WORLDWIDE, THREE TO eight pregnancies in every 100,000 are affected by breast cancer. To put this another way, in the UK, of the hundreds of thousands of women diagnosed each year with cancer, fewer than 100 of these women will be pregnant at the time.
It can be very challenging to detect a breast cancer during pregnancy because your breasts are constantly changing. If you are at all concerned, you should see your GP. Any area of concern will be assessed with an ultrasound. If you need a mammogram, it will be done with a protective shield on your tummy because the X-rays can harm your unborn baby. A core biopsy (see here) will also be taken from any suspicious areas in your breast or lymph nodes to analyse them further.
If breast cancer is found in your lymph nodes, you can’t have staging CT or bone scans (which are normally done to look for distant disease – see here) because of the risk to the baby from the radiation dose. Instead, you may have a chest X-ray (with a tummy shield) and a liver ultrasound scan. You can have the more accurate CT and bone scans after you have given birth.
Being pregnant is meant to be one of the most exciting times in your life. Sadly, however, this excitement can turn into despair with a cancer diagnosis. It can be hard to find help from people who know what you’re going through. That’s where the fabulous charity Mummy’s Star can help (see here for details). It focuses on supporting women and their families who are affected by a cancer diagnosis during pregnancy or within the first year of giving birth. Their website is full of information about coping with work, financial aid and benefits, maternity and sick leave, as well as offering forums for women and their partners, and advice on how to support your children. If you are diagnosed with breast cancer while you are pregnant, we urge you to go to the website for further support.
It is unlikely that you will need to end your pregnancy (a ‘medical abortion’) in order to treat your breast cancer. Most pregnant women are able to have some treatment, although your delivery may be earlier than planned. It is your decision, however, and you may choose to have a termination.
There is no evidence to show that having an abortion improves the prognosis of your breast cancer. This means that women who keep their baby probably have the same chance of surviving their breast cancer as those who choose to have an abortion.
You shouldn’t breastfeed during chemotherapy because the drugs can pass to your baby in your breast milk and potentially cause harm. You also shouldn’t breastfeed with Herceptin for the same reason. If you don’t need Herceptin, you can still continue to express milk (that you can’t give to your baby) so your supply doesn’t dry up. When you have finished chemotherapy, you can then breastfeed your baby.
QUESTIONS TO ASK YOUR DOCTOR
● Have you treated pregnant women with cancer before?
● How will you involve my obstetrician (the doctor looking after your pregnancy)?
● Do I need treatment right away, or can it wait until I’ve had my baby?
● What are the treatment options?
● Do I need to consider ending the pregnancy so I can have breast cancer treatment?
● If I delay treatment, could it affect the chance of my cancer coming back?
● How will the treatment affect me and my baby?
● Can I breastfeed?
Because breast cancer during pregnancy is so rare, there are no hard and fast rules for treatment. Every case is different. Your cancer will be discussed at an MDT with your oncologist and an obstetrician (a doctor who specialises in pregnancy), and your treatment will be planned to give the best possible outcome for you and your baby.
What treatment you have depends on how far along in your pregnancy you are. Pregnancy is divided into three-monthly sections called ‘trimesters’ (0–12 weeks; 13–28 weeks; and 29–40 weeks), and different treatment options are recommended for each one. These are the basic principles:
● You can have surgery in any trimester. There will be an obstetrician monitoring your baby while you are having your operation. There is a small risk of miscarriage with a general anaesthetic.
● You can have chemotherapy in trimesters two and three (from 13 weeks onwards) and this is the most common treatment. You can then have surgery and radiotherapy when you have delivered your baby.
● You cannot have radiotherapy when you are pregnant because it can harm your baby – this might affect which operation you have.
● You cannot have Herceptin when you are pregnant because it can harm your baby.
● You cannot have hormone therapy when you are pregnant because it can harm your baby.
Your medical team may discuss delivering your baby earlier than planned. They may suggest this so that you can start Herceptin treatment, for example.
Getting breast cancer when you’re pregnant does not mean that you have a higher chance of it coming back or dying from breast cancer when compared to a woman who isn’t pregnant. However, because a lot of pregnant women are diagnosed late, often when their cancer has spread to their lymph nodes, their overall outlook is worse than a woman whose breast cancer was diagnosed at an earlier stage.
If you get breast cancer when you are pregnant, your survival and recurrence rates are the same as non-pregnant women who have the same cancer as you. While chemotherapy can affect your future fertility (see Chapter 16), the treatment you have during this pregnancy will not harm children from any future pregnancies.