Study Finds Chemo Is Safe In Second Trimester
By Dan Childs
The spring of 2007 will forever stand out in the mind of 28-year-old Linda Sanchez of Laredo, Texas.
That was when she found out she was pregnant. But it was also in April 2007 that she learned she had breast cancer.
"It definitely was not expected," Sanchez recalled. "It was scary—it was very, very scary, actually."
She had noticed the lump in her breast herself, and by the time a doctor examined it, it had developed into stage 2 breast cancer. To delay treatment would put her life at risk. But doctors at the time told her that to go forward with chemotherapy could pose a health threat for the baby growing inside her.
"My gynecologist at the time, she told me that I was not going to be able to keep the baby," she said.
Sanchez is not alone. Dr. George Perkins, an associate professor in the M.D. Anderson Cancer Center's Department of Radiation Oncology, said a growing number of women face a breast cancer diagnosis while pregnant.
"In the midst of this joyous occasion is the somber news that there might not be hope for them," he said. "Usually … they have been told that the only way they can receive treatment is through the termination of their pregnancy."
But mounting evidence suggests that women in this situation do not necessarily have to decide between their own health and their baby's survival. The latest study to suggest this, which Perkins co-authored, was published today in the current issue of the journal Cancer.
Perkins, lead study author Dr. Beth Beadle and colleagues at M.D. Anderson studied 652 breast cancer patients. What they found was that there was no difference in the odds of surviving 10 years—widely considered as the point at which a woman can be considered cured of breast cancer—between the women who were not pregnant during or slightly before their diagnosis and those who were.
The primary difference in treatment, Perkins said, was that pregnant women should not undergo chemotherapy during the first trimester, as this is the time when the baby's organs are forming and they are particularly vulnerable. But past studies have shown that when chemo begins in the second or third trimester, the children that are born are just as healthy as babies born to mothers without breast cancer—and their mothers have the same chance of survival as their breast cancer-free counterparts.
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Perkins said that this is good news for those women who find themselves in a situation similar to Sanchez's.
"The overall outcome of the newborn child, as well as the mother, can be taken into account [during treatment]," he said.
'Minimal Harm to Baby' From Chemo Later in Pregnancy
Dr. Eva Singletary, associate director of M.D. Anderson's Nellie B. Connally Breast Center, said in an interview with ABC News' OnCall+ Breast Cancer resource site that it is true that women who are further along in their pregnancies can take advantage of chemotherapy.
"In the second and third trimester, we can use chemotherapy very successfully with minimal harm to the baby," Singletary said.
But, she added, if a woman already has a breast cancer diagnosis, it is still wise for her to avoid getting pregnant because of how it could possibly complicate treatment.
"It is important to use birth control, because chemotherapy can have harmful side effects to the fetus in the first trimester," she said. "However, in the second and third trimester, we can use chemotherapy very successfully with minimal harm to the baby.
Diagnosis During Pregnancy Becoming More Common
According to statistics from the American Cancer Society, breast cancer associated with pregnancy is rare, but it does happen in about one in 3,500 pregnancies.
And current trends suggest that this rate could be on the rise.
"We are noticing that we are seeing more patients being diagnosed with breast cancer during pregnancy," Perkins said.
The primary reason for this is that pregnant women, on average, are getting older. In 1982, the median age of a pregnant woman was 26.0 years; in 2002, this figure stood at 27.4 years.
"As the age at which child birth increases for women due to career goals and other reasons, we are expecting the incidence to increase," Perkins said. "We receive several phone calls a month from women who have been diagnosed with breast cancer and who are pregnant who have been told that overall they have an abysmal diagnosis."
When Cancer Goes Undetected
While the new study has good news to offer women who require breast cancer treatment while pregnant, it also exposes a disturbing fact—pregnant women with breast cancer tend to be diagnosed later than those who are not pregnant. This means that by the time their cancers are found, they are generally worse.
"Women who present with breast cancer while pregnant on average have more advanced disease," Perkins said. "This represents a phenomenon of delayed diagnosis. In many cases they don't find out that they have breast cancer until after delivery."
Part of the problem is the fact that pregnant women naturally experience changes in the breast. These expected changes may mask breast cancer symptoms, making detection less likely by both these women and their doctors.
"The natural tendency is to say that this is a benign process, and that we don't have to be concerned about it," Perkins said.
But Perkins added that he remains hopeful that as more evidence comes out that pregnant women have little to fear from cancer treatment, more will have stories similar to Sanchez's. On Nov. 26, 2007, her baby, Isabella, was born. And Sanchez said that thus far, her daughter is meeting all of the normal benchmarks for children her age.
As for her own health, Sanchez is looking forward to this June, when it will be a year since she was declared cancer-free.
"I don't really feel like a survivor yet, but everything looks good so far," she said.
Evidence suggests women do not have to decide between their own health and baby's survival.
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