Former Alone Australia winner Gina Chick diagnosed from breast cancer just days after checking out she was pregnant. She describes in his last book her experience with chemotherapy and what got here after it.
Fortunately, cancers diagnosed during pregnancy and in the 12 months after delivery are rare. But such cases are becoming more and more common in parts With world, including Australia. Scientists aren’t entirely sure why.
Here’s what scientists know thus far and treatment options.
How rare is this?
New South Wales test found that in 1994, for each 100,000 women giving birth, roughly 94 cancers were diagnosed during pregnancy or inside one 12 months of birth. In 2013, this number increased to around 163 per 100,000. Although these statistics are over a decade old, they’re the latest and most rigorous data available in Australia.
Swede from 2023 test pregnancies in the years 1973–2017 showed similar results.
Both studies found that a couple of quarter of pregnancy-related cancers are diagnosed before birth, with the rest diagnosed a 12 months after birth.
What variety of cancer are we talking about?
First in the UK comprehensive assessment cancer during pregnancy – a review of diagnoses from 2016–2020.
This study, the NSW study and others found that breast and skin cancer (often melanoma) are the most typical cancers related to pregnancy. In this group, there was also a high percentage of thyroid cancer, gynecological cancer (especially cervical and ovarian cancer) and blood cancer.
A UK study found that around 92% of cancers were recent diagnoses and around 82% had symptoms. The majority (81%) were treated with curative intent, and roughly 82% of pregnancies related to a cancer diagnosis resulted in a live birth.
However, 20% of the moms died before the end of the five-year study period. Gastrointestinal cancers were particularly concerning. They were characterised by the highest mortality rate of roughly 46% and were related to diagnosis at a more advanced stage of cancer.
This could also be because lots of the symptoms of gastrointestinal cancers, resembling abdominal pain, fatigue and acid reflux disorder, overlap with those of pregnancy. In other words, some cancer symptoms may be confused with pregnancy symptoms, “masking” or delaying the diagnosis of cancer.
Why are there more and more such cases?
The big selection of cancers that occur during and after pregnancy suggest that there are various aspects involved.
In countries with high socioeconomic status, women have children later in life, and the biggest risk factor for a lot of cancers is age. However, the evidence that age is a serious risk factor for pregnancy-related cancers is inconclusive. This may explain some, but not all, cases.
Another factor could also be increasing usage prenatal genetic testing in early pregnancy. They analyze DNA from the mother’s blood to detect chromosomal abnormalities in the developing fetus. But these tests may also provide details about the mother’s chromosomes. This has led to the diagnosis of Hodgkin’s disease, breast and colorectal cancer in pregnant women without symptoms.
Estrogen and progesterone are two hormones essential for the growth and development of breast tissue and supporting other points of a healthy pregnancy. They may also contribute to cancer developmentespecially breast cancer. However, it is unclear whether this is related to the increase in pregnancy-related cancers.
Other cancers, resembling skin cancer, have been linked to environmental aspects resembling exposure to UV radiation. Of note, melanoma was the leading pregnancy cancer in the New South Wales study, reflecting the high rate of skin cancer in the local population. Other environmental aspects, resembling smoking and human papillomavirus, have been linked to cervical cancer. Again, we will not be sure whether such aspects are related to the increase in the incidence of pregnancy-related cancers.
What happens after the diagnosis is made?
Pregnancy complicates the diagnosis of cancer because any potential treatment for the mother may jeopardize the health and viability of the fetus. So some points of treatment may require adjustment.
Surgery can often be performed in any trimester of pregnancy, depending on the location of the cancer.
Radiotherapy requires careful planning because the effects of radiation on the fetus rely upon the developmental stage at which radiation is administered to the body and on the dose.
Chemotherapy must be avoided in the first trimester of pregnancy on account of its potential toxic effects on the fetus. It can often be given in the second and third trimester of pregnancy. Chemotherapy must be avoided inside three weeks of birth to cut back the risk of bleeding and infection in the newborn, who might also have a weakened immune system consequently of chemotherapy.
More targeted immunotherapies are typically given to the mother after delivery. Depending on her treatment, she could also be advised to not breastfeed. This is because the medicine can pass from mother to baby through breast milk.
What’s happening to the children?
Reassuringly, data from New South Wales showed no increase in the rate of perinatal deaths given to moms with pregnancy-related cancer.
However, there have been more planned premature births. This is because women are offered induction of labor and/or cesarean section to make it easier for the mother to undergo cancer treatment while also reducing the risks of treatment for the unborn baby.
There was also the next percentage of babies born with low birth weight and low Apgar scores (indicators of a baby’s condition soon after birth), which were probably related to premature birth.
What do researchers need to know?
We have lots to study why pregnancy-related cancers are rising and what women diagnosed with this cancer can expect.
We also have to mix cancer and obstetrics data in national databases. This would allow us to find out which areas must be prioritized for further research, provide clinical guidelines for cancer screening during and after pregnancy, and help assess responses to screening programs or therapies in the future.