Pregnancy after breast cancer is possible

Oct 2 2007

Once Alyssa Tushman knew her young son would not grow up motherless, her next question was whether he would be an only child.

Tushman was 27 and a new mother when she was diagnosed with stage III breast cancer. After aggressive treatment – including chemotherapy, radiation therapy, a double mastectomy and reconstructive surgery – Tushman was happy to learn that another baby would be possible. And today, she's pregnant with her third child.

Most women are in their 50s or older and thinking about grandchildren when they are diagnosed with breast cancer. But what about that increasing number of women in their 20s and 30s who are diagnosed at a point when they are dating, getting married and just starting their family?

Despite toxic chemotherapy regimens that can mess with ovarian function, it is possible – and safe – for many women to conceive after breast cancer treatment, according to Daniel F. Hayes, M.D., clinical director of the breast oncology program at the University of Michigan Comprehensive Cancer Center.

“Fertility is something we talk to patients about. We try to give them their odds. That discussion is going to be specific for each patient, because it depends how old she is, whether she should get chemotherapy, what kind of chemotherapy, and whether she cares about maintaining fertility,” Hayes says. “Most of us in the field have not been discouraging women from becoming pregnant. What we have learned more are some of the caveats.”

Several factors will affect ovarian function after cancer treatment, including whether a woman receives chemotherapy. Most chemotherapies do have an adverse effect on ovarian function, but a woman's age has a lot to do with that, Hayes says. Younger women have a much greater chance of regaining their periods after treatment than women closer to menopause.

Tushman's period returned about three months after she finished treatment. She was diagnosed with breast cancer just four months after giving birth to her first son.

“I was terrified my son was going to grow up without his mother. That was the worst, scariest part of the whole thing,” says Tushman, now 31. A year after her treatment ended, she easily got pregnant. Now she's pregnant for a third time.

“Getting pregnant for the second time was a big decision. As much as I wanted it, we were told by my oncologists it's a big decision. Because if, God forbid, my cancer comes back, I had to discuss with my husband whether he'd be OK as a single parent with two or three children. We decided it was worth it. I don't want to live like I'm going to die,” Tushman says.

For some women, newer hormone-based therapies can further affect fertility. These drugs are often given for longer periods of time, up to five years. To become pregnant, women would have to stop taking the hormone therapy for a period of time.

“That's something I discourage women from doing because the benefits of the therapy are so great,” Hayes says.

If a woman does become pregnant after breast cancer treatment, it does not seem to have an effect on her health or the baby's health. Studies show the risk of birth defects or miscarriages is not any higher in a woman who has had chemotherapy.

Pregnancy also is not likely to cause a woman's breast cancer to return. At the same time, any traces of breast cancer that may be in a woman's bloodstream have never been shown to cross into the baby's.

Tushman is thrilled with her decision to have more children and says she has learned never to take life for granted.

“My boys are amazing. They are the light of my life and my husband's life. We love every minute of it, we really do,” she says.

About breast cancer:

• 180,510 Americans will be diagnosed with breast cancer this year.
• 40,910 Americans will die from breast cancer this year. It is the third-leading cause of cancer death for women in the United States.
• When caught in its earliest stages, breast cancer can be cured in 80 percent of women.
• Yearly mammograms are recommended for all women older than 50.
• Never ignore a lump or change in the look or feel of your breast.