The stick was positive. You had been trying for months to get pregnant and finally, the little stick turned pink. Feeling the warm glow deep in your belly, you knew you had a little baby growing inside.
But then 3 months later, you felt a lump in your breast. You thought it was just a clogged milk duct, but after two weeks of cold cabbage leaves on your growing bosom, the lump did not go away. So you went to see the doctor, who performed an ultrasound of the lump. It was
a cancer. A needle biopsy confirmed the diagnosis.
Now what?
Won’t surgery harm my baby? Will chemotherapy?
Babies are resilient human beings and with the help of mother’s tender loving care, babies in-utero can tolerate breast cancer treatments pretty well. Chances are you will not need to put your unborn child at significant risk.
Surgery, the primary therapy for breast cancer is safe during pregnancy. The risk of miscarriage is small, smaller in the second or third trimesters than in the first trimester, but the risk of miscarriage is less than the risk of an untreated breast cancer.
What about a Sentinel Lymph Node Biopsy during pregnancy? Won’t the radioactivity of the test harm my child? Both the radioactivity (Tc99) and blue dye (Isosulfan Blue) used in a Sentinel Lymph Node Biopsy can be safely used without significant risk to your baby.
But chemotherapy will surely harm my child, won’t it? Most of the baby’s development is accomplished in the first trimester, by thirteen weeks. The last two trimesters are spent growing and getting stronger. While chemotherapy does kill cancer cells, the cells of your baby, after 13 weeks, are not readily affected by standard chemotherapy regimens for breast cancer.
After 13 weeks, the baby inside of you will remain safe, should you need to have chemotherapy to treat a breast cancer during this time period. There is a very small chance of miscarriage, but, in general, this risk is small compared to the risk of an untreated breast cancer.
What about tamoxifen? You may not need chemotherapy and just need tamoxifen. Unfortunately, tamoxifen and pregnancy don’t play well together.
Many babies will do just fine but there is enough clinical experience and animal models that point to an increased risk of congenital malformations in babies whose mothers took tamoxifen during pregnancy. The FDA gives tamoxifen a Category D, i.e. definite risk of tamoxifen during pregnancy and so tamoxifen should not be taken while one is pregnant.
Radiation therapy to the breast may be safe during pregnancy with proper shielding, but the potential risks are so great that no one recommends the administration of radiation therapy to a pregnant woman. Delaying radiation therapy until after pregnancy is safe, because radiation therapy does not need to be administered for 4 months after surgical excision and hence there is usually time to deliver your baby before needing to start radiation.
Being diagnosed with breast cancer is devastating, all the more so when you have a child growing in your belly. But breast cancer is treatable and we can treat breast cancer without harming your child, in most instances.
We can help you live a long, happy life and help you see your child graduate from school, get married and have their own children. We can help you reach your golden years, those blessed years when you shower love on your grandchildren.
