Samaher Saif Al-Yazal
- Completely prevent radiation and hormonal treatment during pregnancy due to the risk of miscarriage and malformations
- The risk of major fetal malformations may increase seven-fold if chemotherapy is given in the first trimester
- Wait two years after treatment, and stop for two months before pregnancy for those who have undergone hormonal treatment
Dr., a senior consultant in obstetrics and gynecology, specializing in fetuses and high-risk pregnancies, and a member of the Friends of Health Society, said: Naima Abdel Karim said that the rates of recovery from breast cancer have become high, especially among those under forty years of age, exceeding 80%, explaining that about 10% of those who have recovered become pregnant after treatment, but this number is increasing thanks to medical development.
In an interview with Al-Watan, Dr. confirms: Naima Abdel Karim said that pregnancy is prohibited during radiation or hormonal treatment because of the serious risks it may cause to the fetus, while chemotherapy during the first trimester of pregnancy increases the possibility of major deformities by up to seven times. She stressed the need to plan in advance and wait two years after treatment before thinking about pregnancy, while stopping hormonal treatment at least two months before pregnancy to ensure the safety of the mother and fetus. Dr. confirms Naima said that modern medicine has opened new horizons for breast cancer survivors to safely achieve the dream of motherhood, but it sets precise conditions for this, the most important of which are: advance planning, close follow-up, and coordination between specialized doctors to ensure the safety of the mother and the fetus. She points out that with the increase in health awareness among women and the rise in early screening rates, the journey to recovery from breast cancer has become more successful and hopeful than ever before, and with this medical progress, the sensitive human questions that are frequently asked by many survivors are renewed: Can I get pregnant after recovery? Does pregnancy pose a risk to my health or the possibility of the disease returning?
Questions that go beyond the medical aspect to touch on the deep human and psychological aspect. For a woman, motherhood is not only a physical decision, but a feeling that touches the essence of her femininity and being, and a dream that is not extinguished by fear, but rather postponed by hope until a possible moment. She adds that the great development in medical techniques for preserving fertility, in addition to the high rates of recovery globally, has opened the door for women to achieve the dream of motherhood without endangering their lives or the health of the fetus, provided that they adhere to precise medical guidelines and continuous follow-up before, during and after pregnancy. In this interview, Dr. Naima offers readers a comprehensive guide that explains the warnings and advice related to pregnancy after recovering from breast cancer, and the latest medical methods available to achieve it safely, in addition to highlighting the psychological and emotional dimension that constitutes an essential pillar in the recovery journey.
And the text of the dialogue:
How common is pregnancy after cancer recovery?
Breast cancer is the most common type of cancer among women, with approximately 2.3 million cases diagnosed annually around the world, and with the noticeable improvement in diagnostic and treatment methods in recent years, cure rates and five-year survival rates have increased, especially among the age group under the age of forty, as they have exceeded 80%.
Recent global statistics indicate that less than 10% of women who recover from breast cancer become pregnant, but this number is constantly rising with the development of modern fertility preservation techniques and the increasing awareness among women of the possibility of safe pregnancy after recovery.
Can pregnancy occur during treatment?
From a medical standpoint, it is absolutely not recommended to become pregnant while receiving chemotherapy, radiation, or hormonal treatment, because of its serious effects on the fetus, such as increasing the possibility of congenital malformations, miscarriage, or poor growth. However, if pregnancy occurs accidentally and without prior planning during treatment, the case is evaluated individually and carefully, and the decision is made after a comprehensive discussion in a multidisciplinary medical team. During radiation therapy, it is completely prohibited during pregnancy except in critical cases that threaten the mother’s life or affect the functions of vital organs, such as tumor pressure on the spinal cord.
During chemotherapy, its use can be considered after the first three months of pregnancy, and this depends on the type of tumor, its stage, and the type of drug used.
What are the potential risks to the mother and fetus?
The risks vary depending on the type of treatment and the stage of pregnancy. Radiation or hormonal treatment is completely prohibited during pregnancy, as it may lead to miscarriage, fetal death, birth defects, or disturbances in the development of the nervous system. As for chemotherapy, it is prohibited during the first trimester of pregnancy – that is, until the twelfth week – because it is the stage of organ formation and tissue growth, and the most sensitive and likely period for birth defects to occur. Research indicates that using chemotherapy at this stage may increase the risk of major deformities by up to seven-fold. In the second trimester of pregnancy, some chemical medications can be used in specific doses and under the close supervision of oncologists and obstetricians, with close monitoring of the fetus’s growth and vital functions. As for the mother, she may suffer from side effects of treatment, such as suppression of the immune system and increased risk of infection, so it is recommended to stop chemotherapy at least two weeks before birth to give the body a chance to recover and avoid postpartum complications such as bleeding or infections.
How is coordination between oncologists and gynecologists?
It is important to work within a multidisciplinary medical team that includes oncologists, surgeons, obstetricians and gynecologists, children and premature infants, in addition to the midwife. This close cooperation is one of the most important factors for success in treating cancer during pregnancy. Each case is studied individually at the tumor board, where a treatment plan and timing are developed that suit the type of tumor, stage of the disease, and previous treatment pattern, ensuring the safety of the mother and the continuation of the pregnancy without conflict between treatments.
When is it recommended for a recovering woman to think about pregnancy?
The optimal timing for pregnancy after recovery is not precisely determined, but the general rule is to wait at least two years after the end of treatment, to reduce the possibility of recurrence, which is higher in the first years after diagnosis.
After chemotherapy: It is preferable to wait at least 6 to 12 months for healthy egg cells to regenerate. After radiotherapy: It is recommended to wait at least six months for the affected tissues to recover. After hormonal treatment (such as tamoxifen): The medication must be stopped at least two months before pregnancy.
What is the likelihood of the disease coming back and how does pregnancy affect this?
The prevailing belief that pregnancy increases the risk of breast cancer returning is no longer true. Recent studies have proven that pregnancy does not increase the risk of relapse or death. Rather, some research has shown that women who became pregnant after treatment achieved better results than others, perhaps because those who became pregnant were originally in better health after treatment.
How does treatment affect a woman’s fertility?
Chemotherapy may lead to damage to the ovaries or their premature failure as a result of the destruction of stored eggs. This effect varies according to the type of treatment, its duration, and the age of the patient. As for hormonal treatments such as tamoxifen, they do not usually affect the ovarian reserve, but they are used for long periods (from 5 to 10 years), during which a woman’s natural fertility may decrease.
What solutions are available to preserve fertility before starting treatment?
There are several advanced options, including freezing eggs or embryos before starting treatment, or freezing ovarian tissue in specialized centers (an option that is not currently available in Bahrain). Injections of ovarian protectors (GnRH agonists) can also be used during treatment to reduce damage. She points out that these procedures have become among the basic rights of the young patient, and must be discussed before starting any treatment.
What is the role of modern technologies such as IVF and ICSI?
Thanks to modern technologies, pregnancy has become possible even after years of treatment. Women who froze their eggs or embryos before treatment were able to get pregnant safely after recovery. Studies have shown that these technologies do not increase the risk of the disease returning, even with hormonal stimulation of the ovaries, which gives survivors a real opportunity to safely achieve the dream of motherhood.
What tests are required for recovering pregnant women?
Pregnancy after breast cancer is classified as a high-risk pregnancy, and requires careful follow-up by oncologists and complicated pregnancies. Follow-up includes routine pregnancy tests, in addition to monitoring the growth of the fetus with ultrasound, and monitoring the amount of amniotic fluid and the mother’s general condition to ensure their safety. Does the decision for a natural birth or a cesarean section differ depending on the case? – Breast cancer is not considered a contraindication to a natural birth, unless there are special obstetric or medical reasons that require a cesarean section.
Can a recovered woman breastfeed her baby?
A recovering mother can breastfeed her child from the other healthy breast if it has not been exposed to radiation. As for the breast that has undergone surgery or radiation, milk production may be affected due to changes in the tissues and mammary glands. Breastfeeding is completely prohibited while taking chemical or hormonal treatments, because they pass into the milk and pose a danger to the child.
How does anxiety about the disease returning affect the decision to become pregnant?
Anxiety and fear of the disease returning is a natural feeling, but it should not control the decision.
Many women postpone pregnancy due to fear or misinformation, so it is necessary to discuss the decision with the treating physician to reach an informed and balanced decision between the desire for motherhood and medical considerations.
What about psychological support?
Psychological support is a necessity that is no less important than treatment, as the psychological aspect is no less important than the therapeutic aspect. The patient experiences contradictory feelings of fear and anxiety, and needs support from her husband, family, and close environment, in addition to specialized psychological follow-up. Support groups and health education contribute to enhancing confidence and helping to overcome stress and make decisions calmly.
A final message for infected or recovered women?
“The dream of motherhood can be achieved with safe planning and careful medical care before pregnancy. Consult your treating physician and discuss with him at the most appropriate time. Follow up on your examinations regularly, and pay attention to your nutrition and healthy lifestyle. This strengthens immunity and reduces the possibility of the disease returning.” “Changes in the breasts during pregnancy and breastfeeding are normal, but it is important to pay attention to any unusual sign and inform the doctor immediately.”
Are there general tips for prevention and early screening during and after pregnancy?
– Regular breast self-examination. And a clinical examination every 6 months or according to the doctor’s instructions. Pay attention to any changes in the breast, even during pregnancy or breastfeeding. Follow a healthy lifestyle that includes balanced nutrition and regular exercise.
