Treating breast cancer during pregnancy is a delicate process. Doctors must balance caring for the patient’s health with concerns for the health and safety of the unborn child. Treatment options for breast cancer during pregnancy typically depend on the trimester of pregnancy and the stage of cancer. The most frequent treatments, however, include mastectomies and lumpectomies. When deciding whether or not to use chemotherapy, doctors must carefully weigh the benefits of this treatment versus the risk to the pregnancy. Sometimes cancer has progressed so far that treatment is unlikely to prolong the woman’s life significantly, and some women may choose to postpone treatment until they have given birth.
The stage at which breast cancer is diagnosed may influence how it is treated and the risks to the developing baby. Generally, it is easiest to treat breast cancer during pregnancy, without causing harm to the developing baby, when the cancer is in an early stage. Cancer that is found in an early stage may be treated with a mastectomy or a lumpectomy, both of which may be less dangerous for a developing baby than chemotherapy.
Doctors may recommend a mastectomy if stage I and II breast cancer is discovered in the first six months of a pregnancy. Though a lumpectomy may also be considered, a mastectomy may provide the best chance of preventing breast cancer’s spread when radiation treatment must be delayed because of pregnancy. As such, lumpectomies may be preferred for women who are in their last trimester of pregnancy and have less time to wait if radiation treatments are necessary.
If chemotherapy or radiation are necessary for treating breast cancer, care is usually taken in deciding when treatment should begin. If chemotherapy treatment cannot be delayed until after a woman is no longer pregnant, doctors may recommend starting it after the first trimester. At this point, there may be less risk of harm to the unborn child. If radiation treatment is required before child birth, there is significant risk to the baby, and parents and doctors may have a difficult time deciding how to proceed. Since radiation treatment isn't usually performed on pregnant women, termination or early delivery of the baby may be necessary.
Unfortunately, some breast cancers are diagnosed at such a late stage that waiting to begin treatment may not significantly change a woman’s prognosis. In such a case, she must decide whether to attempt treatment for breast cancer during pregnancy or wait until after she has given birth. This is a difficult decision that a woman may make based on the advice of her doctor.
