Pregnant women can be treated for cancer 'without harming baby'
PREGNANT women who develop cancer do not have to abort their baby, delay their own treatment or give birth prematurely as chemotherapy does not harm the child, a collection of studies has found.
There are thought to be hundreds of women each year diagnosed with cancer while they are pregnant who face an agonising decisions over the best course of action.
In some cases women opt for an abortion, particularly when they are in the early stages of pregnancy and if the cancer is very aggressive.
Others risk their own survival by refusing treatment until after the baby is born.
A collection of research studies published in a special edition of The Lancet medical journal has offered reassurance for women as it was found that chemotherapy treatment after the first trimester does not harm the unborn child.
Up to one in 2,000 pregnancies is affected by cancer and this rate is increasing by 2.5 per cent a year as women have children later in life and cancer cases are rising.
An a comment article in the journal, researchers Philippe Morice, Catherine Uzan, and Serge Uzan of the Department of Gynaecologic Surgery, at the Institute Gustave Roussy, in France said: "Treatment of malignancy in pregnancy is still associated with unacceptable errors: eg, the sometimes unjustified termination of pregnancies or the choice of an inadequate strategy for treatment of a tumour with the risk of compromised survival."
Lead author on two of the studies, Dr Frédéric Amant, at the Leuven Cancer Institute, in Belgium, said: “The situation remains challenging since in some situations an advanced cancer can be fatal for mother and foetus.
“In other situations we were able to save the child though we lost the mother immediately after the delivery, for example by keeping her alive with a terminal brain tumour. Sometimes the woman’s partner declares that they feel unable to raise the child in case the mother would not survive her cancer and termination of pregnancy is opted for.”
“Importantly, the new insights we gained during our research facilitate cancer treatment and provide hope for mother and child in most cases. Most mothers feel stronger and are even more motivated to undergo the cancer treatment and its side effects, since she is fighting for her child as well.
“Whether the patient already has children, her desire to continue the present pregnancy, the opinion of the partner and the predicted outcome determine her choices and reactions when breast cancer is diagnosed during pregnancy. The patient and her partner should be informed about the different treatment options and the physician should explain that termination of pregnancy does not seem to improve maternal outcome, but the decision to continue or end the pregnancy is a personal one.”
Researchers in Belgium followed up 70 children whose mothers were treated with chemotherapy while they were in the womb.
They were found to have normal development, IQ, hearing, heart function and general health. Those who were born prematurely had lower IQ scores, which is thought to be connected to the early birth rather than the drugs as this is seen in babies not exposed to chemotherapy, the researchers said.
The findings suggest early delivery so the mother can begin chemotherapy may affect the baby's health, the researchers said.
The study was published in Lancet Oncology.
Lead author Dr Amant said: "We show that children who were prenatally exposed to chemotherapy do as well as other children.
"Our findings do not support a strategy of delay in chemotherapy administration or iatrogenic (ie physician induced) preterm delivery with post-partum chemotherapy administration to avoid harm to the fetus.”
“The decision to administer chemotherapy should follow the same guidelines as in non-pregnant patients. In practice, it is possible to administer chemotherapy from 14 weeks gestational age onwards with specific attention to prenatal care.”
The study added that longer term follow-up of the children is necessary to identify if there are any fertility issues or increased risk of cancer from chemotherapy drugs that damage DNA.
One twin in the study did have significant neurodevelopmental problems and it cannot be ruled out that this was connected to the chemotherapy, the researchers said, however they thought it unlikely due to the exact nature of the issues.
There were also six children who showed differences in their intelligence and behavioural scores but the cause of this needs further clarification, experts said.
A commentary by Dr Elyce Cardonick, of the Department of Obstetrics and Gynaecology, at Cooper Medical School of Rowan University, said: “This study can reassure pregnant women, and their physicians, that the benefits of maternal treatment do not seem to be outweighed by any long-term consequences for the exposed fetus with regards to cardiac or neurological function. Behavioural and emotional issues need further clarification and follow up.
"If we can present this reassuring data to pregnant women with cancer, women might be more likely to accept treatment during pregnancy when indicated."
An article on breast cancer in pregnancy in The Lancet by Dr Amant and others said terminating a pregnancy does not improve the mother's prognosis and that in most cases normal treatment can be used.
Pregnancy can mask many of the signs of breast cancer meaning it is more likely to be diagnosed at a later stage, he said.