Breast Cancer and Pregnancy

Breast Cancer and Pregnancy

It is not common for a woman under 50 to have cancer, but it is not rare, either, and the frequency of cancer is increasing. Breast cancer and cervical cancer and precancer are the most common types. In the United States, there are approximately 3,500 cancer-complicated pregnancies each year.

Most women who have had cancer have an acutely heightened sense of their own mortality and fear that they may not live to see their child grown. For a woman whose overall prognosis is good, the increased risk of early death is not tremendous. However, each cancer survivor should visit this issue and come to peace with it. If you wish to get pregnant, consider these questions. Will your child have a support system that can sustain him if you should die? Are you in a stable relationship and will your partner be able to parent your child on his or her own? Many children lose their parents to illness, accident, or warfare; how the child fares depends on her or his support network. Michele’s sister Maureen died of cancer at age 31, leaving a daughter age 6 and a son age 3. Maureen had time to plan, and she left her children in the care of another sister, with whom they had spent much time during Maureen’s illness.

Every woman’s story is unique, but cancer almost never shows up at an expected and convenient moment.

Judy married young, and her son Tom was born when she was 24-Her life was good until she and her husband divorced when she was 30, after she found him with her best friend. Single parenting was difficult, but she managed. When Judy was 35, life took an unexpected turn for the good: she met Rob, an accounts executive in the insurance company where she worked. Rob was a widower in his late forties with two grown sons. After a cautious two-year courtship, Judy and Rob married. On their honeymoon, Rob found a little lump in Judy’s breast. Judy was nonchalant about it, telling him, «Oh, that’s just a little passing bump; it’ll go away with my period, I’m sure. I’m too young to have any real problem.» Rob, however, insisted that she see her doctor as soon as they returned home.

The following week, Judy had a biopsy, and cancerous cells were found. She then had a lumpectomy. Her lymph nodes were negative for spread of the cancer; she was given the option of follow-up radiation but decided against it.

Three years later, Rob lost one of his sons in a tragic skiing accident. Judy was as devastated as Rob, and after the initial period of shock, she suggested to Rob that they look into the possibility of having a child of their own, knowing that age and the history of cancer were complications that might make it impossible.

Judy’s oncologist and her obstetrician-gynecologist pointed out that Judy had been cancer free for three years and that her cycles had continued, uninterrupted, so there was no strong reason for her not to try to become pregnant. Judy was worried that the high hormone levels that occur during pregnancy might fan a recurrence of the cancer, but her oncologist said that the probability of that was low in her case. Judy’s own prognosis was good, based on her tumor type, and the available studies showed that women with similar histories had not been adversely affected by pregnancy. Of course, he qualified, women with poor prognoses had probably avoided pregnancy and this fact would not be reflected in these studies.

Judy and Rob stopped using contraception and set out to get pregnant.

We cannot advise you about your own particular risk; like Judy you need to consult with trusted professionals who know you and your situation in detail.

If Judy had had chemotherapy or radiation that had stopped her menstrual cycles and caused the changes of early menopause, her situation would have been different. If she had been taking tamoxifen, a drug which opposes the effects of estrogen, she would have needed to discontinue it prior to trying to conceive.

Judy conceived after three months of trying and was blessed with an uneventful pregnancy and delivery. She and Rob are now parents of a healthy daughter, Erin, who fills their days with joy. Judy is so thankful that she made the decision to become pregnant. She has also had no difficulty breastfeeding Erin, although her affected breast does seem to give less milk. The one dimming of her joy is that she will one day have to tell Erin that she herself is at greater risk of getting breast cancer.

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