A rarity: Cancer during pregnancy

Her breast cancer diagnosis came four days before the birth of her son

6 things to know about breast cancer during pregnancy:

1It’s rare, appearing in about 1 in 3,000 pregnancies.

2In the long run, pregnancy decreases a woman's overall lifetime risk of developing breast cancer.

However, during pregnancy, and shortly after, a woman's risk of breast cancer temporarily increases, says Jayne Charlamb, MD, who specializes in breast care and breastfeeding medicine. 3 Breasts change, naturally, during pregnancy. They grow bigger, may be tender or become firm, or may leak colostrum, the first breast milk produced after childbirth. If changes affect only one breast, that’s a red flag worth mentioning to your obstetrician. 4 Diagnosis of breast cancer during pregnancy and lactation is often delayed because the usual symptoms are not recognized as abnormal or because healthcare providers wrongly assume evaluation is not possible during pregnancy. It is always important to seek thorough evaluation of any breast changes that seem unusual to you. 5 Breastfeeding is possible – though likely challenging – for new mothers who are in treatment for breast cancer. 6 The baby is not at risk of catching cancer from the mother.

BY AMBER SMITH

Family nurse practitioner Davia Moss was taking off her sports bra when she noticed a lump in her breast. She was 34 and pregnant with her third child.

Her obstetrician assured Moss it was probably nothing but sent her for a biopsy, just to be sure.

“When I felt the lump, I thought that it was probably pregnancy related, either a clogged duct or just some normal cystic changes. I was very surprised,” Moss says. “Even two years later, I still am a little bit surprised.”

Cancer in pregnancy

Cancer during pregnancy is uncommon. When it happens, it can be a challenge to diagnose and treat, says Jayne Charlamb, MD, an Upstate doctor of internal medicine who specializes in breast care and treating women at high risk for breast cancer.

Moss sought guidance from Charlamb – whom she had previously heard lecture on breastfeeding – after a breast surgeon advised against latching her new baby. Latching is how a baby attaches to its mother’s breast to breastfeed.

“Breastfeeding has been a huge passion of mine,” says Moss, who breastfed her first two children –Eliana Adcock, now 7, and Cason Adcock, now 5 – until they were 2. She says her diagnosis didn’t sink in until she realized it might mean not breastfeeding her third.

Charlamb believes any new mother with breast cancer should be able to consider the risks and benefits of breastfeeding. “I don’t think it’s something that every mom, or even most moms, would want to do. It’s a lot of work,” she says. “It takes a dedicated mom. It takes a very flexible baby. Davia was sort of set up to succeed. She was an

Nurse practitioner Davia Moss with her husband, Patrick Adcock, MD, and their children, Asher, Eliana and Cason.

PHOTO BY SUSAN KAHN

experienced breastfeeding mom. She’d done this before. It was something that was highly important to her. And, fortunately, this baby is the most flexible baby I’ve met. That was very helpful.”

Breastfeeding success

Moss regularly had to pump and discard her milk during the weeks she had chemotherapy, but she was able to breastfeed her son for a few days every couple of weeks when the drugs were out of her system. She clung to those moments. And she drew support from a group of women she found through social media who faced, or were facing, cancer during pregnancy. Asher Adcock is now a healthy 2-year-old.

Charlamb advises any woman diagnosed with cancer during pregnancy to take a deep breath first. Then, compare treatment options as they apply to her situation.

“We try to time things during pregnancy. There are times when it’s safer to do surgery, during the second or third trimester, rather than early on, but we always need to weigh the risk and benefits,” she says. Side effects have to be considered even though the placenta, the organ that forms in the uterus as the baby grows, does a good job of protecting the baby.

Evaluation and treatment of women for breast cancer is pretty much the same, regardless of whether they are pregnant or lactating, Charlamb says. “When you have a woman who comes to you with a breast complaint, who happens to be lactating or happens to be pregnant, you evaluate her in almost exactly the same way, with the same urgency that you would if she were not lactating or pregnant. It’s perfectly safe to do a mammogram, to do a sonogram and to do a biopsy.”

Charlamb says Moss’s obstetrician did everything right. She sent Moss for medical images immediately, followed by a biopsy the next day. As the results came in, quickly a team of specialists was assembled, including from radiology, pathology, oncology, pediatrics, genetics and others. Her breast cancer had spread into her lymphatic system, and it was fed by estrogen.

Exploring genetics

Moss – who works in adolescent medicine at Upstate – delivered her baby four days after her diagnosis. Ten days later, she and her husband, Patrick Adcock, MD, traveled to hear a second opinion. They returned to Syracuse, and Moss had a port placed beneath her skin, which allows easy access for administering IV drugs. Chemotherapy began before Asher was a month old. She had eight rounds of chemo, every other week, for four months.

After learning she carried the BRCA2 gene, which significantly increases her risk of breast and ovarian cancer, Moss had one breast removed to reduce her risk in April 2020. She kept the other, so she could continue nursing Asher until he was 1. That’s when she started the medication tamoxifen, which is used to treat her type of breast cancer.

She had her second breast removed in November 2020, along with her fallopian tubes. “There is growing evidence that this may lower my risk of ovarian cancer,” Moss explains. When she turns 40, she’ll consider whether to have her ovaries removed as well.

Jayne Charlamb, MD

CC

Can surgery reduce ovarian cancer risk?

Doctors have known since the mid1990s that BRCA genes increase the risk of cancers including breast and ovarian cancers, says Rinki Agarwal, MD, medical director of the Upstate Cancer Center’s gynecologic oncology program and its genetics program. Removing both the ovaries and fallopian tubes of women with this gene can significantly reduce that risk.

Researchers searching for a way to detect early signs of ovarian cancer have not spotted precursor lesions in the ovaries. However, they have found precursor lesions in fallopian tubes, she says. “That may be where it starts.” Fallopian tubes preserve fertility. But in addition to their role in fertility, the ovaries produce hormones that impact a woman’s overall health, including mood, sleep, sexual function, cholesterol management, bone health and cardiac function, Agarwal explains. So, preserving a woman’s ovaries would be ideal.

A study supported by the National Cancer Institute is underway –involving some patients from Upstate –to determine whether removing just the fallopian tubes would be adequate in reducing the risk of ovarian cancer. Women at high risk of ovarian cancer can learn about the “SalpingoOophorectomy to Reduce the Risk of Ovarian Cancer” study by calling 315-464-8200. Participants must be between age 35 and 50, with the BRCA1 mutation and fallopian tubes intact. Agarwal says as part of the study, women choose between surgery to remove only their fallopian tubes (salpingectomy), or surgery to remove both the fallopian tubes and ovaries (salpingo-oophorectomy).