Pregnancy And Breast Cancer: Treatment Options And Risks

Breast cancer is the most common cancer diagnosed during pregnancy, occurring in about 1 in 3,000 pregnancies. The diagnosis of breast cancer during pregnancy presents unique challenges, not only because it affects the mother but also due to the potential risks to the developing foetus. However, with advances in medical science, it is possible to treat breast cancer during pregnancy safely, with treatment options tailored to the mother's condition and the stage of pregnancy. Understanding the treatment options and associated risks helps pregnant women make informed decisions that prioritise both their health and that of their unborn child.

The diagnosis of breast cancer during pregnancy

Breast cancer during pregnancy can be particularly challenging to detect early. The hormonal changes during pregnancy often cause the breasts to become denser, making it more difficult to detect lumps through self-examinations or mammograms. Additionally, breast changes such as tenderness, swelling, or lumps are often dismissed as common pregnancy symptoms. As a result, breast cancer in pregnant women is often diagnosed at a later stage, which can complicate treatment.

Pregnant women are encouraged to report any unusual breast changes to their healthcare provider, even if they seem pregnancy-related. Early detection improves treatment outcomes and reduces risks for both the mother and the baby.

Treatment options for pregnant women with breast cancer

Breast cancer treatment during pregnancy must consider both the mother's well-being and the safety of the foetus. The treatment plan depends on the stage of pregnancy, the type and stage of cancer, and the overall health of the mother.

1. Surgery

Surgery is often the first line of treatment for breast cancer during pregnancy. In most cases, a lumpectomy (removal of the tumour) or a mastectomy (removal of the entire breast) is performed to eliminate the cancerous tissue. Surgery is generally considered safe during pregnancy and does not pose significant risks to the foetus.

a. When is surgery recommended?

Surgery is most commonly recommended in the second trimester of pregnancy, as the risks to the foetus are minimal during this time. However, in urgent cases, surgery may also be performed during the first trimester.

2. Chemotherapy

Chemotherapy can be a life-saving treatment option for pregnant women with breast cancer, particularly after the first trimester. However, its use in pregnancy requires careful timing. Chemotherapy is not recommended during the first trimester when the foetus is developing organs, as it could lead to congenital abnormalities or pregnancy loss.

a. When is chemotherapy safe?

Chemotherapy is usually administered during the second and third trimesters, as the placenta helps protect the foetus from most chemotherapy agents. Common chemotherapy drugs used during pregnancy include cyclophosphamide and doxorubicin, which have been studied and shown to have minimal impact on foetal development in later trimesters.

3. Radiation therapy

Radiation therapy is generally avoided during pregnancy, especially during the first two trimesters, as it poses significant risks to the foetus, including growth retardation, malformations, or cognitive impairments. If radiation is necessary, it is usually postponed until after the baby is born, or in rare cases, used very cautiously in the third trimester with protective shielding.

a. Postpartum radiation

If needed, radiation therapy is typically started after delivery, especially if chemotherapy has been the primary treatment during pregnancy.

4. Hormonal therapy and targeted therapy

Hormonal therapy, such as tamoxifen, and targeted therapies like HER2-targeting drugs (e.g., trastuzumab), are not recommended during pregnancy because of the high risk of foetal damage. These treatments are usually delayed until after childbirth.

a. Timing of therapy

Hormonal and targeted therapies are postponed until the baby is born to prevent any harm to the foetus. After delivery, these therapies can be introduced as part of a postpartum treatment plan.

Risks to the foetus and mother

Treating breast cancer during pregnancy comes with risks to both the mother and the developing foetus. While many treatments have been adapted to minimise foetal harm, the specific risks depend on factors such as treatment type, timing, and the stage of the pregnancy.

Risks to the foetus

1. Preterm birth

Chemotherapy and surgery in the later stages of pregnancy may result in the need for early delivery. Preterm birth can lead to complications for the baby, such as respiratory distress, feeding difficulties, and developmental delays.

2. Congenital abnormalities

Certain treatments, particularly those administered during the first trimester, increase the risk of congenital abnormalities or pregnancy loss.

3. Growth restrictions

Some babies may experience intrauterine growth restriction (IUGR), a condition where the baby is smaller than expected for the gestational age, due to the impact of chemotherapy.

Risks to the mother

1. Delayed treatment

Concerns about foetal safety can sometimes lead to delays in cancer treatment, potentially allowing the cancer to progress.

2. Emotional impact

The psychological toll of managing cancer during pregnancy can be immense, requiring additional emotional and psychological support.

A breast cancer diagnosis during pregnancy is daunting, but it is not insurmountable. The key to improving outcomes lies in early detection, timely intervention, and personalised care that ensures the well-being of both mother and child. For women facing this challenging situation, it's important to work closely with a multidisciplinary team of healthcare providers, including oncologists, obstetricians, and paediatricians, to develop the best possible treatment plan. The advances in breast cancer treatment have given women a fighting chance against cancer, even during one of the most vulnerable times in their lives—pregnancy.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.