Pregnancy and breast cancer
Rebecca Byrne had waited years for a doctor to tell her: "You are pregnant." She never imagined that just a few months after she first heard those words, she would hear four more: "You have breast cancer."
Byrne still tears up when telling the story, but then smiles when her daughter, Emelia, leaps into her lap. Emelia is the happy outcome of a painful period of Byrne's life, when the joys of pending and early motherhood were shadowed by chemotherapy treatments, hair loss, radiation, and uncertainty.
It's a combination that seems too cruel to be true, but every year in the U.S., one in 3,000 women will be diagnosed with breast cancer during pregnancy. Many obstetricians and oncologists have never dealt with these dual challenges, but Dana-Farber/Brigham and Women's Cancer Center in Boston has become a leader in achieving healthy outcomes for patients and their babies.
The key is to look at each case individually, explains Ann Partridge, MD, MPH, director of Dana-Farber/Brigham and Women's Cancer Center's Program for Young Women with Breast Cancer.
The program assists women in their early 40s and younger before, during, and after cancer treatment, and works in collaboration with the reproductive endocrinology and high-risk pregnancy centers at partnering Brigham and Women's Hospital (BWH), where individuals like Byrne can consider their reproductive options.
Depending on the type of breast cancer and the stage of pregnancy at which it is diagnosed, the Dana-Farber/Brigham and Women's Cancer Center team may choose among chemotherapy regimes that can be given safely, without clear harm to the fetus or the patient.
Because Byrne was in her second trimester, when the baby was more developed, Partridge said this would be the safest time during pregnancy to have both chemotherapy and any needed surgery.
Partridge also reassured Byrne that her type of breast cancer, HER2-positive invasive ductal carcinoma, was very responsive to a chemotherapy regimen that she could handle while pregnant.
Partridge recommended a lumpectomy as a first surgery, rather than a mastectomy. In April 2010, Byrne had two lumpectomies to remove tumors in the breast, along with some surrounding breast tissue.
Before and after each surgery, clinicians let her hear the baby's heartbeat.
A month later, Byrne started treatment with chemotherapy medications taken every three weeks for a 12-week cycle.
Through it all, Byrne was determined to have as normal a pregnancy as possible. She shaved her head right before her hair started falling out, got a wig, and wore it to Lamaze class, where she and Larry kept their difficult situation private.
Emelia weighed 3 pounds, 9 ounces, when born on July 30, and spent her first 26 days in the neonatal intensive care unit (NICU). Shortly thereafter, Byrne began a new 12-week chemotherapy cycle.
On days when she was scheduled for chemo infusion, she'd spend her mornings snuggling with the baby in the NICU, then head over to Dana-Farber/Brigham and Women's Cancer Center for treatment. Because she couldn't produce safe breast milk during chemo, friends with infants provided their own to feed Emelia.
Byrne's year of chemotherapy treatment ended in August 2011, and she is now focused fully on her family and career. Emelia is a healthy, happy, mile-a-minute toddler, and the garage in which Byrne sat and cried after hearing her diagnosis now holds strollers and diapers.
When she comes to see Partridge at Dana-Farber/Brigham and Women's Cancer Center once every four months for a checkup, she always stops by BWH and says hello to Emelia's NICU nurse. The walk between the two hospitals is much easier now.