Treatment for Breast Cancer During Pregnancy

Getting diagnosed with breast cancer during pregnancy isn’t common. But for people who are diagnosed at any stage of their pregnancy, receiving excellent breast cancer treatment during pregnancy is possible and very important.

The National Comprehensive Cancer Network (NCCN) — a group of 33 leading cancer institutions in the United States — developed guidelines for treating breast cancer during any stage of pregnancy. There are guidelines for treating breast cancer during the first trimester and guidelines for treating breast cancer during the second or third trimesters. Hundreds of institutions around the world use these guidelines.

NCCN guidelines do not recommend that people end their pregnancy if they are diagnosed with breast cancer during the first trimester. But the guidelines recommend that doctors discuss this possibility with anyone who is diagnosed in the first three months of pregnancy if surgery is not possible, urgent chemotherapy treatment is needed, or both. It’s important to consider all the available options when making a decision.

Breast cancer treatment can include mastectomy or lumpectomy, axillary lymph node dissection, chemotherapy, radiation, hormonal therapy, or targeted therapy.

The guidelines recommend mastectomy with axillary lymph node dissection for anyone who decides to continue their pregnancy.

Chemotherapy is not considered safe during the first trimester of pregnancy but is considered relatively safe beginning in the second trimester. If you need chemotherapy after surgery, your doctor is likely to recommend waiting until you finish the first trimester.

Radiation, hormonal therapy, and targeted therapy are not considered safe during any stage of pregnancy.

Because radiation therapy typically follows a lumpectomy and radiation is not considered safe during pregnancy, a lumpectomy might not be an option for anyone diagnosed with breast cancer while pregnant.

The guidelines for treating breast cancer diagnosed in the second and third trimesters recommend chemotherapy before or after surgery. After surgery, doctors should wait until you give birth before treating the breast cancer with radiation, hormonal therapy, or targeted therapy.

The guidelines note that breast cancer found during the second and third trimesters of pregnancy has been safely treated with combinations of these chemotherapy medicines:

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  Adriamycin (chemical name: doxorubicin)

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  Cytoxan (chemical name: cyclophosphamide)

The NCCN acknowledges that there is limited information about the safe use of taxanes (a class of chemotherapy medicine) to treat breast cancer during pregnancy. However, doctors can treat the breast cancer with a weekly dose of the taxane Taxol (chemical name: paclitaxel) starting in the second trimester.

After chemotherapy, doctors should wait until you give birth before treating the breast cancer with radiation, hormonal therapy, or targeted therapy — if those treatments are recommended.