Breast Cancer Treatment Safe During Pregnancy
Mothers and infants can both do well, new research suggests
FRIDAY, June 23, 2006 (HealthDay News) -- Some 3,000 pregnant women in the United States are diagnosed with breast cancer each year, and many worry about the effects cancer treatment could have on the fetus.
But a new study finds that, in most cases, those fears may be unfounded.
"Treating women who have breast cancer diagnosed while pregnant can result in happy mothers and the expected outcome of a healthy baby," said Dr. Richard Theriault, a professor of medicine at the University of Texas M.D. Anderson Cancer Center, Houston.
Theriault and his colleagues have been tracking the health of 57 pregnant women diagnosed with breast cancer. He presented the findings to reporters Thursday at an American Medical Association news briefing in New York City. The study is expected to be published soon by a major cancer journal, Theriault said.
In the past, cancer treatment during pregnancy meant a grim dilemma: not treating the cancer and risking the life of the mother, or treating the cancer and risking the health of the baby, Theriault said.
"The attitude we hear most often is, 'we can't treat the cancer because of the pregnancy,' " Theriault said. Doctors then offered patients one of two options: "Delay the treatment, or terminate the pregnancy, so we can treat it. But terminating the pregnancy doesn't improve the mother's outcome. It does, however, obviate the concern about fetal outcomes."
Things have gotten better for both mother and child, however, Theriault said.
"Breast cancer during pregnancy can be treated successfully," Theriault said. "So, there is hope. The delivery of healthy babies is an expected outcome. [In the study] we have 64 consecutive live births with no stillborns. The outcomes are not different from other high-risk groups."
Among the 57 patients, deliveries occurred between 37 weeks and 42 weeks of gestation, and mean birth weight of the babies was 6.4 pounds. Fifty-seven percent of the women had a vaginal delivery, Theriault said. Thirty-nine percent had a Caesarian delivery, he said.
Sixty-three percent of the infants had no neonatal complications, the Houston doctor said. One child was born with Down's syndrome and another with a clubfoot, neither related to chemotherapy.
"Among the mothers, 75 percent are alive without breast cancer recurrence," Theriault said. In addition, there appeared to be no difference in outcome among women with breast cancer who were pregnant compared with those who were not pregnant, he said.
The bottom line, according to Theriault: "Termination of pregnancy is not required to provide treatment and has no benefit in the perspective of the cancer."
That doesn't mean that a woman's pregnancy has no impact on her breast cancer treatment, however. Theriault said radiation therapy remains the one intervention that can't be used, since it can adversely affect the fetus. Mastectomy is the most common breast cancer treatment for pregnant patients, because most pregnant women are diagnosed in an advanced stage of the disease. Breast-conserving "lumpectomy" surgery is also possible for some women, Theriault added.
Radiation, if needed in addition to surgery, can be postponed until after the baby is born, the Houston expert said. And women can receive chemotherapy during pregnancy, but, "we usually try to time our chemotherapy, so the last cycle will end three weeks before delivery," Theriault said. "We try to avoid the potential for low white-blood-cell count, low platelet counts or anemia," he added.
"This is a very important paper," said Dr. Carolyn D. Runowicz, president of the American Cancer Society and director of the Carole and Ray Neag Comprehensive Cancer Center, University of Connecticut Health Center.
Runowicz noted that newer, highly-targeted cancer therapies probably would not be appropriate for pregnant patients because of their potential effect on the fetus. "There are so many similarities between cancer and pregnancy," she said. "We could learn a lot about cancer by understanding pregnancy. But we have to be really careful about some of these targeted therapies that we don't target a growing baby as well as a cancerous tumor," she added.
At the same briefing, experts described how targeted therapies in lung cancer have moved away from toxic chemotherapy to medications that can be taken as relatively nontoxic pills. In some patients, this approach was just as effective as standard chemotherapy in shrinking tumors and boosting survival. The drawback, however, was that these treatments are only useful in patients with certain genetic profiles.
Another presentation dealt with medications used to stop the growth of the blood vessels that tumors rely on to survive, a process called angiogenesis. Animal experiments showed that it is possible to target a protein in cancer tumors called VEGF to reduce the size of tumors, even in cancers that have spread to other parts of the body.
However, the same drugs can target VEGF in healthy cells, and it also appears the cells can become resistant to these drugs and allow bigger blood vessels to grow to feed cancer cells, the researchers said.
Runowicz said she remains optimistic about the future of cancer treatment.
Highly targeted treatments means that specific patients can get drugs that are especially effective against their particular cancer, Runowicz said. "We will be able to use the drugs that work," she added.
But preventing cancer remains an even more important strategy. "It's far better not to get the disease," Runowicz said. "We can reduce cancer by simple things like diet, exercise and stopping smoking," she said.
For much more on breast cancer, head to the American Cancer Society.