Friday February 22, 2019

Pregnancy is Possible For Survivors of Breast Cancer

Kaur suggested that young women diagnosed with breast cancer need to be made aware about the methods to preserve fertility prior to starting treatment

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Pregnancy, air pollution
Sleeping for long hours during pregnancy linked to stillbirths. Pixabay

Breast cancer, the most prevalent cancer among Indian women, cannot deter motherhood, if intervention takes place at the right moment, say health experts. According to them, pregnancy is possible for women survivors of breast cancer — it does not increase risk of recurrence and neither does it cause any harm to the baby.

“Yes, pregnancy is possible for breast cancer patients. Currently there is no reason or evidence to believe that becoming pregnant after treatment for breast cancer can cause any risk to the mother or the baby,” Upasna Saxena, Consultant (Radiation Oncology), at Mumbai’s HCG Cancer Centre, told IANS.

“It is possible for women to continue with their pregnancy even while diagnosed with breast cancer and take treatments tailored to the stage of their pregnancy concurrently. They can go on to deliver healthy babies,” added Kanchan Kaur, Associate Director, Cancer Institute at Medanta in Gurugram.

However, for some even “natural pregnancy is possible,” Kaur stated.

In a striking case from the hospital, Paula, 33, from Rwanda, conceived naturally and delivered a healthy baby five years after she was diagnosed with breast cancer, the doctor said.

Paula was at high risk of developing breast and ovarian cancer in 2013. She completed four years of hormone blockade treatment, which blocks the action of Estrogen Receptor (ER) on breast cancer cells. Pregnancy is not advisable whilst on this treatment.

Although she had her eggs frozen before she started her chemotherapy, she conceived naturally and delivered a healthy baby after the treatment stopped.

Pregnancy, autism
Pregnancy after breast cancer does not increase a woman’s risk of a relapse. Pixabay

In another case from HCG, a patient who was diagnosed with breast cancer at the age of 27 and treated in 2007 opted for breast conservation, against a full masectomy — and delivered a healthy baby boy in 2013.

“Previously, there were concerns over increased risk of cancer recurrence in women who contemplate pregnancy, but it’s good news that studies show no such higher risk in women who conceive as compared to women who do not conceive,” Saxena said.

In yet another case, also from HCG, a patient treated for breast cancer in her late 30s conceived and delivered a healthy baby — but 2.5 years after her treatment. She had a history of seven miscarriages.

“However, it is not a blanket statement for all breast cancer patients. It depends on the age of the patient. And while deciding about pregnancy, it is important to consider and talk to the patient about her age, family size and type of breast cancer (aggressiveness and risk of recurrence),” Saxena noted.

According to a report from the Indian Council of Medical Research (ICMR), India had 14 lakh cancer patients in 2016 and this number is expected to increase.

“Breast cancer is currently the most common cancer among Indian women, both in terms of incidence as well as mortality, with proportional prevalence in younger age-groups being higher than the global average.”

“The age standardised rate is approximately 25.8 per one lakh women and is expected to rise to 35 per one lakh women in 2026,” the report stated.

Pregnancy after breast cancer does not increase a woman’s risk of a relapse.

Cancer
Cancer Ribbon. Pixabay

According to the American Cancer Society, surgery for breast cancer is generally safe in pregnancy while chemotherapy seems to be safe for the baby only if given in the second or third trimester of pregnancy, not in the first trimester.

Other breast cancer treatments, such as hormone therapy, targeted therapy and radiation therapy, are more likely to harm the baby and are usually shunned during pregnancy.

“The risk could be the need for caesarean section, premature baby and low birth weight baby (vis-a-vis women with no history of breast cancer treatment),” Saxena said.

“There is, by no means, any increase in the chances of birth defects or deformities in the baby or increased risk of cancer in the baby (unless it is a cancer due to genetic mutation which can be transmitted to the baby).

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“There may be difficulty in breast-feeding post surgery and radiation, but it is still possible with probable lower milk production on the treated side,” Saxena explained.

However, it would be advisable to wait for two years post-treatment to check for an early recurrence.

Kaur suggested that young women diagnosed with breast cancer need to be made aware about the methods to preserve fertility prior to starting treatment.

“Their ova (eggs) can be harvested (as is done for patients undergoing IVF) and preserved for future implantation either in the treated patient or a surrogate,” she explained. (IANS)

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Is Mammography Test to Spot Breast Cancer Necessary At All? Find out Here

The experts also recommended MRI, ultrasonography or a biopsy in which breast tissue or fluid is removed for laboratory testing, for younger women

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Breast Cancer
Nano technology offers hope for better cancer testing. Pixabay

A woman under 40, with no known breast cancer risk or visible symptoms of the deadly disease, need not take regular mammography tests, say health experts.

Accordingto the US Centers for Disease Control and Prevention (CDC), a mammogram is an X-ray picture of the breast, used as a screening tool for the detection of early breast cancer in asymptomatic women.

“If a woman doesn’t have symptoms of breast cancer then regular mammography tests before the age of 40 are not recommended,” Ramesh Sarin, Senior Consultant (Surgical Oncology) at Indraprastha Apollo Hospitals, New Delhi, told IANS.

If there is any lump in the breast, then mammography should be done.

“Those with increased risk (which is decided by clinician analysing multiple parameters) can begin screening at a younger age around 25-30 years,” added Upasna Saxena, Consultant (Radiation Oncology) from HCG Cancer Centre in Mumbai.

Cancer survivor, Flickr

In mammography, each breast is examined separately and compressed against the film to obtain maximum visualisation of masses or calcifications.

“This helps identify masses or lumps that are smaller than the size that can be felt on examination. Hence, they help in early detection of breast cancers. But at the same time all masses seen on mammography are not cancerous,” Saxena informed.

However, there are various concerns that mammography can be risky due to radiation. But experts noted that mammography uses low energy to take X-Ray of the breast.

“There are no risks which are associated with mammography, even if a woman gets 20-30 mammograms done in her lifetime,” Sarin said.

At the same time, “mammography is to be avoided in pregnant women as the foetus will be at risk even with minimal doses”.

Cancer
Cancer Ribbon. Pixabay

“If at all required in a pregnant woman, it can be done using a lead shield over the abdomen,” Saxena stressed.

Breast cancer is the most common type of cancer which affects women in India and, by 2026 the country will witness rise in the breast cancer incidence to 35 per 100,000 women as compared to the present rate of 25.8 per cent, says a Confederation of Indian Industry (CII) 2018 report titled “Breast Cancer Landscape in India”.

The cancer burden in India has more than doubled over the last 26 years, the highest increase among all therapy areas, with breast cancer being the most common among Indian women.

However, the National Family Health Survey (NFHS-4) data shows only 9.8 per cent women between the age of 15 and 49 in India have ever undergone breast examination.

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“Mammogram should be supplemented with monthly breast self-examination or breast awareness,” Saxena said, adding that breast self-examination once a month should start by the age of 20 onwards.

The experts also recommended MRI, ultrasonography or a biopsy in which breast tissue or fluid is removed for laboratory testing, for younger women.

“However, these alternatives are not as sensitive as mammography, wherein physical examinations can detect breast cancer only in 60-70 percent of the cases. But mammography can detect breast cancer with 85 per cent accuracy,” Sarin noted. (IANS)