A Belated Mother’s Day Gift

This blog entry comes to us courtesy of one of the Triple Negative Breast Cancer Foundation’s longtime forum members, Natalia M., who shares with us her very personal story about motherhood and TNBC.  Thank you, Natalia, for your “gift” to us all!

Tough decisions (or my quest through whether or not to have a child after breast cancer treatment)

*** Disclaimer:  I hate to start my blog post with a disclaimer but this is the lawyer in me speaking. This blog post is the result of my own personal views and experiences and it doesn’t intend to give any type of medical advice or to influence anyone’s decisions with regards to the issues addressed herein.

  It was at my second opinion surgeon’s appointment that the issue of fertility and cancer treatment was brought to my attention after my cancer journey began. I had been married for over seven years and we had waited for the right moment to have children. I had a miscarriage on our first try. Thankfully we were able to get pregnant easily again and after an uneventful and very happy pregnancy I gave birth to a beautiful healthy boy.

 I had returned back to work and was juggling motherhood and work and I had never been happier. When I was diagnosed with breast cancer the news came to me like a shock; like if I had hit a wall in the middle of the road during a beautiful drive. Of course the first thing that came to my mind was my son. I didn’t want to leave a baby so young without a mother; I didn’t want to think about all the possibilities down that road. I immersed myself in research about triple negative breast cancer and what to do about it and how to improve my chances of being able to see my son grow up.

 But during those crazy, anguish-filled, uncertain and almost surreal weeks, I didn’t think about the possibility, or not, of having more children. When the doctors told us about the fertility issues related to cancer treatment we were faced with yet another important decision to make. We were given the option of seeing a fertility specialist in order to take steps such as freezing embryos or eggs in order to ensure that we could have more kids in the future. For both my husband and I our siblings are a very important part of our lives, so we definitely wanted our son to have them; and we enjoyed being parents so much that we had already talked about trying to have at least one or two more babies.

 However, when we researched about the fertility treatments we learned that I would have to receive treatment with hormones, which would put me in increased risk for cancer on its own (and it could also affect the breast cancer that I already had). So at that moment I decided to focus on getting rid of my breast cancer, as my son was my first priority and I needed to do all I could to make sure I would be there for him. We also knew that studies show that the younger a woman is when going through chemo the better her chances are of being able to conceive. We left it in God’s hands and went ahead with surgery and chemo.

 Once I was done with chemo and radiation I found myself looking forward to having my period back.  It was also the time for me to face the decision of what to do about my ovaries.  The fact that I have the BRCA 1 mutation makes me prone to both breast and ovarian cancer. When I talked about that subject with my doctors, the children issue inevitably came up. They all told me they believed I would get my period back and that it would be safe for me to eventually have children.  They all said that the body got rid of all residues from chemo and radiation quickly and at that time, about 5 months after finishing radiation, my blood counts and the rest of my body were back to normal and healthy enough for me to have a baby.  However their opinions differed as to when it would be wise for me to get pregnant again.

 Half of my doctors said that I should try to get pregnant as soon as I got my period back. They said I should go on with my life and not dwell on cancer and the fear of recurrence.  They also want my ovaries out ASAP. The other half believed I should wait until the three-year recurrence peak for TNBC has passed. As one of them put it, it is already bad to have a recurrence and having it while pregnant would make it worse. He reminded us of how after the three years the chance of recurrence fell and so we would be less likely to face the tough decisions that families face when fighting cancer while pregnant. They also said that since I am still young waiting for a little while will not make much impact on my ovarian cancer risk.

 So it has not been easy for us to decide about when to do it. I used to joke by saying I would split the difference. But it has been already two years and a half since my surgery and at this point I think I want to play it safe and just wait another six months before I decide to try.

 I am a nerd; I have to admit it, I have always been one. As a cancer patient, this means that I try to research and learn about everything I am facing. Although my doctors have all said that it is safe for me to have more children, I have read and heard about PABC or pregnancy associated breast cancer. This has cast some doubts on my decision whether or not to have more children.

 Breast cancer is considered to be associated with pregnancy if diagnosed during a pregnancy or, as in my case, within a year following delivery[1]. Doctors at MD Anderson and other cancer centers have studied it closely as in PABC the rates of death from breast cancer are high. Recent studies have shown that this is mostly due to the fact that diagnosis during pregnancy is difficult as the breasts are too dense for mammograms and tests like PET Scans and similar are not recommended[2]. In these cases treatment is usually postponed until the fetus is able to take the chemo without problems or even until it can be safely taken out of the patient. Since these patients are usually young women whose cancer is usually pretty aggressive, any delays in diagnosis and treatment could affect their survival rates.

 The links between the pregnancy hormones and breast cancer are not yet fully understood. Just recently, several studies have shed some light on how the inflammation of the breast tissue that takes place during pregnancy affects the rate at which breast cancer grows[3].  Another recent study found that giving birth multiple times was related to an increase in the risk of developing triple negative breast cancer[4]. But this still doesn’t answer the question as to whether the pregnancy induces or causes the cancer. Also, the surge in hormones that pregnancy brings to a woman’s body may also promote the development of breast cancer. Although there are no definite studies showing a link between this surge in hormones during pregnancy and breast cancer, there are several studies showing that estrogen levels do affect the development of breast cancer even in hormone negative cases[5].

 BRCA status may also affect the risk of breast cancer associated with pregnancy. Some early studies showed that BRCA related breast cancer risk was associated with pregnancy[6]. But, other studies showed no definite association between pregnancy and BRCA related breast cancer risk[7]. More recent studies showed that the effect of pregnancy on the risk of breast cancer may differ between BRCA1 and BRCA2 mutation carriers at the data seemed to show that an increased number of pregnancies did increase the risk of breast cancer for BRCA2 mutation carriers but not for BRCA1 carriers[8].  Also, some studies have shown that estrogen does play a meaningful role in the development of breast cancer in BRCA1 mutation carriers. Some are even contemplating the use of hormone therapy as an alternative for breast cancer prevention for BRCA1 carriers even in hormone negative breast cancer cases[9].

 On the other hand, a recent meta-analysis that was published last year[10] looked at various studies that followed breast cancer survivors that had children after being diagnosed and treated and in general their survival rates were better than those of women who didn’t. In fact, doctors are currently studying the role that pregnancy hormones play in breast cancer, as they actually seem to prevent it, and there are ongoing clinical trials in which women are being given the hormones to prevent breast cancer[11]. There are no studies showing that a pregnancy after being successfully treated for breast cancer increases the chance of a recurrence[12]. Furthermore, what the studies on the subject seem to show is that pregnancy seems to offer some type of protection from a breast cancer recurrence[13].

 So far my research has not given me a definitive answer; I guess that science isn’t able to provide one yet. I am still undecided as to what to do and although so far none of my doctors have advised me against having another child I don’t want to have any regrets and I am still haunted by the fact that I found my cancer within a few months after giving birth. In the meantime, I am enjoying my little one and have actually found this time I’ve waited to have another one as a blessing, as I am being able to fully enjoy my child.  I have found that breast cancer is more than just a challenge itself as it brings many challenges along side. Fertility and parenthood are some of the ones that I have encountered along the way and as with the rest, I will try to educate myself as much as I can in order to make a decision that I can live with.


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3 Responses to A Belated Mother’s Day Gift

  1. steve k says:

    Dear Natalia,

    Thank you for your poignant, well-researched post.

    One of the joys in my life, is our friendship and I have seen first-hand what a marvelous son you have and what marvelous parents you are. I truly can’t think of anyone who would be a better mother, than you, again.

    If you are looking for a physician to advise you “don’t try to have another baby” I don’t believe that will happen. It is just not something physicians say, I think, for a variety of reasons.

    You face a very difficult decision, in my opinion. All I can say is that, in my unprofessional opinion, there is no clear-cut path. No bright shining light. No precise study to give you guidance. However there seems to be a link, somehow, with estrogen and TNBC and pregnancy, especially combined with the BRCA mutation. But again, nothing definitive from what I have read.

    I would suggest you might get some additional guidance from a Certified Genetic Counselor who is very familiar with the BRCA1+ mutation. But again, I do not believe that professional will advise you what to do but may be aware of some additional studies that can give you some guidance. I have several specific ideas on this that I will discuss privately with you.

    You wrote that hormones are being given prophylactically to women, in certain studies to prevent breast cancer. Were these women BRCA1+?

    I am sorry this is so difficult and whatever path you choose please know that you shall always have my support and love.

    siempre,

    Steve

  2. Shannon says:

    Hello! I can’t tell u how much your post has helped me! I am coming up on my 2 yr anniversary and was diagnosed at 31 with stage 2 triple negative cancer. I have just now started to feel like I may want another baby…We already have 2 little girls and always thought there was one more little soul out there for our family. I have been struggling with all of the issues you speak of in your post and it was so nice to hear some research from another woman in my position….still haven’t decided what to do, but really am grateful for your words! I kept a blog when I was sick shannonshields.wordpress.com thanks again!

  3. Linda says:

    Hi,
    I too have appreciated your posting. I would be interested to hear if you have made any further decisions in the last 6 months. I was diagnosed with stage 3 breast cancer (triple negative) in early 2009, and underwent a double mastectomy, chemo & radiotherapy. I was 35 and had just given birth to our 2nd child. All treatment was completed by November 2009. I have not had a reconstruction.
    Today I have discovered I am 8 weeks pregnant (unplanned) and I am at a loss as to whether it is wise to continue with it. My husband is keen but he doesn’t have the same fear as me with regards to recoccurence.

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