After beating breast cancer, actress Christina Applegate will soon move on to perhaps her most challenging role yet: motherhood.
The former sitcom star, 38, has announced that she is expecting her first child, coming two years after she underwent a double mastectomy in July 2008.
She told "Good Morning America" a month after the surgery that she was "100 percent" cancer-free.
Susan Cacioppo of Port Washington, N.Y., found herself in a similar situation several years ago.
Susan was diagnosed with a serious form of breast cancer in 1996 when she was 32.
"I had 25 positive lymph nodes with cancer," Cacioppo said.
After surgery and several months of chemotherapy, her doctor told her that if she could still have a child after the chemotherapy she had, she would have to wait five years before getting pregnant.
"I went for scans every year," she said. "They were always looking for cancer and, fortunately, I was always good."
The five-year mark came and she decided she was ready to try for a second child.
"It was always in the back of my mind that I wanted to have a baby," she said. "My son wanted a brother or sister."
After discussing it with her doctor, she went for more tests to check for any signs of cancer. There were none. In 2001, she had a healthy baby boy.
During the five years between the end of her chemotherapy and her pregnancy, she often worried about whether she would ever have another child, and also whether she would live to see that day.
"I was always praying that I would be healthy and hoping that I would make it to the next checkup," she said.
She also worried about whether being pregnant would put her at risk for a recurrence of her cancer, or for the development of other cancers.
"Everybody worries about that," she said.
Breast Cancer Survivorship No Barrier to Pregnancy
But medical experts say that while it's something women do worry about, studies have shown that pregnancy a certain period of time after breast cancer treatment is no more dangerous than becoming pregnant at any other time.
"Becoming pregnant immediately after treatment may be associated with an increased risk of recurrence," said Dr. Massimo Cristofanilli, chair of the department of medical oncology at Fox Chase Cancer Center in Philadelphia.
Indeed, research has shown that pregnancy may actually protect women against a recurrence of cancer.
"Studies showed an improvement in outcomes in women who eventually became pregnant after two to five years," he said. "It's possibly a protective effect, there are fewer ovulatory cycles, so there's less estrogen," he added.
Appropriate Time Frame May Vary
Recommendations for when it's safe for women to get pregnant vary on a case-by-case basis and often depend on age and stage of cancer, but doctors generally adhere to a standard protocol.
"For those women who have already had surgery and chemotherapy and took care of their cancer, doctors usually recommend not getting pregnant until they've been cancer-free for two years," said Dr. Daniel Roshan, assistant professor of obstetrics and gynecology at NYU School of Medicine.
Roshan also recommended that women do the following, depending on their situation:
Older women who may not want to wait two years can freeze their embryos or get donor eggs later.
Women who had advanced stage cancers, depending on how much of a tumor is left and if they need chemotherapy, should not get pregnant.
Women who had estrogen-positive cancer and are on tamoxifen should wait until treatment is finished because of the drug's association with birth defects.
Women carrying a genetic mutation that predisposes them to cancer are at higher risk for other kinds of cancer as well, and should be carefully screened before pregnancy.
As for other chemotherapy drugs, if treatment is stopped for an appropriate amount of time, doctors say there won't be any problems.
"There's no risk," Fox Chase's Cristofanilli said. "Women are off chemotherapy, so there's no effect of chemotherapy."
The children of women treated for breast cancer are also at no greater risk for developing cancer in the future.
"Several large studies have confirmed that children born to parents who have had cancer are just as healthy as the non-cancer population," said Gwendolyn Quinn, associate professor at the University of South Florida College of Medicine in Tampa.
Concerns About Fertility
As Applegate and Cacioppo proved, many women can get pregnant after breast-cancer treatment, although doctors say there may be issues with fertility, depending on a woman's age and the kind of chemotherapy she's undergoing.
"Some chemotherapy can cause ovarian damage and cause premature menopause," NYU's Roshan said.
Cristofanilli said, "Many women younger than 40 resume their periods after chemotherapy, so there aren't necessarily fertility issues."
Applegate is still cancer-free, and even though she had a double mastectomy that removed all her breast tissue, Roshan said, women in her situation aren't necessarily out of danger.
"If there are still estrogen receptors, there may be a greater risk of recurrence," he said. "If there's no breast tissue, the risk is much lower. But cancer can still metastasize to a lymph node."
Cacioppo is still healthy as well and, despite her initial fears, has no regrets about her decision to get pregnant after her treatment. She now volunteers with a breast-cancer hotline and counsels women who also want to get pregnant after cancer treatment.
"It's really important that women know that there are people like me who have done it," she said.