Women who receive a cancer diagnosis during pregnancy and women who have undergone cancer treatments prior to pregnancy face unique and difficult challenges. Every year in the United States, one in 3,000 women will be diagnosed with breast cancer during pregnancy. Other common cancers among women of childbearing age include thyroid cancer, blood cancers, and lung cancer.
At Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC), we provide highly specialized care for women with cancer of all types before, during, and after pregnancy. Our multidisciplinary team of experts, including maternal-fetal medicine (high-risk pregnancy) specialists, oncologists, surgeons, anesthesiologists, and specialized nurses, is dedicated to delivering the highest level of care and achieving healthy outcomes for pregnant women and their babies.
Women with a prior history of cancer who are planning a pregnancy and women who are diagnosed with cancer during pregnancy require specialized care. In these cases, it is crucial that a team of specialists in multiple disciplines – including maternal-fetal medicine, oncology, anesthesiology, and other specialties – be closely involved in the care of both the mother and the baby.
For women who have undergone prior cancer treatments, including childhood cancer survivors, planning with the medical team should begin before conception in order to understand how to best manage risks during pregnancy. Some cancer treatments, including chemotherapy and other medical therapies and radiation therapy – even those given many years before pregnancy – can place the mother and the baby at higher risk for certain complications during pregnancy. Young women who are preparing to begin cancer treatments that can result in infertility should receive counseling about fertility preservation.
Tests to assess the mother’s thyroid, pulmonary, heart, and other functions are typically performed prior to pregnancy, and results are considered relative to the changes and increased demands that occur during pregnancy. Review and modification of current medications, including those designed to prevent cancer recurrence, should also be performed before pregnancy as well. Mothers should not reduce or discontinue medications on their own. Imaging related to surveillance for cancer recurrence should also be considered.
During pregnancy, an individualized prenatal care plan is developed by the multidisciplinary team based on the mother’s type of cancer and the stage of pregnancy when the cancer is diagnosed. Treatment strategies will be designed to effectively address the cancer while minimizing risks to the baby.
The condition of both the mother and the baby needs to be carefully monitored and managed throughout the cancer treatment and pregnancy. Close collaboration between the mother’s maternal-fetal medicine specialist and oncologist is crucial.
An individual delivery plan will be developed by the multidisciplinary medical team, including experts in maternal-fetal medicine specialists, oncology, and anesthesiology. Timing of treatments will be considered around the expected delivery. The team also will coordinate postpartum care with the providers for the mother and baby after delivery and discharge from the hospital.
At DF/BWCC, experts in maternal-fetal medicine and leading oncologists have formed an innovative collaborative care program provide multidisciplinary care for patients with cancer. One of few of its kind in the nation, the Oncology Collaborative Care Program team delivers advanced individualized prenatal, delivery, and postpartum care, as well as preconception consultation. Depending on the type of cancer and stage of pregnancy when it is diagnosed, the DF/BWCC team works with mothers to select effective treatment strategies that can be given safely, minimizing risks of harm to a developing infant. Specialists in the Oncology Collaborative Care Program also work as part of the Program for Young Women with Breast Cancer to meet the specific needs of young women with breast cancer.