast while in the shower and found a hard lump that turned out to be cancerous.

"I was devastated," Kistler says. "It had been a great pregnancy, and then all of a sudden I didn't know if I was going to live -- I didn't know if my baby was going to live."

Dr. George Peters, director of the breast cancer center at the University of Texas Southwestern Medical Center and one of Kistler's doctors, says, "It's tricky because you have to treat the mother and the baby. The mothers are in turmoil, so we try to reassure them that they will do well and get them to concentrate on delivering the baby."

Rare situation on the rise

Kistler was suddenly a statistical oddity. Breast cancer is relatively uncommon in pregnant women -- fewer than 3 percent of breast cancers are diagnosed during pregnancy -- largely because the incidence of cancer increases with age, after most women have passed their childbearing years. But doctors say the numbers are increasing.

"It's become more and more common because more and more women are delaying pregnancy. It's not that the cancer is getting more common, but that women are getting pregnant in their 30s and 40s," says Dr. Jeanne Petrek, director of the Lauder Breast Center at Memorial Sloan-Kettering Cancer Center in New York City.

Although all breast cancer patients confront a bewildering array of treatment options -- surgery, chemotherapy, radiation or a combination of therapies -- women who have breast cancer during pregnancy face even tougher choices, because there is always the baby to consider. Chemotherapy may injure the fetus during the first trimester, so it is given only after a woman has passed this point in her pregnancy. Radiation therapy can be harmful at any stage of development, so if it is indicated, it is generally withheld until after delivery.

Further complicating decisions about treatment is the fact that pregnant breast cancer patients are typically diagnosed at later stages of the disease -- for reasons that are not entirely clear. A study at the Memorial Sloan-Kettering Hospital found that 62 percent of the pregnant patients who also had breast cancer tested positive for cancer in their lymph nodes. Women with cancer invading their lymph nodes are generally treated more aggressively, but the same therapy that may slow the growth of the cancer may also pose a significant threat to the fetus.

Like most women, and following the recommendations of the National Cancer Institute for treating breast cancer during pregnancy, Kistler chose to have surgery -- in her case a mastectomy -- followed by four sessions of chemotherapy.

"It was not a difficult decision," she says. "I wanted the breast off. It was like a neon light saying cancer above my head."

Therapeutic abortion: The jury's still out

While pregnancy complicates treatment, there is no hard evidence that therapeutic abortion can improve a patient's chances of survival. Abortions were once routinely recommended to women with breast cancer. Now, however, doctors tend to reserve this consideration only for those women who are in the advanced stages of the disease.

"Personally, I think it does help, that it makes a beneficial difference, but the scientific literature on the subject is very messy," says Petrek.

Second chance?

There is also little research to help women who have had pregnancy-associated breast cancer and want to have another child. Although some doctors advise patients to wait at least two years before trying to conceive, little is known about the effects of pregnancy on women with a history of breast cancer.

"There is no solid information that it is safe. We're just trying to do the prospective studies now," says Petrek.

Kistler, who will have labor induced between the third and fourth rounds of chemotherapy, doesn't know whether the baby will be a boy or a girl, but if it's a girl, she and her husband have already selected a name -- Marion.

"It will be nice to know that there will be a Marion Kistler around for a while," she says.

RELATEDS AT :

Pregnancy and breast cancer
Breast cancer and pregnancy

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RELATED SITES:

Susan G. Komen Foundation
American Cancer Society

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