Pregnancy & breast cancer treatment: Empowering physicians to address common misconceptions

Dr Poovamma CU, Senior Consultant and Director- Breast Oncology at Cytecare cancer Hospital highlights some of the most common misconceptions regarding pregnancy after breast cancer

Breast cancer is the most common cancer among women, with the World Health Organization (WHO) reporting 2.26 million cases globally in 2020. Around 10% of these women are below the age of 40, and in their reproductive phase. Given the norm of later pregnancies among women today, there is a substantial number who get diagnosed before they have had a child.

With early diagnosis and timely treatment options available, breast cancer survivors can go on to lead wholesome lives. Addressing their reproductive intent is a big factor of that wholesome living. Previously held beliefs that pregnancy could bring the cancer out of remission or that conceiving post treatment could adversely affect the foetus are no longer true. The newer datasets indicate the need for a fresh approach towards addressing the reproductive intentions of breast cancer survivors, particularly by physicians.

Let’s look at some of the most common misconceptions regarding pregnancy after breast cancer:

Myth 1: Cancer treatment is not compatible with pregnancy

Traditionally, doctors have been advising women to terminate the pregnancy before opting for cancer treatment in the view that the treatment is not safe for the development of the foetus, or that the pregnancy itself will aggravate the cancer. Both these beliefs are being questioned by new research, which indicates that treatment might not necessarily have a negative impact on the foetus. Also, that pregnancy might itself be a factor slowing the cancer. It is believed that childbirth can reduce the risk of breastcancer.

Myth 2: Pregnancy, post treatment, may cause the cancer to return.

There is no scientific evidence to prove this. Data from breast cancer survivors who have undergone pregnancy post treatment does not support the claim.

Myth 3: Post treatment pregnancy might impact the foetus adversely.

Data from breast cancer survivors does not support this claim either. A planned pregnancy, with atleast a few months between the end of treatment and the attempt at conception, should hold good for most cases.

Myth 4: There are risks associated with breastfeeding post cancer treatment.

Data collected from studies on women who had pregnancies post breast cancer indicate no adverse impact of breastfeeding on either the mother or the infant. In fact, researchers even recommend women breastfeed from the affected breast, if possible. The hindrances could be access to the breast because of the extent of surgery and dose of radiotherapy. Mothers, in fact, need to be reassured about the nutritional benefits of breast milk and encouraged to breastfeed.

Making informed decisions

In the light of new evidence, physicians and healthcare providers need to be empowered to provide the right guidance, backed by the latest scientific findings. While studies are still limited, the overall indication of the safety of reproduction during and post treatment is clear. Cases need assessment on individual basis, and termination of pregnancy before undergoing cancer treatment should not be the only option.

It’s important to note that some treatment could impact the patient’s fertility. The woman might undergo premature ovarian failure from depletion of ovarian follicles or may not be able to carry a pregnancy secondary to radiation-induced uterine fibrosis or hysterectomy. In addition, patients may develop disruption of the hypothalamic-pituitary-gonadal axis that regulates sperm production and oocyte maturation following cranial surgery or irradiation that involves the pituitary gland.

In such cases, patients need to be made aware of other options, such as:

1. Embryo freezing: The embryos created by in vitro fertilisation (IVF) can be frozen till the patient is ready for pregnancy.
2. Ovarian tissue freezing: An avant-garde technique that involves re-implantation of tissue or in vitro maturation of primordial follicles; about 25 children have been born world-wide after re-implantation of tissue.

There is need for more research in the area of addressing reproductive intent post breast cancer, but with better and longer survival of patients, and advances in ante natal healthcare, there are several possibilities of motherhood for breast cancer survivors. Indeed, the possibility of being able to have a child after recovery is a big encouragement for many women to undergo treatment.