In April of last year, Rachel Brown’s oncologist called with bad news — at age 36, she had an aggressive form of breast cancer. The very next day, she learned that she was pregnant after nearly a year trying to have a baby with her fiancé.
She had always said that she would never have an abortion. But the choices she faced were overwhelming. If she has chemotherapy needed to stop the spread of the cancer, she could harm her baby. If he had not had it, the cancer could have spread and killed him. She had two children, aged 2 and 11, who could have lost their mother.
For Ms. Brown and others who are unlucky women receiving a cancer diagnosis while pregnant, the Supreme Court’s decision in June to end the constitutional right to abortion may seem like a slap in the face. If fetal life is of paramount importance, pregnancy may mean that a woman may not receive effective treatment for her cancer. Every year, one in a thousand women who become pregnant is diagnosed with cancer, which means that thousands of women face a serious and potentially fatal disease while they are expecting a baby.
Before the Supreme Court ruling, a pregnant woman with cancer was already “entering a world of unknowns,” said American Society of Clinical Oncology chief executive officer Dr. Clifford Hoodis said. Now, patients as well as doctors and hospitals treating them are caught up in additional complications of the abortion ban.
“If a doctor can’t prescribe medication without fear of harming the fetus, is that going to compromise the results?” Dr. Hoodis asked. “It’s a whole new world.”
Cancer drugs are dangerous for the fetus in the first trimester. Although older chemotherapy drugs are safe in the second and third trimesters, the safety of newer and more effective drugs is unknown and doctors are reluctant to prescribe them to pregnant women.
About 40 percent of women who are pregnant and who have cancer have breast cancer. But other cancers also occur in pregnant women, including blood cancer, cervical and ovarian cancer, gastrointestinal cancer, melanoma, brain cancer, thyroid cancer and pancreatic cancer.
Women with certain types of cancer, such as acute leukemia, often cannot continue with pregnancy if the cancer is diagnosed in the first trimester. They need to be treated immediately, within days, and the drugs needed are toxic to the fetus.
“In my view, the only medically acceptable option is to terminate the pregnancy so that the mother can be given life-saving treatment,” said Dr. Eric Viner, director of the Yale Cancer Center.
Some oncologists say they are not sure what is allowed if a woman lives in a state like Michigan, which has criminalized most abortions but allows them to save the mother’s life. Does Leukemia Qualify as a Cause of Miscarriage to Save Her Life?
Dr. N., an oncologist at the University of Michigan. Lynn Henry said, “It’s so early that we don’t know the answer.” “We cannot prove that the drugs caused problems for the child, and we cannot prove that stopping the drugs would have negative consequences.”
In other words, doctors say, complications from pregnancy — miscarriage, premature birth, birth defects or death — can occur whether a woman with cancer takes medication or not. If he is left untreated and his cancer turns into a deadly disease that kills him, he may, even if he has been given cancer drugs.
Administrators of the University of Michigan’s medical system are not interfering with cancer treatment decisions about cancer treatment in pregnant women, saying that “medical decision-making and management are between doctors and patients.”
I. Glenn Cohen, a law professor and bioethicist at Harvard, is seriously concerned.
“We’re putting physicians in a terrible position,” Mr Cohen said. “I don’t think signing up to be a therapist should mean signing up for jail time,” he said.
Oncologists are usually part of a hospital system, Mr Cohen said, which adds another complication for doctors treating cancer in states that ban abortions. “Whatever their personal feelings,” he asked, “what risks are facing the hospital system?”
“I don’t think oncologists ever thought this day was coming for them,” Mr Cohen said.
Behind the doctors’ confusion and anxiety are the stories of women like Ms. Brown.
She had a large tumor in her left breast and cancer cells in her underarm lymph nodes. The cancer was HER2 positive. Such cancers can spread rapidly without treatment. About 15 years ago, the prognosis for women with HER2-positive cancer was the worst breast cancer prognosis. Then a targeted treatment, trastuzumab, or Herceptin changed the picture completely. Women with HER2 tumors now have the best prognosis compared to other breast cancers.
But trastuzumab cannot be given during pregnancy.
Ms. Brown’s first meeting was with a surgical oncologist, who “made it clear that my life would be in danger if I continued with my pregnancy because I would not be treated until the second trimester.” He told her that if she waited for those months, her cancer could spread to distant organs and become fatal.
Her treatment in the second trimester would be a mastectomy with removal of all lymph nodes in her left armpit, which would have increased her risk of lymphedema, an incurable fluid buildup in her arm. She could have started chemotherapy in her second trimester but could not have trastuzumab or radiation treatment.
Her next consultation was with Dr. Lisa Carey, a breast cancer specialist at the University of North Carolina, who told her that she could have had a mastectomy in the first trimester before chemotherapy, but it was not optimal. Typically, oncologists give cancer drugs before a mastectomy to shrink the tumor, allowing for less invasive surgery. If treatment doesn’t eliminate the tumor, oncologists will try more aggressive drug treatments after the operation.
But if she had a mastectomy before she had chemotherapy, it would be impossible to know if the treatment was helping. And what if the drugs weren’t working? She worried that her cancer could be fatal without her knowing.
She feared that if she tried to maintain her pregnancy, she might sacrifice her life and destroy the lives of her children. And if she delayed making a decision and then miscarried later in the pregnancy, she feared the fetus might be in pain.
She and her fiancé discussed her options. This pregnancy will be their first biological child.
With great sadness, they made their decision – her abortion would be medicine. She took the pills one morning when she was six weeks and one day pregnant, and cried all day. She wrote a eulogy for the child who could be. She was convinced that the child was going to be a girl, and she named her Asha. He saved an ultrasound of Hope’s heartbeat.
“I don’t take that little life lightly,” said Ms. Brown.
After ending her pregnancy, Ms. Brown was able to begin treatment with trastuzumab, along with a cocktail of chemotherapy drugs and radiation. She had a mastectomy, and there was no evidence of cancer at the time of her surgery—a great prognostic sign, Dr. Kerry said. She did not need to have all of her lymph nodes removed and did not develop lymphedema.
“I feel like it took a lot of courage to do what I did,” Ms. Brown said. “Your first instinct as a mother is to protect the child.”
But after going through that grueling treatment, she also wondered how she could ever take care of a newborn baby and her two other children.
“My bones hurt. I couldn’t walk more than a few steps without holding my breath. It was hard to get nutrients because of the nausea and vomiting,” she said.
The Supreme Court’s decision hit him hard.
“I thought the reason I did what I did didn’t matter,” she said. “My life didn’t matter, and my kids’ lives didn’t matter.”
“It didn’t matter that I lost my life because I was being forced to get pregnant,” she said.
(This story has not been edited by seemayo staff and is published from a rss feed)