This month is “Breast Cancer Awareness Month.” According to 2005 American Cancer Society estimates, 211,240 women developed breast cancer and 40,410 died from the disease that year. The risk for breast cancer rises with age and the lifetime risk for a woman developing the disease is 1 in 8. At age 20, the risk of developing breast cancer over the next 10 years is only about 1 in 2000, but by age 30 that risk increases to 1 in 200. Approximately 1 out of every 3000 pregnancies is complicated by breast cancer and, as a growing number of women delay childbearing into their 30’s, we are seeing an increase in this problem during pregnancy.
There are not too many of us that do not have our lives touched by breast cancer. Dr. Paul Auerbach (author of the Healthline blog Medicine for the Outdoors) and I went to medical school with a guy who had married his high school sweetheart. She was the ‘salt of the earth’ and stuck by his side in support, financially and emotionally, through college, medical school, graduate school, and post-graduate training. It is my understanding that, when they finally decided to start a family late in this process, infertility issues delayed things further. At this point she was in her mid to late 30’s. She finally conceived, and early in the pregnancy found out that she had breast cancer. I do not know the details of her treatment, options, or choices during the pregnancy, but I do know that she succumbed to the disease not long after giving birth to their daughter. I did not hear about this for some time after the fact, and to this day I have the same gut-wrenching feeling I had the first time, whenever I am reminded of this tragic event.
Breast cancer during pregnancy raises many issues and it is one of those conditions that can place the fetus and the mother at odds. What are the signs of breast cancer during pregnancy? How is the condition diagnosed? Does pregnancy make the diagnosis of breast cancer more difficult or less certain? Are the diagnostic procedures safe for my baby? Does pregnancy shorten my survival or worsen the chances for an optimal outcome from therapy? What are the options for therapy during pregnancy? What treatments are safest for the baby? When can those treatments be started during the pregnancy or is it safer to wait until after delivery? Does terminating the pregnancy help? Does delivering early help? Can breast cancer itself be transmitted to my baby? Can I breast feed my baby if I have had, or am undergoing treatment for, breast cancer? If I have had breast cancer treated before a pregnancy, will pregnancy increase the risk of recurrence?
In the memory of my friends above, and the tremendous love and respect they shared for each other, I will try to answer some of these questions in the next couple of posts…..