Wednesday January 29, 2020

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)

Next Story

Here’s Everything you Need to Know About Male Breast Cancer

Know about the rarely seen breast cancer in men

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Breast Cancer
Male breast cancer is rarely seen and that is people are not aware about it. Pixabay

Breast cancer in men is rarely seen. It shares many similarities with cancer of the breast in women but there are some important differences too.

Male breast cancer represents between 0.5 and 1 per cent of all breast cancers diagnosed each year. Higher rates of male cancer in central and eastern Africa may be related to higher liver infectious diseases that lead to hypoestrogenism.

Dr Kumardeep Dutta Choudhury, Senior Consultant & Head of Department, Dept of Medical Oncology (IOSPL), Fortis Hospital, Noida, shares the facts you need to know about it.

Risk factors associated with breast cancer in men:

Genetics and family history

Breast Cancer
Higher rates of male breast cancer in central and eastern Africa may be related to higher liver infectious diseases that lead to hypoestrogenism. IANS

Family history of cancer in a first-degree relative is associated with an increased risk of breast cancer among men. Approximately 15 to 20 per cent of men with breast cancer have a family history of the disease compared with only 7 per cent of the general male population.

The risk is higher with inherited BRCA2 rather than BRCA1 mutations. Other genes which have been associated with an increased risk of breast cancer in men are PTEN tumor suppressor gene (Cowden syndrome), tumor protein p53 (TP53; Li-Fraumeni syndrome), partner and localizer of BRCA2 (PALB2), and mismatch repair genes (Lynch syndrome).

Alterations of the estrogen to androgen ratio

Excessive estrogen stimulation may be due to hormonal therapies (e.g., estrogen-containing compounds or testosterone), hepatic dysfunction, obesity, marijuana use, thyroid disease, or an inherited condition, such as Klinefelter syndrome may increase risk of male breast cancer.

Primary testicular conditions

Testicular conditions may increase risk of breast cancer in men include orchitis, undescended testes (cryptorchidism), and testicular injury.

PRESENTATION:

Male breast cancer has been diagnosed at a more advanced stage than female breast cancer, due to a lack of awareness. They generally present with a painless, firm mass that is usually subareolar, with nipple involvement in 40 to 50 percent of cases. The left breast is involved slightly more often than the right, and less than 1 percent of cases are bilateral. There may be associated skin changes, including nipple retraction, ulceration, or fixation of the mass to the skin or underlying tissues. Axillary nodes are typically palpable in advanced cases.

Breast Cancer
Excessive estrogen stimulation may be due to hormonal therapies can lead to breast cancer. Pixabay

Most histologic subtypes of that cancer seen in women are also present in men, men with breast cancer are rarely diagnosed with lobular carcinomas is due to lack of acini and lobules in the normal male breast, although these can be induced in the context of estrogenic stimulation.

TREATMENT:

Approach to treatment in men is same as that for women. However, role of breast conserving surgery is limited because of small volume of breast tissue. In hormone receptor-positive disease, we give adjuvant tamoxifen rather than an aromatase inhibitor (AI), because of insufficient evidence to support AI monotherapy for men. If there are contraindications to tamoxifen (e.g., hypercoagulable state), an AI with GnRHa may be administered. AIs do not reduce testicular production of estrogens, that’s why GnRHa is administered concurrently with AI. They are treated with mastectomy, radiotherapy, chemotherapy and hormone therapy.

SURVEILLANCE:

Limited data suggest these patients are at an increased risk of a contralateral breast cancer, but absolute risk is low. They are also at risk for secondary malignancies and 12.5 percent may develop a second primary cancer. The most common types were gastrointestinal, pancreas, non-melanoma skin, and prostate cancer.

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PROGNOSIS:

Ten-year disease-specific survival rates for histologically negative nodes – 77 and 84 per cent, one to three positive nodes – 50 and 44 per cent and four or more histologically positive nodes – 24 and 14 per cent. (IANS)