Treating Breast Cancer During Pregnancy
If you are diagnosed with breast cancer while pregnant, your treatment options will be more complicated because you will want to get the best treatment for your cancer while also protecting the baby. The type and timing of treatment will need to be planned ?carefully and coordinated between your cancer care team and your obstetrician.
When treating a pregnant woman with breast cancer, the goal is the same as when treating a non-pregnant woman: to cure the cancer whenever possible, or to control it and keep it from spreading if it can’t be cured. But the extra concern of protecting a growing fetus may make treatment more complicated.
Is it safe to have breast cancer treatment during pregnancy?
If you are pregnant and have breast cancer, you might have hard choices to make, so get expert help and be sure you know all your options. Pregnant women can safely get treatment for breast cancer, although the types of treatment used and the timing of treatment might be affected by the pregnancy. If you are pregnant and have been diagnosed with breast cancer, your treatment recommendations will depend on:
- The size of the tumor
- Where the tumor is located
- If the cancer has spread and if so, how far
- How far along you are in the pregnancy
- Your overall health
- Your personal preferences
It is generally safe to have surgery for breast cancer while you’re pregnant. Chemotherapy seems to be safe for the baby if given in the second or third trimester of pregnancy, but it isn’t safe in the first trimester. Other breast cancer treatments, such as hormone therapy, targeted therapy, and radiation therapy, are more likely to harm the baby and are not usually given during pregnancy.
Treatment choices can become complicated if there is a conflict between the best known treatment for the mother and the well-being of the baby. For example, if a woman is found to have breast cancer early in her pregnancy and needs chemotherapy right away, she may be advised to think about ending the pregnancy. A counselor or psychologist should also be part of your health care team to help give you the emotional support you may need.
Some older studies found that ending a pregnancy in order to have cancer treatment didn’t improve a woman’s prognosis (outlook). Even though there were flaws in these studies, ending the pregnancy is no longer routinely recommended when breast cancer is found. Still, this option may be discussed when looking at all the treatment choices available, especially for metastatic (stage IV) or aggressive cancers that may need treatment right away, such as inflammatory breast cancer.
Breast cancer surgery during pregnancy
Surgery to remove the cancer in the breast and nearby lymph nodes is a major part of treatment for any woman with early breast cancer, and generally is safe in pregnancy.
Options for breast cancer surgery might include:
- Removing the entire breast (mastectomy)
- Removing just the part containing the cancer
(lumpectomy or breast-conserving surgery [BCS])
The type of surgery a woman might have depends on the extent of her cancer and when the cancer is diagnosed during the pregnancy.
Checking lymph nodes for cancer spread
In addition to removing the tumor in the breast, one or more lymph nodes in the underarm area (axillary lymph nodes) also need to be removed to check if the cancer has spread. One way to do this is an axillary lymph node dissection (ALND). This is often the standard procedure for pregnant women with breast cancer and removes many of the lymph nodes under the arm. Another procedure, called a sentinel lymph node biopsy (SLNB), might be an option depending on how far along you are in pregnancy and your cancer stage. SLNB allows the doctor to remove fewer nodes, but there are concerns about the effects the SLNB dye might have on the baby. Because of these concerns, most experts recommend that SLNB only be used in certain situations such as later in pregnancy, and that the blue dye not be used during the procedure.
Is anesthesia safe during pregnancy?
Surgery for breast cancer generally carries little risk to the baby. But there are certain times in pregnancy when anesthesia (the drugs used to make you sleep for surgery) may be risky for the baby.
Your surgeon and anesthesiologist, along with a high-risk obstetrician (OB), will need to work together to decide the best time during pregnancy to operate. If the surgery is done later in the pregnancy, your obstetrician may be there just in case there are any problems with the baby during surgery. Together, your doctors will decide which anesthesia drugs and techniques are the safest for both you and the baby.
Treatment after surgery
Depending on the cancer’s stage, you may need more treatment such as chemotherapy, radiation therapy, hormone therapy, and/or targeted therapy after surgery to help lower the risk of the cancer coming back. This is called adjuvant treatment. In some cases, this treatment can be put off until after delivery.
Chemotherapy
Chemotherapy (chemo) may be used after surgery (as adjuvant treatment) for some earlier stages of breast cancer. It also can be used by itself for more advanced cancers.
Chemo is not given during the first 3 months (first trimester) of pregnancy. Because a lot of the baby’s development occurs during this time, the safety of chemo hasn’t been studied in the first trimester. The risk of miscarriage (losing the baby) is also the greatest during this time.
For many years, it was thought that all chemo would harm an unborn baby no matter when it was given. But studies have shown that certain chemo drugs (such as doxorubicin, cyclophosphamide, fluorouracil, and the taxanes) used during the second and third trimesters (months 4 through 9 of pregnancy) don’t raise the risk of birth defects, stillbirths, or health problems shortly after birth, though they may increase the risk of early delivery. Researchers still don’t know if these children will have any long-term effects.
If you have early breast cancer and you need chemo after surgery (adjuvant chemo), it will usuall