There’s more to Mother’s Day 2016 than meets the eye in the Manhattan home of Sarah Norris, her husband, and their baby girl Sasha.
The young family’s quiet celebration speaks volumes about how far modern medicine has come.
Just a month and a half after discovering a lump in her breast last year, Norris realized there was a possibility she might be pregnant.
So she went to see Dr. Sharon Rosenbaum Smith, a breast surgeon at Mount Sinai West.
Norris had no family history of breast cancer. Only 34 years old, she hadn’t yet started having routine mammograms.
Both the pregnancy and the diagnosis were soon confirmed. Norris had invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast.
Though overwhelmed, Norris worked with Rosenbaum Smith to come up with a treatment plan that wouldn’t harm her baby.
The Balancing Act
Decisions about surgery came first.
The type of surgery, a lumpectomy versus mastectomy, doesn’t change with pregnancy, said Rosenbaum Smith.
“There are a lot of factors at play. If the area is small, a lumpectomy can be safely done,” she told Healthline.
According to Rosenbaum Smith, one reason some women might choose a mastectomy over a lumpectomy is if they carry certain genetic mutations. Norris tested negative.
A lumpectomy can be done under sedation while a mastectomy requires general anesthesia.
There were also extensive conversations regarding the timing of treatments.
“For her, I didn’t see a downside to waiting for the second trimester, since she was close anyway,” Rosenbaum Smith said.
Generally, surgery is avoided during the first trimester when the baby’s major organs are being formed.
Rosenbaum Smith performed a double lumpectomy during the 13th week of Norris’ pregnancy.
Chemotherapy was also needed, but they would have to be careful. Some chemotherapy drugs are too powerful, but others can be safely given during pregnancy.
“We weren’t delaying everything and we didn’t compromise her cancer care,” said Rosenbaum Smith. “As a breast surgeon, my role is taking care of the whole patient and coming up with her entire treatment plan. Other treatments were worked out with a medical oncologist over at Cornell.”
“I felt really well taken care of by everybody,” Norris said in an interview with Healthline.
Norris had five rounds of Adriamycin and Cytoxan.
“You hear you’re not allowed to eat a hot dog while you’re pregnant,” said Norris. “I was totally floored that I could have chemo. I needed a lot of reassurance and convincing.”
Norris said the pregnancy went well and the chemotherapy wasn’t too bad. “Chemo felt kind of yucky. It kind of made me nauseous, but it wasn’t much worse than that. I was still able to enjoy the pregnancy and continue working from home.“
“It was nice to have something else to think about,” she added. “I was able to focus on the good part. When the surgery and chemo were done, I got to look forward to having my baby.”
The plan was to delay a third chemo drug, Taxol, until after the baby was born. Following that, Norris would also need radiation treatment.
Norris said the biggest challenge was just getting reassurance that it’s OK to have treatments while pregnant.
“I thought, ‘If I don’t do this, I won’t be around to take care of my baby,’” she said. “My husband was extremely helpful with that.”
Baby Arrives…Now What?
Baby Sasha made her much-anticipated entrance into the world on March 26 and Norris couldn’t be happier.
“She’s perfect. She has more hair than I do, a good sign the drug didn’t make it to her,” the new mother said.
The family’s Mother’s Day plans are simple. They’ll spend time with family and probably share a nice meal.
Like most new mothers, Norris thought a nap would be a good way to spend the afternoon.
With a baby in the house and more cancer treatment on the horizon, she faces a few challenges. But she feels fortunate that her husband has a somewhat flexible work schedule and her mother-in-law can help when daily radiation therapy starts.
“Sasha will be well taken care of,” she said.
Norris recently reached out to her oncologist to get an idea when treatment would begin again. She was surprised to learn that her case had been re-assessed.
Because her chemotherapy sessions were spread out more than if she hadn’t been pregnant, it was decided that further treatments would have only a minor effect on the potential for recurrence. Her chemotherapy was complete.
Now it’s on to radiation treatment.
Cancer and Pregnancy
Rosenbaum Smith wants women to realize they can develop breast cancer while pregnant.
“A lot of women who feel a lump while pregnant assume it’s the normal changes of pregnancy. It’s very important that you check your breasts and take lumps seriously,” she said. “Most of the time it won’t be cancer, but if it is, it can be treated.”
Treatment must be taken on a case-by-case basis, said Dr. Diana Ramos, M.P.H., OB-GYN, and co-chair of the National Preconception Health and Health Care Initiative (PCHHC).
“You really have to look at the type of cancer to indicate the treatment,” she told Healthline. “It’s a multifaceted decision. It can sometimes wait until after the baby is born or it can start earlier. A lot depends on the cancer stage and the mother’s risk factors.”
Some of those risk factors include the mother’s age, diabetes, high blood pressure, and other issues not related to cancer.
“You can’t isolate the cancer. It’s an overall picture,” said Ramos.
Depending on the treatment given during pregnancy, the baby may need some special monitoring.
Ramos believes the most important thing is to start thinking of the health of your baby before conception. That means getting Pap smears and breast exams so cancer can be diagnosed before pregnancy.
“Under the Affordable Care Act (ACA), these tests are available,” said Ramos. “Wellness exams are covered without a copay. This is all to try to diagnose cancer early on and to deal with that issue before becoming pregnant.”
In addition to cancer screening, Ramos said wellness checkups could also detect diabetes, hypertension, and other conditions that can complicate pregnancy and delivery, as well as the future health of mother and baby.
“Preparedness is the key to preconception health,” said Ramos.
Norris said she recently read a story about a pregnant woman who had cancer and delayed treatment for the safety of her baby.
“I know it depends on the specifics of each case, but I want mothers to know that in certain cases, it’s totally fine to be treated during pregnancy,” she said. “Obviously, it’s very scary, but it can turn out well.”