During her pregnancy Sarah Williams began noticing changes in one of her breasts. Before conceiving she had undergone several in vitro fertilization (IVF) treatments, so she initially presumed the changes were just a side effect. Twenty weeks into her pregnancy doctors gave her the rare diagnosis of breast cancer.
Knowing the risks of cancer treatments, Williams, 40, began to worry. “I was 20 weeks pregnant and kept thinking, what about the baby?” Williams said. “I was terrified this would mean I would lose him or her.”
Although it is rare to be diagnosed with breast cancer during pregnancy, happening only about once in every 3000 pregnancies, such a diagnosis can cause extra stress and anxiety. The idea of undergoing treatments like chemotherapy can cause extra worry about the health and well-being of the unborn baby.
Screening for breast cancer can be difficult because the breasts swell and stretch, undergoing changes necessary to support a new baby. These changes cause breast tissue to grow larger and develop a more lumpy or bumpy texture as milk ducts form. This can make it difficult for pregnant women to notice a lump until it has become quite large.
Pregnant women with suspected breast cancer can safely undergo certain diagnostic procedures with minimal risk to the baby. Mammograms are an option if there are signs and/or symptoms of a breast problem. Although mammography does use radiation, the amount is considered small and the radiation is focused on the breasts, so other body parts are mostly avoided. Lead aprons help prevent radiation from reaching the pregnant belly.
Ultrasounds can be used to safely examine the breast tissue to evaluate a palpable lump. An ultrasound can identify if a breast lump is a harmless, fluid-filled cyst or a solid mass that might be cancerous. A follow-up mammogram can identify if the lump is or is not cancerous.
The best way to diagnose a lump is a biopsy. During pregnancy a breast biopsy can be performed as an outpatient procedure. A doctor numbs the breast and either removes a tissue sample with a needle or surgically removes the entire lump. Biopsies pose little risk to the unborn baby.
Because screening is more difficult during pregnancy, women who are diagnosed while pregnant are often in more advanced stage than women who are not and the cancer is more likely to have spread to the lymph nodes. Even though this is the case, pregnant women respond just as well to treatment as non-pregnant women of the same age and at the same stage and type of breast cancer.
Williams was one of those women. After her diagnosis, doctors devised a treatment plan to rid her of cancer while protecting her unborn son. During her pregnancy, she underwent five rounds of chemotherapy. “Although I felt in safe hands, it was the most terrifying experience of my life having chemotherapy while knowing I had this precious bundle of joy inside me,” she said.
Chemotherapy, radiation and hormone therapy are options that doctors try to avoid during pregnancy when possible, because all three can potentially harm the growing baby. Because a breast cancer diagnosis in pregnancy is rare, extensive studies in pregnant women have not been conducted for all treatment options. However, animal studies have shown certain options are harmful to the baby and should not be used.
Chemotherapy is not given during the first trimester because of the baby’s developmental stage and the increased risk of miscarriage during this time. It can be used the second and third trimesters, in certain cases and with certain chemotherapy drugs. Radiation therapy is not used during pregnancy because of increased risk of birth defects. If radiation therapy is needed, doctors wait until after the baby is born to administer radiation. Hormone therapy has also been linked to birth defects and so is not used in pregnant women. Targeted therapy uses drugs to treat breast cancer, but is also not safe during pregnancy so is not used until the baby is born.
Surgery is a major part of breast cancer treatment and in non-pregnant women can be used in combination with any of the other treatments options. Pregnant women can have surgery, then after they give birth have follow up with chemotherapy, radiation or any of the other treatment options.
In Williams’ case, doctors opted for chemotherapy to shrink the tumor during pregnancy and surgery right after she delivered. In October 2013 she delivered her son, Jacob via C-section and 30 minutes later had a mastectomy and lymph node removal. She had three additional cycles of chemotherapy and then radiation therapy. “Chemotherapy was a nightmare physically and mentally but it did the trick and, thankfully, reduced my tumor,” she said.
The now cancer-free Williams says she has a new appreciation for life. Being among the rare few who are diagnosed with breast cancer has made her thankful. “I feel so blessed now,” she said. “I can’t believe that just months ago all this was at risk. I have never valued life so much.”
By Brandi M. Fleeks