Pregnant women with breast cancer can be treated successfully

Chicago Tribune

Sarah Mital, a 35-year-old resident of New York was trying to get pregnant when she discovered a lump in her right breast.

The next month, at her annual OB-GYN visit, Mital was referred to Dr. Sharon Rosenbaum Smith, a breast surgeon at Mount Sinai West in New York to assess the lump.

Rosenbaum Smith diagnosed Mital with invasive ductal carcinoma in her right breast and ductal carcinoma in situ in her left breast after a series of scans and biopsies.

A week after the diagnosis, Mital learned she was pregnant.

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Worried about her health and that of the baby, Mital began a series of consultations with surgeons, medical oncologists and obstetricians/gynecologists to design a plan to treat her cancer while ensuring the delivery of a healthy baby.

Rosenbaum Smith stressed that surgery is completely safe during the second and third trimesters of pregnancy. During the first trimester, however, the organs of a baby are forming and any treatment is discouraged. Second- and third-trimester surgery is safe provided the anesthesiologist and surgeon work together to decide on the best timing and the safest anesthetics to use.

Mital had a lumpectomy in each breast and a sentinel node biopsy that showed that some cancer cells were detectable in the lymph nodes, but not enough to cause increased concern.

Every year 1 in 3,000 women in the U.S. will be diagnosed with breast cancer during pregnancy, according to the National Cancer Institute. Terminating pregnancies was encouraged in the past for women who were diagnosed with cancer. It's been learned that termination does not improve a mother's chance of surviving cancer, however, and no evidence exists to indicate that a mother's cancer harms a baby in utero.

Certain treatments can cause harm, but with physicians who have experience in treating pregnant women with breast cancer, individually designed plans of action can successfully treat cancer while keeping the baby healthy.

In 2015, a significant study was published in The New England Journal of Medicine comparing 129 babies born to women diagnosed with breast cancer who were treated during pregnancy with a similar group of babies born to women who did not have breast cancer. The study showed no difference in outcomes, including length of pregnancy, size and cognitive development of babies, and infant heart disease or malformation.

"With the proper team and attention, breast cancer diagnosed during pregnancy is treatable and beatable," said Dr. Ann Partridge, founder and director of the Breast Cancer Treatment Center at Dana-Farber/Brigham and Women's Cancer Center in Boston.

According to the American Cancer Society, although breast cancer in pregnant women is rare, it is the most common cancer diagnosed in women who are pregnant.

The risk is slightly higher for older women who decide to have a baby because the chance of being diagnosed with breast cancer increases with age.

The increase in breast density during pregnancy makes lumps harder to detect, and a diagnosis of cancer is often made later than it might be otherwise. Once a lump or other sign of breast cancer is discovered, though, the next steps are what will determine the outcomes for mother and baby. The ultimate goal is to control the cancer and keep it from spreading, while protecting the fetus.

The NCI noted that all treatment decisions are individual and the result of tests that show how quickly the cancer may be growing, how likely it is to spread, how well certain treatments might work and how likely it is that the cancer will recur. The prognosis, said the NCI, depends on the stage of the cancer, the type of breast cancer, the age of the unborn baby when cancer is diagnosed and the mother's general health.

Dr. Joanne Stone, director of maternal fetal medicine at Mount Sinai Health Care Systems in New York, said it's important for women to know that if breast cancer is diagnosed during pregnancy, they have options and safe treatments can be administered that don't adversely affect the outcome.

"Our job is to work with a team of doctors and to discuss these options with the patient to achieve the best possible results," said Stone.

Rosenbaum Smith recommended that Mital have an oncotype or genomic test that, for some cancers, can predict the chance of metastasis or the likelihood of the disease spreading to other organs. Based on the oncotype score and a range of other factors, a joint decision was made by Rosenbaum Smith and Dr. Tessa Cigler, Mital's medical oncologist, to give Mital chemotherapy during the second and third trimesters of her pregnancy. She received six rounds of chemo every three weeks.

While experts agree that chemotherapy is safe for pregnant women after the first trimester, radiation treatments to reduce the risk of the return of cancer should never be administered during a pregnancy.

At the end of March, Sasha Mital made a safe and healthy entrance into the world. In May, her mother began daily radiation treatments for a month. She will be followed for another year and will be taking hormone drugs for the next 10 years.

Because the risk of recurrence is highest in the near term, a woman who has undergone treatment for cancer during pregnancy will often remain on hormone treatment for two or three years. If she decides she wants to have another baby, her doctor would advise her to stop taking hormones, try to get pregnant and to resume hormone treatments after the baby's birth.

Partridge and Dr. Erica Mayer work together daily with women who are pregnant and have breast cancer at the Dana-Farber Cancer Institute's breast oncology center. They say the most important ingredient in delivering a healthy baby and curing a mother with cancer is to assemble an integrated team of experienced and collaborative colleagues who together and individually get to know their patients, because the decisions that have to be made involve fitting various pieces together in order to maximize the efficacy of the treatment for each patient. "Women need to know," says Partridge "that the evidence shows that pregnant women with breast cancer can be successfully treated."

Barbara Sadick is a freelancer.

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