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One out of every 1,000 pregnant women have cancer. It’s a situation that oncologists and OB/GYNs don’t often encounter, and one that can leave many women feeling very scared and alone, says Susan Musialowski, the patient coordinator for Hope for Two: The Pregnant With Cancer Network.
“I think until it is something that crosses your own path personally, people don’t think about it,” says Musialowski. “Many doctors only experience a few cases in their entire careers and so women feel like they are the only ones in the world going through it.”
Hope for Two has been working to change that since 1997, matching 80 to 100 women per year with other “support women” who are going through or have already gone through a pregnancy during cancer. Their website is packed with research, resources, and inspiring photos of cancer survivors holding their newborn children. Their key goals are to educate and provide support, says Musialowski.
“There are so many misconceptions regarding cancer during pregnancy,” says Musialowski.
Dr. Elyce Cardonick, a professor of obstetrics and gynecology and specialist in maternal-fetal medicine at Cooper Medical School of Rowan University, has been working with Hope for Two to help them dispel these misconceptions. Cardonick run the Pregnancy and Cancer Registry, which tracks outcomes and trends worldwide for pregnant women undergoing cancer treatment.
Here are the three biggest myths regarding cancer in pregnancy Cardonick and Hope for Two encounter the most:
Myth 1: Pregnant Women With Cancer Should Always Terminate
Many women falsely believe that a cancer diagnosis automatically means they have to choose between their health and the life of their unborn child. Even some doctors are misinformed on this issue, says Musialowski.
“Some women are still seeing doctors that are saying, ‘You have to terminate before I will treat you,’” says Musialowski. “That is unfortunate because that is not true in most cases.”
Research has shown that whether or not a woman continues her pregnancy or decides to terminate does not impact her prognosis, says Cardonick. In addition, many women have gone on to have healthy pregnancies and babies despite a cancer diagnosis, says Cardonick.
“Only about 20 percent of patients that are diagnosed with cancer during their pregnancy are advised to terminate,” says Cardonick. “It really just depends on the comfortable level of the doctor and the type and stage of cancer.”
Myth 2: Cancer Treatment Is Not Safe During Pregnancy
In a world where women are told to skip deli meat and aspirin while pregnant, it might be shocking to learn that chemotherapy and other treatments have been proven to have little to no impact on the health and development of an unborn child. A recent multicenter case-control study published in the New England Journal of Medicine 1 compared children whose mothers received a diagnosis of cancer during the pregnancy with matched children of women without a cancer diagnosis and found no significant difference in cognitive, cardiac, or general development, regardless of whether or not the women underwent treatment for cancer.
Many studies confirm these types of findings, says Cardonick, although there are limitations.
“In the first trimester, we try and avoid chemotherapy, but patients can have surgery in the first trimester, and patients with brain tumors can even have radiation in the first trimester because the fetus and the brain are so far apart that the radiation exposure is really be limited,” says Cardonick. “In the second and third trimester prior to 34 weeks, certain chemotherapy agents are not going to harm the baby and can help treat the mother’s cancer.”
In certain types of cancer, patients may also have the option to delay treatment until after the birth of the baby.
“You might have a patient that has Hodgkin’s disease that is 28 weeks pregnant and the doctor may say, ‘Even if you weren’t pregnant I would be comfortable waiting 10 weeks to treat you,” says Cardonick. “I tell patient to ask their oncologist, ‘If I were not pregnant based on my tumor right now how would you treat me and what wiggle room is there?’ If they wouldn’t wait to treat a non-pregnant patient in the same condition they shouldn’t wait to treat a pregnant one.”
In some cases, not treating can actually be more dangerous to the baby than treating.
“Patients always think no medicine is better, but you have to explain that their uncontrolled cancer could be as high-risk to their baby as the treatment exposure. If the mom is not kept healthy that is not good for the baby either,” says Cardonick.
Patients should seek a second opinion if they are not comfortable with their oncologist’s recommendation of no treatment or delayed treatment, she advices.
Myth 3: Women of Reproductive Age Don’t Get Cancer
Sometimes cancer warning signs are similar to common pregnancy symptoms, resulting in a delayed diagnosis. A breast mass, swelling, or lumps under the arm, are likely to be attributed to pregnancy, when they may actually be the result of breast cancer; the most common type of cancer experienced by women who are pregnant, says Cardonick.
Abdominal pain and bleeding — signs of colon cancer — are also often attributed to hemorrhoids and constipation in pregnant patients, as these can be common pregnancy symptoms.
In addition to these similarities, many women and doctors falsely assume that women in their childbearing years are too young to get cancer, and don’t consider it until everything else has been ruled out.
“If someone has a breast mass or a darkening mole and they are younger and pregnant, cancer isn’t the first thing that comes to mind for many doctors,” says Cardonick. “For a doctor, if they would normally be suspicious of a mole or lump or rectal bleeding in a non-pregnant patient, they need to be suspicious of it in a young and pregnant patient. Women often get misdiagnosed or get a delayed diagnosis because they are pregnant.”
However, in some cases it is the pregnancy itself that leads the women to discover they have cancer.
“The good thing is that prenatal care often brings patients in that wouldn’t necessarily be coming in and sometimes these things get caught earlier than they would have otherwise,” says Cardonick. “Eventually, even when cancer is misdiagnosed initially, it is caught because these women keep coming back to the doctor for prenatal care.”
Amant, F, Vandenbroucke T Verheecke M “Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy” New England Journal of Medicine ClinicalTrials.gov number, NCT00330447