Written By Robin Warshaw, Contributing Writer
Reviewed By Jennifer Litton, MD
As preparation for her upcoming marriage,Karen Ortiz visited her gynecologist. Karen, then 37, often had breast lumps. The Ogden, Utah, woman told her doctor about her latest lump and was sent for a mammogram and ultrasound.
The next day, on a whim, Karen and her fiancé got married. “It was more like eloping because we didn’t want the whole family thing at the wedding,” she says.
Three days later, she was told to see the surgeon. “I didn’t think [breast cancer] was possible,” she says. “I thought they were just gonna say, ‘Yeah, you’re lumpy.’”
She was told she had breast cancer on her one-month wedding anniversary. She promptly bought a pregnancy testing kit with two tests. Both turned up positive.
“I called the surgeon and she said, ‘Are you gonna get an abortion?’ The surgeon told me it changed everything [about treatment],” Karen says. That isn’t so, but being pregnant during breast cancer treatment does change some things.
Treatment During Pregnancy
Karen’s oncologist also asked if she planned to terminate the pregnancy. ( Research suggests that does not benefit breast cancer outcome.) But her oncology nurses mentioned two women they knew who carried pregnancies through treatment.
“It seemed like the life inside of me was a sign from God,” says Karen, whose faith is an important source of support to her. “I felt it was going to be OK.”
Karen had surgery to remove her right breast and some lymph nodes. Tests confirmed she had stage IIIB triple-negative breast cancer. Because prolonged anesthesia would risk the pregnancy, she couldn’t have the reconstructive surgery she wanted at the same time.
Chemotherapy can harm the fetus during the first three months of pregnancy, so Karen had treatment during her second trimester.
“I was going to the gym, doing pump classes, feeling great, except for really bad migraines the first few days after treatment,” she says. Lowering the dose of her anti-nausea medicine reduced the problem. Her husband and teenaged daughter helped out at home.
Karen’s doctors scheduled her for an early delivery, at 36 weeks (about four weeks sooner than average childbirth), so chemotherapy could begin again sooner. The baby was born healthy, at 5 lbs., 9 oz.
After the baby arrived, Karen started more chemotherapy. Radiation followed, at a center near her job and daycare. “I would run and get the radiation, then pick up the baby after work,” she says.
Karen’s son recently turned two. “I’ve noticed some development delay in his fine motor, speech and feeding, but I don’t know if it’s associated with treatment,” says Karen.
A 2010 study shows that infants exposed to chemotherapy after the first trimester do not have higher rates of congenital problems, early delivery or limited growth. A 2012 study of the long-term outcomes, or effects, for children exposed to chemotherapy during pregnancy has shown that most have normal heart, brain and cognitive functions despite exposure to treatment. But many moms like Karen have similar worries.
Another Challenge Appears
Karen had reconstruction about eight months after her infant was born. She healed well, but she and the baby frequently got sick with infections. Stress from her department store management job added to her feeling overwhelmed, so she took a six-month leave of absence. When she returned to work, she began having headaches, eyelid pain and a tingling sensation in her legs.
“The headache never stopped,” she says. Nose and face tingling prompted her to call the oncologist. Tests showed the breast cancer had traveled to her brain.
Instead of having neurosurgery and radiation, Karen chose a newer technique,stereotactic radiosurgery. This method uses high doses of targeted radiation to destroy brain tumors. The tumor shrunk by half after one session. Karen is now receiving additional chemotherapy for it.
Drawing on Strengths
Karen has learned to manage her whole healthcare experience, including nutrition and exercise, both of which she considers important. And she decided to reduce her load of responsibilities.
“When I went into chemo, I thought, ‘What don’t I have to do?’” Now, when her husband’s sons from a previous relationship are staying with them, he handles their laundry.
For support, Karen relies on two close friends from her Bible study group. Other supportive people, like caring chemotherapy nurses, emerged during treatment.
And her faith continues to sustain her. Says Karen, “God has pretty much carried me through everything.”
This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.