Planning your pregnancy after breast cancer.
More and more women under the age of 45 are being diagnosed with breast cancer. Alarmingly the percentage of all breast cancers that occur in younger women has increased from 5% to 9% in just the past 5 years. The possible reasons for this scary incline are for another blog post. But, happily, an increasing number of these women are also surviving.
This means that there is an ever growing population of pre menopausal women who, as I did, are needing to navigate through the minefield that is pregnancy after breast cancer in order to grow their families.
Sound familiar? If you are currently in the process of deciding whether or not to go ahead with having a baby, or have already made the decision and want to know more, this is the post for you.
Disclaimer: I am not a medical professional, just a woman that has experienced breast cancer and a post cancer pregnancy first hand. If you’d like, go read my pregnancy story before you get started.
Planning your pregnancy after breast cancer.
Deciding whether or not to have a baby after having breast cancer is a difficult decision, with many things to consider. There is a lot of information out there, but also a lot of uncertainties. The physical, emotional and moral implications can feel overwhelming. So, let’s break it down and have a look at the main points you need to think about when planning your pregnancy.
Things to consider when planning your pregnancy after breast cancer.
Is it safe?
I think I can safely say that this is at the forefront of every woman’s mind when considering going on to have a baby after having breast cancer. It certainly was for me. As I was pregnant when my cancer started growing, the risk of recurrence was magnified. Like me, some of you may have existing children and partners to consider. People you desperately don’t want to leave behind. It’s a lot to take on.
The simplified answer to whether it is safe is yes, overall it is safe for you and your baby. There is no evidence to suggest that pregnancy will increase your chances of recurrence.
This is however different for everyone depending on a few things. The type and stage of cancer you had is important. Also the treatment you had or are still having is a significant factor. For example there is a big question mark over whether or not stopping endocrine meds whilst trying to conceive and pregnant, increases the risk of recurrence in women that had hormone positive breast cancer.
There is currently an extensive trial called POSITIVE (Pregnancy Outcome and Safety of Interrupting Therapy for women with Endocrine responsive breast cancer) that will hopefully yield more encouraging information. I will delve deeper into the subject of recurrence risk during pregnancy, including the POSITIVE trial, in the coming weeks.
In the meantime, the best first step is to talk to your oncologist about your own unique circumstances in order to reach a well rounded conclusion. I also sought a meeting with an Oncofertility doctor to have another professional opinion in my arsenal. She was able to give me even more clarity and reassurance. I highly recommend you do the same if possible.
How long should you wait to embark on your pregnancy after breast cancer?
This again varies based on your age, the type and stage of breast cancer you had, and what long term treatment (if any) you are having.
In general, most women that had to undergo chemotherapy are told to wait around 2 years from the end of treatment.
When I spoke to my Oncofertility doctor about it, she clarified that the reason for this recommendation is NOT that pregnancy increases the chance of a recurrence. More that breast cancers are most likely (but not exclusively) to recur within those first 2 years, if they are going to at all. Treatment whilst pregnant is complicated and risky, so they want to avoid it as much as possible.
There is also research to suggest that you should wait at the very least 6 months after chemotherapy, to allow any eggs affected by it to be “flushed out”.
High grade (aggressive) breast cancers.
In some cases you might be advised to wait even longer than 2 years. My oncologist and Oncofertility doctor initially said that because I had a quite advanced and very aggressive type (triple negative), I should on paper wait 3 years. But, combined with my advanced maternal age (love that label) and the fact that I had responded well to treatment, they thankfully cleared me to start at the 2 year mark.
In the case of HER2 positive breast cancers, which are also likely to be high grade, the recommendation is to wait at least 6 months after treatment with Herceptin before trying to conceive.
Hormone receptor positive breast cancers.
Women that had hormone receptor positive breast cancer are recommended to have hormone therapy for 5 to 10 years after the first line treatment. These drugs, such as Tamoxifen, lower estrogen levels and complicate the journey to pregnancy even more. The current advice is to stay on these drugs for 2 years, then come off for a “baby break”. You then resume treatment after your baby is born.
Early stage breast cancers.
Of course if you had early stage cancers (DCIS and stage 1) and didn’t have chemotherapy, you might not need to wait at all.
Whatever your situation, it is imperative that you are comfortable and happy with your plan. The best way to achieve that is to meet with your medical team and come up with a time frame tailored specifically to you.
Consider how it will impact you mentally and emotionally.
From my own experience, pregnancy after breast cancer comes with pretty much every single emotion in the book. The joy and gratitude is heightened, but so is the fear and anxiety. You might feel cheated out of a care free pregnancy, and the hospital visits, blood draws and scans can be triggering.
It is wise to prepare for this so that you are well supported when the time comes. Look for a therapist that is qualified in trauma and/or pregnancy. Open up to your partner and family about what to expect from you during your pregnancy so that they know how to help you.
You might find that as the precious new life grows within your belly, so does the fear of your cancer coming back. Subscribe (in the box to the right of this page) and receive my free guide on how to deal with the fear of recurrence. It was my bible when I was pregnant with my post cancer miracle!
What if you have a known BRCA gene mutation?
Upon diagnosis of breast cancer most of us are offered genetic testing. This is a simple blood test that looks for mutations on certain genes that can make you more susceptible to breast (and other) cancers. The most common and well known is the BRCA gene mutation.
If you have this it means that you inherited it and may have a history of breast cancer within your extended family. It also means that there is a chance that you can pass on the gene to any children you have. Specifically, any child you have has a 50% chance of inheriting the faulty gene.
This poses an extra dilemma when deciding whether or not to have a baby. But if this applies to you, rest assured that there is a way around it. It is called Pre Implantation Genetic Testing (PGT). Simplified, embryos are created through a round of IVF and are then tested for gene mutations. The ones that are negative for the mutation are implanted back into your womb.
There are potentially moral and financial implications to this that are deeply personal and should be discussed with your oncologist or an Oncofertility specialist.
In the meantime.
Deciding on whether or not to try for a pregnancy after breast cancer is a huge deal. Don’t rush it. While you are in this waiting period be sure to stay on top of whatever form of non hormonal contraception you are using. It is possible to get pregnant even if you are on hormone therapy.
If you want to be proactive on your baby quest, you can start taking Folic acid (which can be prescribed by your doctor) and COQ10 (co enzyme Q10) 6 months before you plan to start trying to help with egg quality. I used these ones, which are vegan and contain no synthetic additives. It’s also beneficial to eat well and exercise regularly. Nothing too extreme or strenuous, you just want your body and mind strong and raring to go.
I wish you well!
With the right information, the support of your medical team, loved ones and a healthy outlook, I promise you that your pregnancy can be the beautiful healing time of life that you so deserve. There is no prouder moment than looking down at your baby knowing what your body has been through to get to them. Knowing just how differently things could have gone.
I hope that you found this post helpful and reassuring. It is the first in a series of 3 that will guide you through the basics before, during and after your pregnancy after breast cancer. I will also cover many other topics within the pregnancy after breast cancer genre, such as breastfeeding after breast cancer, and the moral dilemma of having a baby after cancer. Please consider subscribing if you’d like to read more.
In my experience there is nothing that quite matches connecting with somebody that has actually experienced what you are going through. If you would like to talk to someone that has been through it firsthand, head on over to my “how can I help?” section and drop me a message.ah