Cancer and Pregancy

Dr John Kehoe looks at the outcomes for pregnant women with cancer

Some people argue that the phrase in the Irish Constitution which refers to the 'equal right to life' of the pregnant mother and her child is bound to cause legal conflict. To me, using the maxim that common words have common meaning, this means that neither life can be deliberately extinguished for the perceived good of the other. However, advocates of abortion have welcomed the ECHR's recent ruling in the hope that the Dáil will legislate in some form or fashion for abortion in response, finally getting the thin end of the abortion wedge into our country.

Just as in the X-case, the European Court did not hear any medical evidence and based its judgement on assumption. Ms C did not present any evidence that her life was endangered by her pregnancy. The decision of the ECHR in the C case is not surprising. Nevertheless, it draws attention to the plight of women who are diagnosed with cancer while pregnant. The incidence of women who develop cancer while pregnant is, internationally, increasing. This is partly because more women are having their first baby in their late 30's. Here in Ireland, for example, the number of women under 50 who developed cancer of the breast increased from 451 in 2000 to 600 in 2007. If one accepts international statistics, one would expect 60-70 women to develop cancer while pregnant every year in Ireland. Naturally in such cases, concern for the baby is foremost in parents' minds, but a worrying trend in other countries is that some oncologists will even refuse to treat a pregnant woman before she has had an abortion. While statistically significant medical studies of pregnant women with cancer are not easy to come by, the studies that do exist show that, in cancer cases, abortion will not improve or treat the mothers' outcome.

One enormous landmark study published in the Clinical Journal of Oncology in 2002 looked at 42,511 women and found no intergroup differences for cause-specific death between pregnant and non-pregnant women. In other words, pregnancy did not make any type of cancer worse. They also found pregnancy a protective factor for women diagnosed with cancer after pregnancy.

Another study looked at a cohort comprised of 185 women diagnosed with melanoma during pregnancy and 5,348 women of the same childbearing age diagnosed with melanoma while not pregnant. There was no statistically significant difference in overall survival between pregnant and non-pregnant groups.

So the real question is how much, if any, harm will be done to the baby in her womb. Once again, we see the constant phenomenon of the morally good being consistent with the temporal good. Studies show that unborn babies of mothers being treated for their cancers do surprisingly well. In one international collaborative setting, patients with invasive cancer diagnosed during pregnancy between 1998 and 2008 were identified. Clinical data regarding the cancer diagnosis and treatment and the obstetric and neonatal outcomes were collected and analyzed. Of 215 patients, five (2.3%) had a pregnancy that ended in a spontaneous miscarriage and 30 pregnancies were interrupted. Treatment was initiated during pregnancy in 122 patients and postpartum in 58 patients. The most frequently encountered cancer types were breast cancer, hematologic malignancies, and dermatologic malignancies. Delivery was induced in 71.7% of pregnancies, and 54.2% of children were born preterm.

In the group of patients prenatally exposed to cytotoxic cancer treatment, the prevalence of preterm labor was increased but there was no increased incidence of congenital malformations. Another Belgian 2009 study states unequivocally that "cancer complicating pregnancy endangers two lives. Any approach should look at both maternal and foetal safety. Maternal prognosis will not improve by terminating the pregnancy ....Chemotherapy during the second or third trimester can be administered without increasing the incidence of congenital malformations."

The last thing a pregnant woman with cancer needs is pressure on her to have an abortion. She needs the best possible treatment for herself and her unborn baby from an obstetrician also trained in oncology. Or from an oncologist in collaboration with an obstetrician who is concerned for the welfare of her unborn baby.

She also needs support from one of the many cancer support groups. In the absence of this – one such group is headed by a former CEO of the Irish Family Planning Association. The setting up of a National Register is also to be recommended as there does not appear to be any systematic recording or studies from this state, the absence of which only feeds into the hands of those who support abortion and will have no qualms using misinformation and scare-tactics to attain their objective of inflicting it on vulnerable women and their unborn children.

References / Sources

1. Cancer During Pregnancy: An Analysis of 215 Patients Emphasizing the Obstetrical and the Neonatal Outcomes. Journal of Clinical Oncology (JCO) Feb 1, 2010:683-689.
2. Gynaecologic cancer complicating pregnancy: An overview. Best Practice & Research. Clinical Obstetrics & Gynaecology, Sept 7, 2009.
3. Treatment of pregnancy-associated breast cancer. Expert Opinion on Pharmacotherapy, Oct 10, 2009 (14):2259-67.
4. Gynaecologic cancers in pregnancy: guidelines of an international consensus meeting. Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Leuven Cancer Institute (LKI), UZ Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
5. Cause-Specific Survival for Women Diagnosed With Cancer During Pregnancy or Lactation: A Registry-Based Cohort Study. Journal Clinical Oncology Jan 1, 2009:45-51;
6. Effect of Pregnancy on Survival in Women With Cutaneous Malignant Melanoma. Journal of Clinical Oncology, Nov ,2004:4369-4375; DOI:10.1200/JCO.2004.02.096