Pregnancy and breast cancer present unique challenges. This article clarifies the relationship between breast cancer and pregnancy, covering fertility, risks, and management strategies.
Pregnancy with Breast Cancer: The Possibility
Conception is possible with breast cancer, though generally not advised due to complexities. The cancer itself doesn’t prevent conception, but treatments pose substantial challenges. These include risks to the developing fetus from therapies and prioritizing maternal treatment. Medical professionals typically recommend avoiding pregnancy during active breast cancer treatment.
Fertility and Breast Cancer Treatment
Breast cancer treatments can significantly affect fertility. Chemotherapy, a common treatment, may damage ovarian function and egg quality, potentially leading to premature menopause or infertility. The impact depends on factors like specific drugs, dosage, duration, and the woman’s age.
For instance, some chemotherapy regimens, such as anthracycline- and taxane-based treatments, can compromise ovarian reserve. Hormone therapies, often prescribed for hormone receptor-positive breast cancers, also impact fertility by blocking estrogen production or its effects, which are necessary for ovarian function and ovulation. These therapies are typically taken for several years, often coinciding with a woman’s reproductive years.
Radiation therapy, if targeted at areas beyond the breast that include the pelvis, can also affect ovarian function. However, when radiation is focused solely on the breast, its impact on fertility is generally considered low because the ovaries are not directly exposed to significant radiation doses.
Given these potential fertility impacts, discussing preservation options with a healthcare team before starting treatment is important. Options include egg freezing (oocyte cryopreservation) and embryo freezing (in vitro fertilization or IVF), where eggs or fertilized embryos are collected and stored for future use. Ovarian tissue freezing is another method, particularly for those needing urgent treatment or for younger patients, where ovarian tissue is removed and later re-implanted. Additionally, some medications, like gonadotropin-releasing hormone (GnRH) analogs, may be used during chemotherapy to temporarily suppress ovarian function, potentially protecting the ovaries from damage.
Risks and Considerations During Pregnancy
Pregnancy in the presence of breast cancer carries distinct risks for both the mother and the baby. For the mother, diagnosing breast cancer during pregnancy can be challenging due to normal pregnancy-related breast changes, potentially leading to a delayed diagnosis or an advanced stage at detection. Managing treatment during pregnancy also presents complexities, as some therapies, like hormone therapy, targeted therapies, and immunotherapy, are not recommended due to potential harm to the developing baby and are often postponed until after delivery. Chemotherapy is typically avoided in the first trimester due to the risk of fetal malformations but may be considered safer in the second and third trimesters, though it can still increase the risk of complications such as prematurity or low birth weight. Psychological stress on the mother is also a significant consideration, balancing cancer treatment with concerns for the pregnancy.
For the baby, the primary concern revolves around exposure to certain medications if treatment is ongoing during pregnancy. While some chemotherapy drugs can be administered in the later stages of pregnancy, there is a risk of prematurity and lower birth weight. Breast cancer itself does not typically spread to the fetus, and cancer cells do not pass from the mother to the baby. The placenta is usually examined after birth to rule out rare instances of cancer cell presence there. General pregnancy risks, such as preterm delivery and the need for a cesarean section, might be slightly increased in women with a history of breast cancer.
Navigating Pregnancy After a Breast Cancer Diagnosis
Navigating pregnancy after a breast cancer diagnosis requires careful planning and a multidisciplinary approach involving oncologists, obstetricians, and fertility specialists. For individuals diagnosed with breast cancer while already pregnant, treatment plans are adjusted to prioritize both maternal health and fetal safety.
Surgery, such as a lumpectomy or mastectomy, is generally considered safe throughout pregnancy, with modifications to anesthesia as needed. Chemotherapy, if necessary, is typically deferred until the second or third trimester to minimize risks to the developing baby. Radiation therapy and hormone therapy are usually delayed until after delivery due to potential fetal harm. A team approach ensures that treatment is tailored to the specific type and stage of cancer, as well as the progression of the pregnancy.
For those planning a future pregnancy after completing breast cancer treatment, medical professionals often recommend a waiting period. This waiting period is typically around two years after treatment ends, as this timeframe allows for monitoring for any early recurrence of the cancer, which is most likely within the first two years post-diagnosis.
For women with hormone receptor-positive breast cancer on long-term hormone therapy, pausing this treatment to attempt pregnancy may be considered. Recent research suggests that temporarily interrupting endocrine therapy for approximately two years to conceive may be safe for some early-stage breast cancer patients, without increasing the risk of cancer recurrence. After pregnancy, hormone therapy can often be resumed. Continuous medical supervision, including ongoing monitoring for cancer recurrence and assessment of fertility status, is important for individuals considering or undergoing pregnancy after a breast cancer diagnosis.