Topic: Impact of new laws on cancer treatment during pregnancy

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ISSUE AT A GLANCE

Up to 1 in 1,000 pregnant women in the United States will be diagnosed with cancer. When women are diagnosed while pregnant, both mother and baby usually have good outcomes.

However, some factors, including the type, location, size and stage of the cancer and how far along a woman is in her pregnancy, may affect outcomes.

In a few situations, cancer treatment during pregnancy poses a serious risk to the mother or the fetus.  In these cases, women may need to consider terminating their pregnancy. In states with abortion bans or strict limitations, pregnant women diagnosed with cancer may not have the option of terminating a pregnancy in order to receive treatment for their cancer.

As of this writing, 14 states have banned most abortions while another five limit abortion based on the age of the fetus. Some of these states make exceptions, including if the life of the woman is at risk. The Guttmacher Institute, a U.S. research and policy organization that studies reproductive health and rights, provides an interactive map of current abortion policies by state. You can view the map here.  

Safety of cancer treatment during pregnancy

Most pregnant people can be safely treated for cancer if their fetus is three months or older. Treatment may include a combination of surgery, radiation and other treatments such as chemotherapy, targeted therapy or immunotherapy.

Treatment should be discussed by women and their healthcare providers. Such conversations should include which treatment options are safe, the length of treatments and at what time during pregnancy they are considered safe.

Generally, imaging such as MRI or ultrasound and surgery can be safely performed anytime during pregnancy. Some types of treatment, such as chemotherapy, are safest in the second and third trimesters. Other treatments, including certain targeted therapies and immunotherapies, can harm a developing fetus.

Types of cancer treatment during pregnancy

Limited research has been conducted on the safety of different types of cancer treatment during pregnancy. Many cancer treatment research studies do not allow pregnant people to participate. This limits how much we know about long-term outcomes for pregnant people with cancer.

Surgery

Surgery is almost always necessary to treat cancer. While surgery is generally considered safe for pregnant women, it carries a very small but increased risk of miscarriage, especially in the first trimester. Other risks include premature birth and the need for a C-section.

Radiation therapy

Radiation therapy is generally not given to pregnant women, regardless of the site of their cancer.

Chemotherapy

Chemotherapy has different risks, depending on whether a person is in their first, second or third trimester of pregnancy. Generally, chemotherapy should be avoided during the first trimester. However, after 12-14 weeks, most chemotherapy is considered to be relatively safe. However, some chemotherapies have been linked to low birth weight, stillbirth or premature labor when given anytime during pregnancy.

Targeted therapy and immunotherapy

Some targeted therapies and immunotherapies can harm a fetus and are not recommended if a person is pregnant. Experts recommend people using these types of therapies use effective forms of birth control.

Concerns of healthcare providers

New laws may affect the cancer treatments doctors can recommend to pregnant patients.  Depending on the state where they practice, healthcare providers may face penalties if their recommended treatment leads to the loss of a pregnancy. This may lead doctors to question whether or not they can use a cancer treatment that may increase the risk to the fetus.

Some states allow exceptions for abortion if continuing the pregnancy puts the patient’s life at risk. However, it is not always clear what this means or if this only applies if the patient’s life is in immediate danger.

What does this mean for me? 

The breast screening report sent to your provider by the imaging facility will now have a letter grade that indicates your breast density. In women with dense breast tissue, scientific information indicates that additional imaging tests can find cancers that are hidden in dense breast tissue. These imaging studies include MRI and ultrasound.

Cancer may be found at a later stage in people with dense breasts because it is harder to spot in a mammogram. Cancers that are found later are often harder to treat.

Talk with your doctor or other healthcare provider to learn what type of screening is recommended for you, based on your personal and family medical history. They can tell you about the benefits, risks and costs of additional screening so that you can make a decision that is best for you.

Also, keep in mind that breast density is just one factor that may increase your risk of breast cancer. Your doctor will help you understand the impacts of other risk factors, such as a history of pregnancy and breastfeeding, alcohol use, obesity, family history or having a gene mutation that increases your risk of breast cancer.

If you have a genetic mutation that puts you at higher risk for breast cancer, you may already have additional screenings, including MRI. Doctors can spot cancer that may not be seen on a mammogram with MRI or ultrasound.  However, you will still need to get your annual mammogram.

Reference

U.S. Food and Drug Administration. FDA Updates Mammography Regulations to Require Reporting of Breast Density Information and Enhance Facility Oversight. Published on March 10, 2023.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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posted 6/8/23