Q & A Breast Cancer During Pregnancy

The University of Texas MD Anderson Cancer Center

CancerWise, March 2006

 

Q&A: Breast Cancer During Pregnancy

Research shows that chemotherapy given to pregnant breast cancer patients reduces tumor size in mothers and does not appear to harm their children, scientists say.

One of the most recent studies included more than 13 years of data collected from 54 mothers and their children who were exposed to chemotherapy in the womb, says the study’s first author Peter Johnson, M.D., a fellow in M. D. Anderson’s Department of Breast Medical Oncology. Here, Johnson answers questions about the study results.

What were the goals of the study?

We wanted to determine the effectiveness of treating pregnant women with invasive breast cancer with the standard neoadjuvant or adjuvant chemotherapy (chemotherapy given before or after surgery). The treatment is called FAC chemotherapy (5-flurouracil, doxorubicin, and cyclophosphamide). The chemotherapy was given during the second and third trimesters. We waited until after the first trimester when a baby’s major organs had developed.

Additional chemotherapy or radiation therapy, as well as therapies such as Herceptin® and tamoxifen, were to be given after delivery, if needed.

What was the common diagnosis of participants?

The women who consented to the protocol tended to have aggressive (lymph node-positive, hormone-insensitive) tumors. This is why some physicians recommend surgery right away. However, we know that chemotherapy before surgery is beneficial because it can reduce or eliminate the tumor.

What effect did chemotherapy have on patients?

Neoadjuvant chemotherapy made it possible for some women in our study to have a better surgical outcome. In a sizeable portion (63%) of the group, neoadjuvant therapy was effective in down-staging tumors so that less of the breast had to be removed. We believe that this allowed patients to undergo breast conservation surgery, whereas they otherwise may have had to have a complete mastectomy.

Saving the breast is not the primary reason for giving chemotherapy to pregnant women. The sooner chemotherapy can be administered, the more likely we would be able to improve their outcome and survival. The hope was that this could be done without any significant adverse events affecting the children, which seemed to be the case in the study.

What has been the effect on the children?

Most of the babies were delivered at or near term, with only a few babies born a bit younger and needing supplemental oxygen or mechanical ventilation for a day or two. Aside from some breathing difficulties, one baby was born with Down’s syndrome and another with a common kidney abnormality – all of which are keeping within population norms.

Telephone and written surveys completed by parents or guardians showed that, overall, the children did not seem to be seriously affected or impaired. This suggests that the placenta, which supplies food and oxygen to the baby, may have some protective mechanisms that reduce the fetal exposure to these drugs.

Could the children have side effects later in life?

While the children are doing well, there are still potential problems that could crop up as they get older. The long-term effects are not known. We’ve followed some children, from birth to age 15 years, whereas other kids are still very young. It may be years before we can say conclusively that the long-term effects of chemotherapy exposure in utero are small.

But for now, it appears to be true. In a follow-up questionnaire, nearly everybody considered their child to be healthy and developing normally as compared to their siblings and other children.

What is the status of the patients today?

Of the 54 expectant mothers, 70% are still alive and disease-free despite having been originally diagnosed with advanced disease.

What future studies are planned?

Several of our doctors plan to work together with a maternal/fetal specialist at another Houston hospital to collect the placentas and umbilical cords from children born to mothers who received FAC chemotherapy during pregnancy.

We want to measure drug exposure levels in these tissues as well as analyze whether any genetic changes were induced by the chemotherapy and what that may mean for long-lasting health.

In the meantime, M. D. Anderson will continue to treat pregnant breast cancer patients while following their outcomes and those of their children.

Internet Research Builds Cancer Patient Confidence

Internet Research Builds Cancer Patient Confidence

Newly diagnosed cancer patients who use the Internet to gather Information about their disease have a more positive outlook and are more active participants in their treatment, according to a new Temple University study published in the March 2006 Issue of the Journal of Health Communication.

“This is the first study to look at the relationship between Internet use and patient behaviors; said principal Investigator and public health professor Sarah Bass, Ph.D. “We wanted to see if access to readily available Information about their condition helped patients to cope with Issues such as hair loss and other treatment side effects.”
For this study, the researchers recruited patients who called a National Cancer Institute-funded 1-800 number, where trained specialists answered questions about the disease and directed callers to cancer- related resources in their area. Once selected, the 442 participants were broken into “direct user, Indirect user and non user” categories based on their Internet usage patterns.
According to Bass, direct and indirect users tended to be females between the ages of 50 and 60 who had graduated from college and made more than $60,000 a year. During the survey, Bass and her colleagues began to see strong parallels between Internet use and the patients’ feelings about t heir treatment . Those who used the Internet and those who received Internet information from family members or friends were more likely to view their relationship with their doctors as a partnership, and were more comfortable asking questions and challenging treatment alternatives.
“They saw the Internet as a powerful tool that enhanced their decision-making ability,” Sass said.
Moreover, Bass and her team were pleasantly surprised by the number of early nonusers who after eight weeks turned to the Internet for information. When asked about the change, approximately 75 percent said that either family/friend encouragement or the cancer diagnosis Itself prompted them to increase their internet use.
“They didn’t want to feel powerless or have to rely on the doctor to make all of the decisions” Bass said.
Bass warns that as more and more funding Is cut for medical phone hotlines, now Is the time for doctors and health workers to encourage patients to do their own research on the Web. “But as with most things, let the buyer beware. Stick to Web sites that are associated with large, well -recognized non-profit groups, or get recommendations from your physician.”