- Up to 1 in 1,000 pregnant women receive a cancer diagnosis each year in the United States, reports the ACS.
- Patients in states with anti-abortion laws may face challenges accessing radiation therapy, chemotherapy, or other treatments that can negatively affect fetal development and potentially cause miscarriage.
- Multiple organizations including the American Cancer Society have issued statements urging lawmakers to protect cancer care access for pregnant patients.
In June 2022, the Supreme Court of the United States (SCOTUS) overturned the landmark Roe v. Wade decision that granted a constitutional right to abortion. Since then, many states have implemented new laws to restrict abortion access or ban abortion nearly entirely.
These laws not only limit reproductive autonomy but may also affect some individuals’ ability to access treatment for certain health conditions—including cancer.
“Legislation that restricts reproductive rights is affecting cancer care,”
“In addition to the cancer patient and oncologist, we’ve now got a third party in discussions around cancer care—and that’s the government,” she said.
In particular, patients in states with anti-abortion laws may face challenges accessing radiation therapy, chemotherapy, or other treatments that can negatively affect fetal development and potentially cause miscarriage.
“We are nonpartisan, and our only lens is that of the cancer patient and their family,” said Knudsen. “Our goal is purely to do what we believe is critical to improve the lives of patients and families coping with cancer. For that to be realized, we believe there should be no impediment at any time to adequate and quick cancer care.”
Up to 1 in 1,000 pregnant women receive a cancer diagnosis each year in the United States, reports the ACS.
Early treatment is often essential to prevent death from cancer, especially in the case of fast-growing cancers that can rapidly spread from one part of the body to another.
Cancer that is diagnosed early is frequently treated with surgery, which is generally although not always considered safe during pregnancy.
However, many people need other types of cancer treatment that may not be safe for a developing fetus.
For example, radiation therapy can restrict fetal growth, cause fetal defects, and raise the risk of miscarriage.
Chemotherapy may also harm a fetus, particularly in the first trimester of pregnancy.
Certain targeted therapies and immunotherapies may also have harmful or unknown effects on fetal development as well. The fetal effects of many of new cancer treatments are unknown because pregnant women are excluded from clinical trials.
In states where pregnant people can access abortion, those who require cancer care that could harm a fetus face an often difficult decision: terminate the pregnancy and get treatment right away, get immediate treatment while risking harm to the fetus, or delay treatment until later in pregnancy or following childbirth.
“The majority of terminations are in the first trimester of pregnancy,” said Dr. Katherine Van Loon, MPH, an associate professor and oncologist at the University of California San Francisco. “The mother requires a therapy that is not compatible with the viability of the first-trimester or early-second-trimester fetus and the cancer is aggressive enough that it needs urgent treatment.”
Delays in treatment raise the risk that cancer could spread and become harder to treat.
If a pregnant person cannot access abortion, their cancer treatment options are narrowed.
Cancer care providers may be reluctant or unwilling to provide treatment that could harm a developing fetus or result in miscarriage, particularly if they live in a state where abortion has been restricted or banned.
“We’re hearing stories where people are being turned away from medical care because they’re pregnant and the physician fears they’re going to be criminalized for providing the care this individual needs,” said Van Loon.
“If the threat is that by delivering this care and doing what’s right for the patient, you’re going to be taken to jail and taken away from your own kids or family? That’s terrifying,” she added.
Some anti-abortion laws include exceptions for cases when the health or life of a pregnant person is in danger, but it’s not always clear when those exceptions apply.
“Part of the challenge is the murkiness of the language in some of the laws,” said Knudsen. “We would opine that cancer qualifies as a medical emergency, but there needs to be some assurance that states would agree.”
Recent court filings in Ohio show that concerns over disruptions in cancer care are not just hypothetical. Abortion restrictions have already affected care.
After Roe v. Wade was overturned, Ohio implemented a bill to ban abortion after a fetal heartbeat is detected, which usually happens around 6 weeks of pregnancy.
That law is currently on hold, due to a court challenge from abortion providers.
But affidavits from the suit report that while the bill was in effect, multiple pregnant women were denied cancer treatment until they could travel out of state for an abortion.
Some types of cancer grow so quickly that even traveling out of state might create life-threatening delays in care.
Beyond cancer therapies themselves, fertility preservation is another aspect of cancer care that may be negatively affected by laws that limit access to reproductive healthcare.
Some types of cancer treatment can lead to infertility.
As a result, young cancer patients who want to have children in the future may undergo fertility preservation.
The most effective method of fertility preservation is to create an embryo through in vitro fertilization and freeze it until a patient is ready to get pregnant.
“While you can freeze sperm and you can freeze eggs, that has a much lower chance of actually preserving someone’s fertility as opposed to creating and storing an embryo,” Knudsen said.
Typically, more embryos are created and frozen than can actually be used, which means that some embryos may be destroyed.
The ACS worries that current or future laws that restrict reproductive healthcare may pose legal barriers to fertility preservation methods that create embryos that may be destroyed later on.
“Fertility preservation is an essential component of cancer care for patients diagnosed with cancer at reproductive age,” stated the ACS in a September press release. “The SCOTUS ruling could potentially interfere with fertility preservation of [adolescent and young adult] cancer patients due to new restrictions on genetic testing, storage, and disposal of embryos, including those created in vitro.”
Laws that restrict cancer patients’ ability to end a pregnancy can make an already difficult situation more challenging, said Dr. Katie McHugh, MD, an obstetrician-gynecologist and abortion provider in Indiana.
“Abortion is safe, evidence-based, and compassionate healthcare for those who choose it,” McHugh told Healthline. “This is especially true for patients facing life-threatening conditions whose state legislatures are prioritizing a potential fetal life over the patient’s.”
“Telling a patient that the state prohibits abortion, even in the case of cancer and other dangerous medical conditions, provokes deep rage and grief. For some, this is a death sentence,” she added.
Speaking from California, Van Loon told Healthline that she’s grateful to practice oncology in a state where abortion is still legal and unrestricted up to the point that a fetus becomes viable. She described a recent patient encounter that would have gone differently in a state where abortion was banned.
“I had a patient last week who was scheduled for treatment this Monday and had a positive pregnancy test. She looked at me and said: ‘If I was in a different state, this treatment wouldn’t be happening, would it?’ And she was 100% right,” Van Loon said.
“That was her life on the line, and I’m grateful she was able to make an autonomous choice. She and I were able to have a conversation about where her priorities were, and it was clear that protecting her life so she could continue to be a mom to three kids that she already has was her priority,” she continued. “It’s devastating to think there are women in states who have lost that right to make an autonomous choice to protect their own lives.”