Treatment Options During Pregnancy

When you're pregnant, finding out that you also have breast cancer is overwhelming. At the same time that you're hoping to bring a new life into the world, you enter into a fight to protect your own life. You may be concerned that the treatment you need could harm your baby. Or you may worry that treatment won't be as effective if you're pregnant.

It's true that the breast changes that normally go along with pregnancy can disguise the symptoms of breast cancer. As a result, the diagnosis might be delayed or even missed. But research has shown that women diagnosed during pregnancy respond just as well to cancer treatment as similar women, with cancer at the same stage, who are not pregnant.

In the past, women were sometimes counseled to end their pregnancies when they found out they had breast cancer. But this advice is less commonly given today.

Still, pregnancy can affect decisions about the cancer treatment you get.

Surgery and radiation

Surgery is OK for you and the baby during pregnancy. But the decision about what type of surgery to have may become more difficult. In general, breast removal (mastectomy) is recommended if:

• the breast cancer is large
• there are multiple cancers in the same breast
• you want to lower the risk of the cancer coming back in the same breast

If you have early-stage disease and want to keep your breast if at all possible, then lumpectomy with clear margins is an option, followed by chemotherapy if indicated. Radiation to the remainder of the breast is also necessary after lumpectomy.

But radiation is not recommended at any time during pregnancy. So you would have to delay radiation until after chemotherapy is done (if recommended) and the pregnancy is over.

After mastectomy, you're less likely to need radiation therapy.

If you don't feel comfortable postponing radiation and would like to get the surgical part of your treatment over as soon as possible, you might opt for mastectomy instead of breast-conserving therapy, regardless of the cancer stage. If it's more important to you to preserve the breast and you have small, early-stage disease, you may opt for lumpectomy, knowing that you'll have to have radiation therapy after the pregnancy is over.

Even if you have a breast removed, you'll probably be able to breast feed your baby, if you decide to do so.

Chemotherapy

Chemotherapy can cause birth defects if you receive treatment during the first three months (first trimester) of your pregnancy, when the embryo's organs are forming.

If you are only in the first few weeks of pregnancy and your stage of disease requires immediate chemotherapy, your doctor may recommend that you end the pregnancy.

If you are further along in your first trimester and your stage of cancer is favorable, your doctors will likely delay any recommended chemotherapy until the start of the second trimester (the fourth month of pregnancy).

Tamoxifen

Tamoxifen is not recommended at any stage of pregnancy. If it's included in your treatment plan, it should be postponed till after the pregnancy is over.