Family Matters

Pregnant Women with Breast Cancer Should Do Chemo

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Sheila Reigner was 26 weeks pregnant when she found out she had breast cancer. “You are going to die within six months if you don’t do chemo,” she remembers the doctors saying.

When she showed up for treatment and the nurses learned she was pregnant, they recoiled. Chemotherapy for pregnant patients? They’d never done that. Only one — a mother of three — agreed to administer the drugs. (More on Fertility Preservation for Cancer Patients)

Next month, baby Joshua — who was in utero when his mother began chemo — will turn 2. He’s happy, apparently healthy and jazzed for the family’s upcoming trip to Disney World.

More significantly, Joshua still has a mother.

New data from researchers at The University of Texas MD Anderson Cancer Center reveals that pregnant women treated for breast cancer do at least as well as non-pregnant women, although the opposite has long been thought to be true. (More on Breast-Feeding after Breast Cancer Is O.K.)

To track outcomes, researchers followed 75 pregnant women treated for breast cancer at MD Anderson between 1989 and 2008 and compared them to 150 non-pregnant breast cancer patients; they were matched for age and stage. Pregnant women had a five-year disease-free survival rate of 74% compared to 56% percent in non-pregnant patients. Overall survival rates for pregnant women were a bit higher too.

Previous studies have shown that outcomes were worse for pregnant women treated for breast cancer, but that’s likely due to those women receiving less-than-adequate doses or being advised to postpone chemo until after they deliver, says lead author Jennifer Litton, an assistant professor in MD Anderson’s Department of Breast Medical Oncology, who reported her findings at the 2010 Breast Cancer Symposium. (More on Cancer Doesn’t Mean You Can’t Have Kids: The New World of Oncofertility)

Even Litton was surprised by the numbers and is unsure what’s behind them. Perhaps the pregnant patients actually got more aggressive treatment? Perhaps pregnancy itself conveys a chemotherapeutic boost? Regardless, the takeaway is that women treated while pregnant are not doing worse. “There have been a lot of people saying terminate the pregnancy because pregnant women can’t receive standard-of-care chemotherapy,” says Litton, who has counseled some of those women in her office when they sought a second opinion. (More on Photos: The Landscape of Cancer Treatment)

In 1992, Richard Theriault, a professor in Litton’s department, began studying the effect of chemotherapy on pregnant patients. He eventually concluded that the drugs are safe for mom and baby. Today, pregnant patients are supposed to receive the same drugs as non-pregnant patients in the same proportional doses. “They don’t need smaller doses,” says Litton. “They should be dosed according to weight.”

All the women being tracked received the standard chemotherapy regimen (5-fluorouracil, doxorubicin and cyclophosphamide); both groups got additional therapies such as tamoxifen or herceptin if needed, although the pregnant patients started them only after delivery.

Treating pregnant women does require some medical concessions: even if cancer is diagnosed early in pregnancy, chemotherapy is put off until the second trimester to sidestep the risk of birth defects.

Data released to date on the babies’ outcomes show they are doing well. Three had complications, a rate which is not out of proportion to the general public: one had Down syndrome and another had club foot, neither of which is linked to treatment. A third was diagnosed with ureteral reflux, which could be related.

Reigner, 42, of Willow Street, Penn., received chemo for two months before Joshua’s birth and continued the regimen afterward. She finished treatment a year ago and is now in remission. On Monday, her doctor told her she didn’t need to come back for six months. (More on Special Report: Advances for Breast Cancer Patients)

A former medical worker whose job involved reporting test results to physicians, Reigner was cheered by news of the research but not naïve. Two other women diagnosed with breast cancer while pregnant whom she was introduced to have since died.

She lives her life in clichés, in near-constant wonder and joy that she is able to raise Joshua and her other two sons, who are 4 and 6. What that means is saying yes to her boys’ request for cake for breakfast — sometimes. “It definitely gives you more to live for,” she says. “I want to watch them grow up, I want to stay healthy as long as I can.”