Pregnancy after breast cancer might be a bittersweet experience for survivor mums, say experts

Having a baby after completing the treatment for breast cancer is possible and safe, however, it might be physically and emotionally challenging for women in the reproductive ages.

“My major fear is if it comes back while I am pregnant and then what happens? My family is not all that happy about me wanting more kids,” wrote a breast cancer survivor on Reddit.

While breast cancer survivors can have kids with studies showing no evidence of pregnancy increasing the risk of recurrence, the experience is overwhelming for the survivors, with doctors often asking women to delay pregnancy for minimum two years to assess the risk.

According to the Indian Cancer Society, one in 28 Indian women are affected by the disease, with it occurring at any age after puberty with a higher risk among older women.

With increasing instances of obesity and lifestyle irregularities, more women in reproductive ages are getting diagnosed with breast cancer.

Can a person have a baby after cancer treatment?

When the cells in the breast start to grow out of control, it develops into breast cancer, a disease affecting women worldwide.

If the dysfunctional cells start to spread to other parts of the body, the disease can become life-threatening.

Breast cancer can have types which also determine the mode of treatment most suitable for treating them. Some respond well to targeted therapies and others depend on aggressive treatments like chemotherapy, radiotherapy and surgery.

As per the American Cancer Society, some forms of breast tumours are hormone-hungry. These tumours have proteins that attach itself to fertility hormones like estrogen and progesterone. If the spread of this cancer is hormone-dependent, all efforts are made to inhibit these hormones in the body to restrict the growth of the cancer.

For women having hormone-positive (dependent) forms of breast cancer, the continuation of hormone therapy is important even after the cancer is removed. 

In many cases, the cancer survivors have to interrupt the hormonal therapy to get pregnant after the treatment is over.

While a study published in the New England Journal of Medicine showed a temporary pause to hormonal therapies didn’t increase the risk of cancer recurrence, however, it keeps the affected women on a calculated risk.

Women having hormone-negative forms of breast cancer are at a higher risk of recurrence within the first three years of the treatment, said the Breast Cancer Research foundation, with these forms being more aggressive than others.

Hence, in many cases the treating oncologist can ask the survivor to delay pregnancy for a few years.

How much gap a woman can take after the completion of treatment for breast cancer depends on the type of the cancer and how we proceed to treat it. In hormone positive breast cancer, at least 2 years of endocrine therapy needs to be continued before conception. For triple negative breast cancer, we ask them to wait for over two years owing to high risk of recurrence. For HER2-positive breast cancer, a wait of minimum one year is needed before conception.

Dr Adarsh Pratap Singh, Breast and Endocrine Onco-Surgeon (MS, MCh, AIIMS, Delhi)

In some cases, if the eggs have been damaged by chemotherapy, some survivors have to look for alternative fertility treatments.

Breast cancer survivors should always consult fertility experts on how to preserve their eggs and ovarian tissue. Unfortunately, the treatment for breast cancer can affect the ovarian reserve and can lead to premature ovarian insufficiency.

Dr Adarsh Pratap Singh, Breast and Endocrine Onco-Surgeon (MS, MCh, AIIMS, Delhi)

A bitter sweet journey

While planning to get pregnant post the cancer treatment is considered safe if some time has passed with no signs of recurrence, it can still cause emotional disturbance in those affected.

Women survivors who temporarily pause the intake of hormone blockers to get pregnant are more likely to be in fear of a relapse as pregnancy temporarily increases the hormones in the body.

Also, regular imaging or ultrasounds can trigger negative emotions in the survivors, causing them to worry excessively about recurrence.

Some might even lose the dream of getting pregnant owing to expensive fertility treatments.

Due to increased density of the breast tissue during pregnancy, there is a common risk of mammograms giving a false positive due to lack of clarity, causing panic among the breast cancer survivors.

Sometimes clogged milk can lead to formation of galactocele which mostly occur in cases of untimely interruption of breast feeding. It usually requires a simple USG screening and not necessarily a surgical excision unless it gets all infected and painful. Fear of developing galactocele should not be a barrier for conceiving after breast cancer treatment.

Dr Adarsh Pratap Singh, Breast and Endocrine Onco-Surgeon (MS, MCh, AIIMS, Delhi)