Breast Cancer in Pregnancy: You’re stopping chemo early - is that really a good idea mummy?
December 2016 & shortly after my 1st round of chemo, Ethan is about 10 weeks old in this picture.
Breast Cancer in Pregnancy: My big wake up call
For me cancer has turned out to be a huge wake up call. Cancer shook me, it forced me to think deeply about everything I held dear, my life so far, my current beliefs and ways of living, and also how I wanted to live and to be in the future.
Fundamentally though - I knew that I wanted to live!
I wanted to live, not just for my new-born son or for my husband, but for me. And I knew that I didn’t just want to simply survive it, which I imagined as clinging on, being alive but not necessarily being particular well. That wasn’t what I wanted for myself.
I wanted to thrive! I wanted to be fully back to health. No compromises.
This was and still is to some extent, a big, rather self-assured desire, but especially then given the dire state of my health. However, health didn’t seem that far away. Only 2 years earlier, I’d been at the peak of physical fitness, I’d fallen so far and so fast, that while I was at the depths, I wholeheartedly believed full health was possible but how was I going to turn things back around? I had dug myself into one hell of a health hole, it was going to take some serious climbing out!
Before I can delve more deeply into this though, I probably should provide a little more background into the decisions that I made leading up to this point. I’ll take a step or two back and talk about my diagnosis, the various treatment options available for people who are diagnosed with breast cancer in pregnancy, and also my specific treatment protocol.
If you would like some support negotiating your way through this challenging time, then take a look at our 90 day programme to see how we can help you. Alternatively, if you have any questions then send us a message and we will get back to you as soon as possible.
Breast Cancer in Pregnancy: Treatment Protocols
In some respects I was very fortunate in that I was diagnosed at 41 weeks pregnant when my pregnancy was almost at its end. Consequently, I didn’t have to make some incredibly difficult decisions regarding when (assuming that I was going to follow the recommended protocols) I would start treatment. Many women are not so fortunate and have to make such decisions during their pregnancy with some opting to start treatment for their cancer while still pregnant. I’ll run through the treatments relevant to my own protocol and the official view on whether they can be performed during pregnancy.
Surgical Treatment
There is robust evidence regarding the safety of surgical procedures and use of anaesthetics in pregnant women, and consequently, the general recommendation is that oncological surgery can be carried out at any moment during pregnancy and should not be delayed (1).
Chemotherapy
Most chemotherapeutic agents have low molecular weight and cross the placenta (1). Nearly all of them are known or suspected teratogens (i.e. an agent which causes malformation of an embryo) according to animal studies (1). Due to the rarity of the cancer-pregnancy condition and ethical issues related to conduction of clinical trials within this population, there is limited human research data available (1). Given that chemo drugs cross the placenta, I would expect that chemo is not recommended in pregnancy at all, however, as the formation of the major body systems and organs takes place primarily during the 1st trimester, it is only during the this period that chemotherapy is not recommended. In fact, despite it crossing the placenta, chemotherapy during the second and third trimester is considered relatively safe (1), yet while there is apparently no increase in malformations rates, obstetrical and neonatal complications, such as in intrauterine growth restriction, low birth weight and preterm labour may occur more frequently (1). If you want more information on this subject, then the study referenced here is a good start.
Radiotherapy
The typical dose in radiotherapy is over 100 times higher than the doses utilised for diagnostic methods. Considering such high values, there is a great concern about possible harms to the foetus and for this reason, radiotherapy is not routinely recommended during pregnancy and should be postponed until after childbirth whenever possible (1)
Endocrine treatment
The physiological changes necessary for a healthy pregnancy and foetal development are mainly hormone mediated. Consequently, the utilisation of drugs that block oestrogen and progesterone production or action will interfere with those physiological processes (1). Of note, tamoxifen, the most utilised drug in the pre-menopausal context, is teratogenic in animals and has been associated with birth defects in children of women who inadvertently have utilised the medication during pregnancy. Hence, endocrine treatment is not recommended during pregnancy (1).
I do feel incredibly fortunate that I did not have to make a decision on whether to undertake treatment for my cancer whilst I was still pregnant. Similarly, due to the timing of my diagnosis, I didn’t carry the stress of that diagnosis and the resulting flood of stress hormones during my pregnancy, for which I am also grateful. But, as I’m sure most people will agree, there really is no good time to find out that you have cancer.
Breast Cancer in Pregnancy: My journey - diagnosis and beyond (2016-2019)
Breast Cancer in Pregnancy: My Diagnosis and Treatment Protocol
My Diagnosis
I didn’t keep copies, and as I am no longer in touch with the team, I don’t have my exact diagnosis, however I do remember that following my mastectomy it was confirmed as Grade 2 / Stage 3 invasive breast cancer, which means that the cancer cells had spread to some lymph nodes - 9 out of 22 nodes in my left armpit per the surgeon - and the cancer cells were replicating faster than normal cells replicate (2).
When I was first diagnosed, it was a terrifying. I think cancer tends to be viewed as this huge scary disease that preys on people indiscriminately in ever increasing numbers with the majority of people feeling that they have little control over the outcome. They feel that they must succumb to the advice of the medical professionals - the oncologist and the surgeon primarily - as these are the only people that can help them. They themselves are often left feeling helpless.
This is certainly how I felt initially. I have always been fiercely independent, tending toward being a ‘control freak’ by nature’. When I was younger, my friends often compared me to Monica from Friends, which may give you a better picture of just how in control I liked to be - and also how competitive I could be! Thankfully, I feel that I’ve mellowed, but still, for me to suddenly have to relinquish full control of life to others was extremely challenging. My life was now, so it seemed, completely in the hands of these medical professionals, and they made it pretty clear that my situation was serious, with my tumour being so large, around 8cm in diameter, and cancer cells having spread to the lymph nodes. There were positives however. According to my surgeon, clear margins had been achieved during the mastectomy, the cancer cells were ER-positive and highly oestrogen responsive, with an Allred score of 8 out of 8 (3). Consequently, I was informed that my cancer was highly treatable and should respond well to the prescribed treatment of a full mastectomy (tick), followed by 6 rounds of chemotherapy, radiotherapy and 10 years of Tamoxifen. Good news apparently! Yet, it still sounded pretty terrible to me.
The Mastectomy
As mentioned previously, because of my wish to continue breastfeeding, I had the mastectomy first, at 4 weeks post partum. While obviously not pleasant for me, I remember how traumatic it was for Matthew who was left to manage a screaming 4 week old baby that suddenly had no mummy to feed on or snuggle up with. But I was home after just one night in hospital, and so able to continue feeding him for a little while longer - 4 weeks to be exact, but every day counts - until I had to face the dreaded chemo.
The Chemo
And I was truly dreading it. I tried to postpone it by a few months to breastfeed for longer. This was received with questioning glances from my surgeon, which I acknowledged but chose to ignore. However, after the oncologist presented Matthew and I with some pretty dire statistics I found myself in that chair within the week.
Despite my reservations, I was still of the view that I had no alternative but to follow the oncologists advice. With the birth and now a mastectomy to recover from, plus a small baby to deal with, I had had little time to spend researching. However, I had started to do some reading, I’d spoken with a naturopath, and I had talked to a few friends who I thought might give me some good advice, so by the time I started chemo I was taking a whole host of supplements - mainly medicinal mushrooms, astragalus and greens - all of which my oncologist advised that I discontinued (I ignored this advice), and I decided that I would fast around each chemo round - which he did support as he had been involved personally in a research project which found benefits from doing this.
I had 4 treatments roughly 3 or 4 weeks apart starting in the November (8 weeks post partum) and each round took a progressively harder toll on my body, with the severity and number of side-effects mounting. I felt dreadful. For my 4th round the chemical protocol changed and was apparently even more toxic. There was now a significant risk that the nerves in my extremities (hands and feet) could be permanently damaged and it was recommended that I wore ice gloves and feet mitts to reduce the risk. This was on top of the ice hat that I was wearing to reduce the risk of my hair falling out (which didn’t work). The 4th round completely wiped me out. The ice gloves and feet mitts combined with the chemical cocktail being pumped into my veins made me throw up repeatedly during the procedure. It was awful. Afterwards, I remember crawling into the bath at home and looking at myself in the mirror. I appeared as close to death whilst still living as I think I possibly could have, with enormous black circles under my eyes and yellowy grey, sickly skin. I felt that the treatment was killing me and I just knew then that I could not take any more.
Mummy is Having No More Chemo
As soon as I was able to, I started reading and researching, which was not easy given a 4 month old to manage, and the now dire state of my health. I started looking into Tamoxifen initially, as I wasn’t comfortable with the idea that I might be taking a medication which blocks such an important and vital female hormone. I understand the rationale of why it is recommended but intuitively, I felt that the risk of negative effects would also be high. So I did a bit of digging, superficial reading of the internet initially but my thought processes, combined with the intolerable side effects that I was suffering with, were already leading me in one direction. By the end of the day, I had made my decision, I was not having any more chemotherapy, it was not for me, I was not going to have radiotherapy, that was also not for me, and I was not going to take a medication that would block the activity of my oestrogen hormones. I had made my decision and I intuitively felt that it was the right decision for me.
Stopping chemo early or refusing chemotherapy in the first place requires enormous strength.
So I had made the decision that I would be stopping chemo early, yet I knew that this would not be simple. I believed that I would potentially come under pressure from close relatives to continue with the treatment, perhaps friends too. People are scared, people fear cancer and by turning my back on the only treatment that modern medicine had to offer me, those close may have felt that I was turning my back on life or even that I was acting irresponsibly given that I had a new born child to consider. I find that many people appear to have a blind faith in modern medicine, and while I also feel that for certain conditions modern medicine is truly amazing, for cancer and many chronic diseases, I am less convinced that it has the answers.
The concept of first do no harm, “primum non nocere”, is a doctrine as old as medicine itself. For cancer treatment, the medical profession seems to have strayed from this principal, perhaps erring more towards the principal of ‘being useful to the patient’, given that the treatments currently on offer, such as, chemotherapy, radiotherapy, surgery and immunotherapy are the only tools that they have. As far as I was concerned chemo was greatly harming me. Four months earlier, while I clearly had not been in great health, otherwise my body would not have been nurturing a large cancerous tumour, I felt ok. Whereas, now I felt and looked on the verge of death. The current treatment of chemo had the potential to not only kill me, but should I survive the treatment, there was a high probability that I would have permanent damage to vital parts of body, such as my nervous system. Additionally, it was around this time that the mainstream media were reporting that studies were showing that chemotherapy actually increased a persons chances of metastatic cancer occurring at a future date. In fact, emerging pictures from cancer research in the last decade show that, paradoxically, chemotherapy can actively induce changes in cells that favour cancer progression (4). I needed no more convincing, I felt that the risks far outweighed the potential benefits.
This is such a difficult decision to make, it takes great strength to make such a decision and even more to stick with it under the weight of pressure from well-meaning friends and relatives. I knew it was the right decision for me though. I certainly wasn’t turning my back on life and, I firmly believed, and still do, that I was taking the only responsible action to preserve my life, as I knew and wanted it, and to support my new-born child long into his young life.
I desperately wanted to live but I didn’t want to simply survive, I wanted to truly thrive.
I wanted to be fully back to health. No compromises.
So for me stopping chemo early was my only option.
Making that decision was so hard, I knew that I needed people on my side to support me through the process, as I suspected that my closest family would probably not understand. It is such a hard place to find yourself when you are so ill and it can be quite lonely and stressful. Thankfully, I have an amazing, supportive husband - Matthew - and I quickly got him on my side. I asked him to read all the information that I was reading, the research that I’d found, whatever I thought appropriate to ensure that he would fight my corner if and when I was struggling to. I really needed him and it worked. He backed me up with statistics and quotes from relevant studies whenever I came under pressure from others around this subject. He was and still is my rock.
Such a decision is not for everyone and nor am I advocating that people reading this pull out of conventional treatment. Each person must make their own mind up as to what is best for them, ideally by weighing up the potential risks compared to the potential benefits for themselves. An informed decision. However, if you are reading this and considering either stopping chemo early or refusing chemo in the first place then I would definitely recommend getting someone close to you on board who will support you wholeheartedly in your decision. Ensure that they fully understand your rationale, have read the research and information that you have read, and basically have your back. It can be a very challenging time.
Looking back now I appreciate what a bold decision I was taking, and how strong I was to stand by it.
But this was just the beginning, I was in a terrible state of health.
I now needed to transform my ailing body into a body in which disease and specifically cancer could not thrive.
I had so much work to do.
March 2017 - 2 months post chemo
If you too want to become empowered to take back control of your health, to turn your ailing body into one in which cancer can not thrive then we can support you. Take a look at our 90 day programme for more information, or alternatively, if you have any questions then send us a message and we will get back to you as soon as possible.
“We fall, we break, we fail... But then we rise, we heal, we overcome.”
— Unknown
Sarah Eglin: Registered Nutritional Therapy Practitioner (mBANT) and breast cancer ‘thriver’
If you would like to read more about my personal experience with breast cancer and my journey back to great health then please click on the following links for more in depth information.
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References & Notes
(1) Hepner A et al. (2019). ‘Cancer During Pregnancy: The Oncologist Overview.’ World J Oncol. Vol:10(1), p28-34. doi: 10.14740/wjon1177. Epub 2019 Feb 26. PMID: 30834049; PMCID: PMC6396773.
(2) NHS website. (2023). ‘What do Cancer Stages and Grades Mean’. Available at https://www.nhs.uk/common-health-questions/operations-tests-and-procedures/what-do-cancer-stages-and-grades-mean/. (Accessed 22 February 2023)
(3) Breast Cancer.Org. (2023). ‘Breast Cancer Hormone Receptor Status’. Available at https://www.breastcancer.org/pathology-report/hormone-receptor-status. (Accessed 22 February 2023)
(4) Middleton JD et al. (2018). Chemotherapy-Exacerbated Breast Cancer Metastasis: A Paradox Explainable by Dysregulated Adaptive-Response.’ Int J Mol Sci. Vol 19(11):3333. doi: 10.3390/ijms19113333. PMID: 30373101; PMCID: PMC6274941.