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Breast Cancer in Pregnancy: Chemo OK

Researchers Say Aggressive Treatment Is Safe for the Babies of Pregnant Women
By
WebMD Health News
Reviewed by Louise Chang, MD

April 18, 2008 -- Facing a diagnosis of breast cancer is challenging enough, but facing breast cancer during pregnancy can be nothing short of devastating.

Can I have chemotherapy? Will the treatment hurt my baby? New research helps to answer these questions, and the findings should serve to reassure patients and their doctors.

In a German study examining outcomes among 122 pregnant breast cancer patients, researchers concluded that pregnant patients can often be treated as aggressively as non-pregnant patients, with little evidence of ill effects to their babies.

The findings were presented this week at the 6th European Breast Cancer Conference in Berlin.

Sibylle Loibl, MD, of the University of Frankfurt, tells WebMD that it is now clear that most pregnant breast cancer patients do have options.

"The evidence now shows that women who are pregnant are often good candidates for standard breast cancer treatments," she says.

Breast Cancer and Pregnancy

The patients in the study were enrolled in a registry of women diagnosed with breast cancer while pregnant.

All were diagnosed between April 2003 and December 2007. Their average age at diagnosis was 33 and the average gestational age of their babies was 21 weeks.

While a few women terminated their pregnancies, most did not, Loibl says. A total of 33% had surgery alone, 43% had surgery and chemotherapy, 5.4% had chemotherapy alone, and 2.7% had no treatment.

The health problems reported among the babies during their first month of life were generally minor and outcomes among babies born to mothers who had chemotherapy were similar to those of babies born to mothers who did not.

Loibl adds that some of the children in the registry have now been followed for five years, with little evidence of developmental delays or learning issues.

Chemotherapy During Pregnancy

Much of the pioneering research on breast cancer treatment during pregnancy has been done over the past two decades at Houston's University of Texas M.D. Anderson Cancer Center.

M.D. Anderson clinicians were among the first to treat pregnant women with standard chemotherapy protocols. Some of the children born to these women are now in their late teens, and oncologist Jennifer Litton, MD, tells WebMD they are doing quite well.

"There haven't been significant cardiac effects or learning disabilities," she says.

Chemotherapy is not given at M.D. Anderson during the first trimester of pregnancy, when vital organs are still forming and the risk of birth defects is highest.

"The birth defect rate is as high as 20% when chemotherapy is given in the first trimester, but that rate drops to around 1.3% when chemotherapy is given later," she says. "That is on par with the national average," she says.

Chemotherapy-treated patients usually get a combination of three drugs -- fluorouracil, doxorubicin, and cyclophosphamide.

The American Cancer Society estimates that about one in 3,000 pregnant women are diagnosed with breast cancer, and the number is expected to grow as more women have babies in their late 30s and 40s, says Litton.

Litton agrees that pregnant breast cancer patients usually do have options, but they may not hear about them unless they are treated at a major cancer center like M.D. Anderson.

"Studies like this one are getting the message out to community physicians, but it is slow," she says. "This is a case where seeking a second opinion may make a big difference."

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