Stories of Hope
Expectant Mothers With Unexpected Breast Cancer
Article date: October 4, 2002
There's hope...It's extremely possible and successful to take chemo and have surgery while you are pregnant, have a healthy baby and live — and beat the disease.
Rare But Doable For Mother And Child
Pregnancy can be a time of great joy and anticipation. But when a woman is pregnant and suddenly learns she has cancer, it's a surreal clash of emotions, a double-jolt of fear for oneself and the baby.
Jarred from thinking about names for the child, the expectant mother learns new cancer terms: lumpectomy, mastectomy, and drug names of chemotherapy.
Although being pregnant with cancer is rare, breast cancer is the most common cancer in pregnant and postpartum women, occurring in about one in 3,000 pregnancies, according to the National Cancer Institute (NCI). The average patient is between 32 to 38 years of age and, with many women choosing to delay childbearing, it is likely that the incidence of breast cancer during pregnancy will increase.
Breasts Reactive To Estrogen
It is common for pregnant women to develop unusual masses or lumps in their breasts, but it is rare that those masses or lumps turn out to be breast cancer.
"There's an estrogen surge with pregnancy; the breasts are very reactive to estrogen," said Otis Brawley, MD, associate director for cancer control at the Winship Cancer Institute of Emory University in Atlanta.
So women can expect to feel changes in their breasts during pregnancy.
"Women should always be aware of their breasts through breast self-exams," said Brawley, "be they 21 and not pregnant, or 27 and pregnant, or 50. And then changes that they note should be brought to the attention of a physician."
In some instances the change should just be watched closely, but in others the change may require a biopsy, he said.
Breast Self-Exam Caught Lump
Lisa Radel of Buffalo, N.Y., was in her second pregnancy at the age of 34, when she felt a lump in her inner right breast. She just thought it was a clogged milk duct. When it didn't go away, she brought it to the attention of her ob-gyn, who ordered a mammogram.
She was told after an initial reading of the mammogram that it didn't look bad — no angry edges, so she should come back in a few months. A radiologist did a needle biopsy and sent it off to pathology. But the pathology report told a different story: breast cancer.
Radel was 17 weeks pregnant (in her second trimester) when she had a lumpectomy (tumor surgically removed). Then, she sought three opinions, and unexpectedly, the third doctor found a second lump on the other side of the same breast. This lump did not show up in her mammogram, but did on an ultrasound exam.
She opted for a mastectomy (total breast removal) when she was 19 weeks pregnant, after finding that the second tumor was also malignant. She asked for her chest wall to be scraped, to get all the remaining breast tissue.
Radel had a fetal monitor on during her mastectomy and afterwards while in the intensive care unit for 24 hours.
She had chemotherapy during the rest of her pregnancy. Radel's labor was induced three weeks early, and a healthy 7 lb., 4oz. Connor was born on Jan. 7, 1995. She had her fourth chemotherapy treatment five days later.
"It was a joy," she said, "a brand-new miracle baby."
And, it was so very good to have a different focal point other than the cancer. "Sometimes I got over saturated with the chemo, chemo, chemo — cancer, cancer, cancer," said Radel. "I needed to read romance novels, watch funny movies, do something else. I had a great support system with my husband, friends, and family, and that really helped me get through it as well as I did."
Whether a woman is in her first, second, or third trimester at the time of cancer diagnosis is an important issue. During the first trimester no chemotherapy can be given because of the possibility of causing birth defects.
In the second and third trimester, chemotherapy can be given when necessary. "We are selective in which drugs we use," said Brawley, noting the most commonly used agents are ones such as Adriamycin and Cytoxan. The molecules of these drugs are too large to pass through the placenta, so it aids the mother and doesn't harm the baby.
"But we prefer to try to wait [to give chemotherapy], if possible," he said. "If I can do a mastectomy and everything looks good, and give the chemo after the child is born, I will," he said.
"If it's early in the pregnancy and the woman wants to keep the child," he said, "we prefer to do a mastectomy versus lumpectomy and radiation. We don't want to expose the child to six to eight weeks of external beam radiation. The mastectomy doesn't require the radiation. So that's the preferred treatment for women diagnosed early in pregnancy.
"If it's in the last trimester, we can induce labor," said Brawley.
Women taking chemotherapy cannot breastfeed, as it gets into the milk. "If she is past all treatments and she can produce milk, it's fine," he said.
A Friend Found, Hundreds Helped
In 1994 Radel met Mary Rose McDermott in the waiting room at Roswell Park Cancer Institute. McDermott was also pregnant, but they each thought the other was the caregiver, and that McDermott's mother and Radel's husband were the patients. When they both started their chemo treatment, they excitedly exchanged phone numbers. McDermott's son, Matthew, was born one day before Connor.
McDermott, who had had Hodgkin's disease during pregnancy, had a dream of helping other pregnant women with cancer. They met in Radel's kitchen in 1997 with Patty Murray, who also had had breast cancer during pregnancy. While their kids played in the next room, they brainstormed a support network, called Pregnant With Cancer.
Now with their Web site, they have assisted about 170 women in the last year, 100 of those with breast cancer. They've helped women from Russia, Nova Scotia, Bermuda, Aruba, and across the US. To give the best support from their network, they match women as closely as they can with their type of cancer, time of pregnancy, age, type of surgery, and chemo drug.
"In the beginning it was just us three," said Radel. "Sometimes we'd get a request that wasn't Hodgkin’s or breast cancer, so we couldn't support them. But now we also have non-Hodgkin’s, melanomas, thyroid, ovarian, cervical, all different types. So we can reach out to more women."
Usually the first question asked is, "How is your baby?"
Radel, McDermott, and Murray want pregnant women with cancer to know they can get through this.
"There's hope," said Radel. "If you choose to and can continue your pregnancy, it's possible. It's extremely possible and successful to take chemo and have surgery while you are pregnant, have a healthy baby and live — and beat the disease."