Pregnancy and Breast Cancer Treatment
This past weekend, the New York Times published an article by Pamela Paul called “With Child, With Cancer.” I had to set it aside for several days before I could bring myself to read it. When I finally did, I was very moved, equally surprised and left with many unanswered questions.
I did not enjoy being pregnant. I was plagued with constant, low level nausea, heartburn and crushing fatigue for the duration of my pregnancies. I was also affected by what I later learned was ante-natal depression (this lifted almost immediately upon giving birth. My spouse swears that my first post-partum words were, “I’m so happy not to be pregnant anymore!” He exaggerates only slightly). I also found myself to be in a constant fog (not unlike the effects of chemotherapy) and that coherent thought was often just beyond my reach.
During those periods, deciding what to eat for breakfast was a challenge. I cannot imagine having to deal with the kind of life and death decisions faced by a woman dealing with a diagnosis of breast cancer while pregnant.
Editor's Note: Two young women, Anya Silver and Heather Kellis Young, share their stories of being diagnosed with breast cancer while pregnant in video interviews. To view these videos, visit the Young Survivors page or click on their names above.
When I was first diagnosed with breast cancer in 2006 (my kids were then 2 and 7), I attended an orientation session for patients about to undergo chemotherapy. We were advised that, should we vomit on our clothing after receiving chemo, we should put our clothes into a garbage bag and bring them into the cancer centre to be burned. Chemotherapy is that toxic.
And yet, many women undergo chemotherapy while pregnant, including the infamous “Red Devil,” which has been known to cause third degree burns when it comes into contact with skin. This was the case for Lizette Irvin, a 32 year old diagnosed with breast cancer while pregnant with her third child. She gave birth to a very healthy daughter last month.
I was very surprised to learn that, although research has necessarily been limited in this area (testing drugs on pregnant women being highly unethical), what studies have been done appear to indicate a rate of birth defects that is not significantly higher than in the general population. What’s more, children born to mothers in treatment do not seem to be affected by developmental delays or cognitive disabilities.
How can this possible? This brings me to some of the other questions the article raised for me:
Pregnant women report fewer side effects than most women undergoing chemotherapy. This is not true when it comes to post-partum treatments (and I cannot begin to imagine how hard it must be to undergo cancer treatment while caring for a newborn, even with a supportive and involved partner). The author states that no one knows why.
What about the increased risks for mother and baby of infection (due to white blood cell depletion) during surgery and labour?
The article states that almost all pregnant women with breast cancer undergo mastectomies. What are risks to the fetus of a general anesthetic? Are their other options?
Does the blood-thinning effect of chemotherapy increase the danger of hemorrhaging during surgery and labour?
Women undergoing chemotherapy are advised not to breastfeed. Is it the placenta that provides protection that is not present in breast milk?
The author of the article speculates as to whether pregnancy actually heightens the risk of breast cancer:
"While pregnancy lowers a woman’s lifetime chances of developing breast cancer, her risk is actually heightened in the 2 to 10 years following childbirth. Moreover, if a woman has been pregnant within the last two years and develops breast cancer, she is twice as likely to die from the disease."
My last pregnancy was within this time-frame. However, my cancer was hormone negative (not fueled by estrogen or other pregnancy related hormones). Could my pregnancy have played a role in the progress of my cancer?
The question that looms largest for me, though, is 'what would I have done?'
If I had been diagnosed with aggressive breast cancer while pregnant with my second child, what would my choices have been? I am resolutely pro-choice but the decision to abort a fetus that was conceived in love and long-planned seems almost unfathomable.
However, I was already mother to one child who needed me.
And living with incurable cancer has made me realize how very determined I am to live.
In hindsight (and as the mother of two very healthy boys) I can speculate that I probably would have opted to continue the pregnancy and undergo treatment, despite all the unknowns involved.
But I really can’t say for sure.