By: Dr Nupur Gupta
Motherhood is a boon for many women but it may also be sifted with the fear of developing breast cancer. When a breast cancer is diagnosed during the pregnancy or in the first year postpartum, it is termed as Pregnancy-associated breast cancer (PABC). While this ailment remains the second most common cause of malignancy to be profound among women in the reproductive age, is recorded to affect one in 3000.
With the current trend among the working parents to delay parenthood, the chances and risk associated to PABC are very high. postponing conception attributes to a rampant increase in breast cancer rates and are expected to go high in the coming times.
The initial diagnosis
While a pregnant woman can be diagnosed with breast cancer in the initial stages, during her first trimester, the doctors may perform physical breast examination and monitor through self-assessment throughout the pregnancy term.
Doctors may find a palpable lesion or thickening of the breasts, which may arise suspicion and opt for further radiology tests. Though pathologies in over 80% of the cases are reported to be benign, a complete breast ultrasound may help to characterize the lesion features and are a successful tool in identifying the masses in case of PABC. As some pregnant women may be diagnosed with advanced stage of breast cancer, further evaluation is done to monitor the potential metastasis (spread to other organs) to the lungs, bone and liver.
The following tests should not be carried during pregnancy –
- Gadolinium enhanced MRI –Though Gadolinium enhanced MRI, have not reported to have any adverse effects on the foetus, it is not a recommended test for pregnant women, until serious medical complication.
- Tumor Marker tests – Certain tumor marker tests may be misleading a breast tumor during pregnancy and thus are not at all recommended. Such tests are used only to confirm advanced stages of breast cancer.
- Pelvic CT or X-ray –Due to the possible effects of the radiation on the fetus in the womb, certain radiological tests like X-ray, Pelvic CT or bone scanning are also not recommended.
Planning your delivery amid PABC
While it is observed that most of the pregnant can complete the full term of the pregnancy and opt for normal or induced delivery. But if the mother is on chemotherapy sessions, then the treating surgeon will suggest for atleast a time period of 2 to 3 weeks for delivery after the last session of chemotherapy is over. This is done in a mutual consultation of the oncologist, breast cancer surgeon and the obstetrician. Certain drug induced treatment may require atleast three months gap before trying to conceive so that the half-life of the drug is finished. Routine imaging is advised in such cases to the couple trying to conceive.
How is it treated
Over the last decade, even though there is a rise in incidence of breast cancer, but with awareness, access and changing paradigms in cancer care, the mortality rate has come down gradually.
Even though symptoms may not be persistent while diagnosing and sometimes screening may be done at early stages which may require different treatments and therefore the specialist may prescribe the best suitable treatment. Though treatment for breast cancer has undergone major breakthroughs, its cure and treatment solely depend on the grade and stage at which it has been diagnosed. Based on this, you will be advised to undergo one of these treatments, or a combination: Surgery, radiotherapy, chemotherapy, hormone therapy and biological therapy (targeted therapy).
Depending on the severity, size and spread of the lesions, there are certain treatment modules available including –
- Surgical intervention – Medically known as mastectomy, this is considered in advanced cases when the lesion has spread completely. This can be done in one or both the breasts to avoid the risk of metastasis/ recurrence. While treatment in initial stages include medication, chemotherapy, surgical intervention is the last resort option.
- Radiotherapy – Due to the risk of effects of radiation, this is contraindicated until delivery term, but may be used in case of life saving event.
- Chemotherapy – Systemic chemotherapy thus may be avoided in the first trimester, needs to be provided to the affected patients, with the onset of the second trimester.
Awareness should be created among the masses to get most breast cancers detectable at early stages, as most women with breast cancer arrive with advanced disease. In metastatic or advanced stages of cancer, it isn’t completely curable, and the treatment aims to achieve remission (where the tumor shrinks or disappears).
The writer is Director – Obs & Gyneocologist, Well Woman Clinic
