This week "World News With Charles Gibson" reported on Linda Sanchez, a 26-year-old who is battling breast cancer during her first pregnancy.
We invited you to post your questions about pregnancy and cancer on our message boards. We sent your questions to Jennifer Litton, the breast oncologist at the M.D. Anderson Cancer Center, who was quoted on that broadcast and whose expert answers appear below.
Question: What are the chemo drugs used in pregnancy that do not cross the placenta barrier?
Dr. Jennifer Litton, breast oncologist, M.D. Anderson Cancer Center: We use a combination of 5-fluorouracil, doxorubicin and cyclophosphamide. We cannot say that it does not cross the placenta. In fact, when given in the first trimester, these drugs have been associated with birth defects that can be up to 19 percent. However, when given in the second and third trimesters, this rate drops to 1.3 percent, which is approximately the same for the general public. In the second and third trimesters, the children at birth do not appear to be having the same side effects as their mothers. More research needs be done with both the mothers and the children.
Question: My mother was diagnosed with breast cancer in 1965 while pregnant with me and is a survivor and has never had a relapse since her mastectomy. My question is, do I have a higher risk of developing cancer?
Litton: We do not have significant evidence that you have a higher risk of developing cancer because you were exposed to chemotherapy in utero. However, if your mother was diagnosed at a young age, she may want to consider talking to her medical oncologist and being seen by a genetic counselor to see if there is any concern for an inheritable genetic predisposition to cancer, such as mutations in the BRCA 1 or BRCA 2 genes. These are genes that fix mistakes in cells when they are dividing. In about 5-10 percent of breast cancers, these genes can be shut off and so cancers can develop including breast, ovarian and other cancers.
Question: What are your feelings on low doses of radiation therapy while pregnant? I am 27 weeks pregnant with Hodgkin's and have been delaying treatment until this point. My doctors think the radiation to the neck would be a better option than chemo. Just looking for more info!
Litton: There are reports of giving radiation therapy with specialized techniques for treatment of Hodgkin's Disease in the second and third trimester. I would really consider doing this at a large cancer center or seeking a second opinion with a radiation oncologist that has experience with these techniques before you make any decisions.
Question: Do you happen to know if the same applies to one with cervical cancer stage 1b1 while in 2nd trimester of pregnancy?
Litton: There are several case reports about chemotherapy during pregnancy for cervical cancer. But, like breast cancer, there are no big studies and long term follow-up of the mother and the children will be important for the medical community to address. You will have to make the decision that is best for you and you will need to discuss your questions and concerns with your gynecologic oncologist and obstetrician who need to take your specific case into account.
Question: I am a nursing student and would like to write a paper on pregnancy and breast cancer. Are there any books or Web sites that contain current information as seen on your program, that may be helpful? What are the drugs used during the 2nd and 3rd trimester that does not cross the placenta? What are the side effects of these drugs on the mother and possible side effects on the fetus? How long is the treatment? How are the drugs administered? Is the Mother hospitalized throughout the entire pregnancy? Are there any studies/statistics that have been done on the percentage of healthy babies delivered to mothers on chemo?
Litton: These are all great questions. We use 5-fluorouracil, doxorubicin and cyclophosphamide and as above, the children do not appear to have the same side effects as the mother, but we cannot say that these drugs do not cross the placenta. The mothers tend to have the same side effects from the chemotherapy as nonpregnant breast cancer patients. I have not seen any increase in nausea in the pregnant breast cancer patients. The chemotherapies are given intravenously in our infusion center as an outpatient. For the doxorubicin, our patients go home with a pump that gives the drug over 72 hours.
Question: I am a 50 year old woman with breast cancer with mets to my bones and liver. I was diagnosed in 2000. I am currently on herceptin once every three weeks. My cancer, despite the mets, is stable. I have had no advancement of my cancer since 2002, when I was told there was cancer in my liver. I have been on herceptin for over 3 years, (since June 2004) with no bothersome side effects.
My question is: Can I try to have a child? I am willing to use donor eggs, donor sperm (because I don't have a man in my life right now), but I'm wondering if I can carry the pregnancy? I have not ruled out using a gestational carrier, but, it's really my heart's desire to carry the pregnancy myself!!! I have 2 grown daughters, ages 27 and 28. These pregnancies were wonderful, and my daughters are beautiful, but I long to have just 1 more child!
I also am on the duragesic patch (125 MCG.) for bone pain. I am back to doing all my pre-cancer activities, including working. Can you please give me your professional opinion? -- Carmen
Litton: Carmen, I think it is fantastic that you are having such a good response to trastuzumab and it is important to continue this important treatment if you are tolerating it and responding to it. This drug and more like it are making such a difference in the treatment of breast cancer. Unfortunately, trastuzumab has been associated with decreased fluid around the baby and so at this time, I couldn't recommend a pregnancy that may not be safe for you or for the baby. I would advise you to talk about your specific cancer and your concerns with your medical oncologist.
Question: I am not pregnant, but am nursing my 3-month-old baby. I just found out I have inflammatory breast cancer. Are there any chemotherapy drugs that are safe for a breast-feeding mother? Thanks.
Litton: There is data about chemotherapies getting into the breast milk and so for now, we generally counsel a woman not to breast feed while on chemotherapy. I would stress that you should discuss your concerns with your medical oncologist. We generally advise not to delay starting chemotherapy.
Question: I had breast cancer 25 years ago when I was pregnant with my first child. Fortunately, I was able to deliver before I had a mastectomy and treatment. I have been told recently that testosterone is the driver for cancer during pregnancy. In my case interestingly enough my daughter was born not only with a full head of hair but also with patches of hair on her back. As an adult she has PCOC. Is there a correlation?
Litton: There is no known link to polycystic ovarian syndrome at this time.