Pregnant After Breast Cancer: The Joy and the Worry

When I announced to friends and family that I was pregnant for the first time at age 40, the responses were predictably jubilant. My father nearly dropped the phone, then yelled “Oh no! Oh YES! Dorothy!!!!” as he bellowed for my mom to join the conversation. My mother-in-law burst into happy tears. Our daughter’s birth mother screamed at the top of her lungs and started jumping up and down in the middle of her kitchen.

That was most of the responses. A couple of people ventured to ask if this was definitely a good thing. My friend Lisa, after rejoicing with me in an e-mail headed “OMG OMG OMG OMG!!!” tentatively asked, “Without intending to be a buzz-kill-does this increase the risk of the cancer returning?”

When you’ve had breast cancer at 37, all kinds of things are different-and pregnancy is one of them.

When I was first diagnosed, three and a half years ago, the doctors offered the option of freezing eggs prior to starting chemotherapy, in case I wanted to try and get pregnant afterward. I said no. I had gone through enough medical procedures already and was about to start even more, and the last thing I wanted was more poking and prodding. I also didn’t want to delay the inevitable chemotherapy longer than I had to. Let’s just get started, please.

Plus-I was scared of getting pregnant after cancer. For most people who’ve had cancer during their reproductive yearse, the big issue is, *can* you get pregnant (or get someone else pregnant) after chemotherapy and/or radiation have beaten up your system? But for women who’ve had breast cancer, the added (and perhaps even bigger) question is-*should* you?

That’s because breast cancer often feeds on hormones, and there’s nothing like pregnancy for sending your body’s hormone production into overdrive. If you think you’ve treated your breast cancer successfully, there still may be tiny “micrometastases” lurking somewhere in your body, indolent and nonthreatening for the moment. Could pregnancy wake them up?

The answer to that question, and to my friend Lisa’s similar one, is “Nobody really knows.” Some studies have shown that there’s no increased risk of cancer recurrence for women who get pregnant; in fact, a literature review published in the European Journal of Cancer in 2003 found that overall survival in women who got pregnant after breast cancer compared favorably with those who didn’t. That, however, may be explained by the “healthy subject” bias-if you’re healthy enough to try and get pregnant after breast cancer, that probably means you aren’t one of the women who had a very early recurrence of your disease (within the first year or so).

But these are all small studies. Because breast cancer in women under 45 is relatively rare (about 24,000 women in that age group are diagnosed every year, compared with more than 200,000 women over 45), and pregnancy after breast cancer is even rarer, that means it’s hard to recruit many women for research.

My breast surgeon, Jeanne Petrek, was one of the nation’s leading experts in breast cancer in younger women, and she headed up the largest and only prospective study to examine this question. It looked at both issues of premature menopause in young women with breast cancer (how likely is it that the menopause will be permanent?), and pregnancy in those same women (how risky is it)?

Dr. Petrek told me that although the small studies showed no risk, biologically speaking, there should be an increased risk. That didn’t mean she was telling me or any other breast cancer survivor not to get pregnant-just that we needed to know there were still unanswered questions, which she hoped her study would help to answer.

Her study is still ongoing, led by another doctor, because Dr. Petrek died in a tragic car accident in Manhattan in 2005. The menopause results came out a year or so ago, but it will take longer to really know if the women enrolled in the study who got pregnant after cancer then developed recurrences at a higher rate than those who didn’t get pregnant.

And my biological clock isn’t just ticking, it’s chiming the hour. Waiting another year or two or three for the study results was, effectively, deciding not to get pregnant. So this past spring, my husband and I decided to throw caution to the wind. We had one beautiful daughter via domestic open adoption, and were thinking of starting the adoption process again. But before we did, we wanted to try getting pregnant. How did I get to that point, after being so terrified of the prospect post-cancer that I hadn’t bothered to freeze eggs in case “chemopause” became permanent?

First, I had had a remarkable response to treatment-something called a “complete pathological response,” which meant that when the doctors went in to remove what was left of my breast lump after initial chemotherapy, it was gone. Nothing but benign tissue remained. Every time I mention this to any breast specialist, they ooh and aah over how lucky that was. It’s considered the best predictor of whether or not your cancer will come back.

Second, it had been three years since treatment, and my watchful doctors had spotted no sign of recurrence. Those were the riskiest years, and I’d made it through them safely.

Third-well, there’s no real third. Not exactly. The first two factors were real, specific items about my risk that I could weigh and consider. The third factor was totally intangible: my desire to experience pregnancy and childbirth. I love my daughter with all my heart and soul, and I wish more than anything that I could have carried her inside me and given birth to her-but of course, that would have made her a different child from the perfect one she is.

While she was pregnant, our daughter’s birth mother told me that she so hoped that I could get pregnant someday so that I could experience this. I told her it would be all right if I didn’t-and it would have been. And if there had been some document telling me that I would double my risk of the cancer coming back if I did get pregnant, maybe I wouldn’t have. But the answer to that question was unknown, and putting an unknown fear against a deep and real desire to have a baby, I chose not to worry (too much) about the unknown.

So far, all looks well. I’m almost 18 weeks along and both the baby and I are healthy. My oncologist was so unworried about the risks that when I asked if she needed me to come in for a visit sooner than my usual appointment, she said, “Nah. See you in December.”

Some people might say I made a foolish decision, took a crazy risk when we could have adopted again, risked leaving my daughter without a mother at a young age. I think that I decided to choose faith: faith in my body, faith in my instincts, faith in my future. And anyone who’s ever had breast cancer-or any kind of cancer-knows that those things can often seem to be lost when you face this disease. Having this baby means I’ve got them back. And when he comes into the world, it will be my promise to him and to his big sister that I intend to be here for a long, long time.

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