Life manages to make its way in the most adverse conditions, just as a daisy germinates on the asphalt. Mónica Piqueres Mateu (37 years old) found out that she was pregnant at the same time that she was diagnosed with breast cancer: “In April 2020, in the middle of the pandemic, they detected a cyst and they did a biopsy, the next day I knew it was going to be mother, and two days later they gave me the diagnosis”. The bittersweet news was still to be followed by worse ones: “I was in a private clinic and they told me that I had to start the treatment quickly and stop the pregnancy because the medication was incompatible, that I was young, then I was 34 years old, and I could have more children. At that moment I called a gynecologist who was a friend of the family and who referred me to the public health service, there they explained to me that they were going to treat me and carry out the pregnancy. So it was”.
Piqueres recalls that she was 12 weeks old when she entered the operating room and that two months later, after the first trimester of pregnancy, they administered the first phase of chemotherapy: “I gave birth on December 11, 2020, at I was 40 weeks pregnant, and 10 days after delivery they put me on another type of chemotherapy that they couldn’t give me before because it’s contraindicated”.
Maintaining the pregnancy while treating the cancer is something common in clinical practice, as explained by Begoña Bermejo de las Heras, coordinator of the Breast Cancer Unit of the Hospital Clínico Universitario de Valencia and researcher in the Research Group of Biology in Breast Cancer from the INCLIVA Foundation: “During the first trimester of pregnancy we cannot administer any type of systemic treatment, neither chemotherapy nor oral drugs, but it is possible to operate just as if the woman were not pregnant. In the second and third trimester it is already possible to use the most effective medication for breast cancer. However, radiotherapy is contraindicated throughout pregnancy.
Emotionally adjusting to a cascade of bad news and good news is complicated. “You must seek a balance between the best that you can get (pregnancy) and one of the worst that you can receive (cancer). At times I was euphoric and at times sad. In a matter of weeks a wealth of information reaches you: you are expecting a child, you have a malignant tumor, you are a carrier of the BRCA1 oncogene (hereditary breast cancer), you are going to undergo chemotherapy, you are going to go bald… But the pregnancy gave me strength to face it”, recalls Mónica Piqueres almost three years later. Her reward was to see her daughter’s face after her delivery: “The connection I felt with her cannot be explained in words, it must be taken into account that I have spent all her treatments next to she. She is a healthy and happy girl”.
Adding cancer and pregnancy may seem unusual, but the truth is that breast cancer during pregnancy has increased in recent years. According to a data review prepared in 2019 by the National Institutes of the United States, indeed, its incidence is increasing. The report reached this conclusion after comparing data from 2002 and 2012, when the incidence of pregnant women with breast cancer grew from 75 cases per 100,000 to 138 cases per 100,000. And in the world, between 7% and 14% of pregnant women under 45 years of age suffer from this oncological disease, according to the GEICAM breast cancer research group. Currently, this organization is made up of more than 900 experts, who work in more than 200 centers throughout Spain. Among its objectives is to promote clinical, epidemiological and translational research, continued medical training and dissemination to provide information to those affected, among others.
Where is the cause? “There have been big changes in the way of life of women and one of them is the delay in the age to have a child,” replies the oncologist. The expert adds that although its incidence in general has remained stable for many years, it is appearing in younger women, under 45 years of age, who have greatly delayed their first pregnancy: “We know that pregnancy protects against breast cancer when you are going to have a baby with less than 20-25 years. But from that age there have already been mutations in the breast and breastfeeding could be a factor that would increase the risk. Bermejo warns that at the slightest suspicion of something strange in the breast of a pregnant woman, a biopsy should be performed.
A window into motherhood
Laura Rueda Romero (43 years old) became pregnant after six cycles of chemotherapy, several radiotherapy sessions and 18 months of endocrine therapy, an adjuvant treatment that reduces the risk of breast cancer relapse, but is not recommended during pregnancy because It can cause malformations in the fetus.
“You have cancer, a disease that must be faced and you do not consider being a mother. They detected it at the age of 35 and at the hospital they offered me the possibility of freezing oocytes, in case I wanted to have children in the future. But after surgery, undergoing chemotherapy and radiotherapy, and endocrine therapy that you have to take for five years, I had already ruled out motherhood ”, he explains. However, in the midst of this hostile environment, a window opened for her to become a mother: “My oncologist suggested that I enter an experimental trial whose objective was to pause adjuvant treatment to try to get pregnant. I was strong and we decided to do it”.
His bet was high, since pregnancy increases the level of hormones in the body and, consequently, can increase the risk of relapse in this type of tumor with a positive hormone receptor (sensitive to hormones): “I entered the program of Assisted reproduction at the age of 39, as the oocytes were frozen, I only had to follow a treatment to prepare the uterus for the implantation of the embryo. I got pregnant on the first try and had my daughter at the age of 40. It was a normal pregnancy, the girl was born full-term and without problems. She achieved the pregnancy to the limit, since the National Health System establishes an age limit to access assisted reproduction treatments: 40 years for women and 55 for men.
Rueda is one of the 72 Spanish patients who have participated in the POSITIVE study (2023), coordinated by the SOLTI research groups and the GEICAM Group. The research included 518 women from 20 countries with hormone-sensitive breast cancer who wanted to become pregnant. The results, published last May in the journal New England Journal of Medicine, reveal that pausing endocrine therapy in these patients to seek pregnancy —under medical supervision and for a temporary period not exceeding two years— does not increase their risk of relapse in the short term. “The study participants had completed 18–30 months of adjuvant hormone therapy out of the five years planned and the objective was to demonstrate the safety of this technique,” explains José Ángel García Sáenz, a medical oncologist at the Hospital Clínico San Carlos, in Madrid, principal investigator. of the study at this medical center and member of the board of directors of the GEICAM Group.
According to this specialist, in the 40-month follow-up the incidence of tumor events was identical to that of women who had not had a pregnancy, the pregnancy viability rate was high, and the number of cases of complications in the newborn was not different. to that of the general population. However, he comments, it is still early to incorporate this procedure into clinical practice: “We cannot document it as a care therapy for all patients because follow-up is short. It takes 10 more years to obtain mature safety data. You have to see the data in the successive communications of the coming years to be able to implement it universally”. Although García also acknowledges that he does offer some security to assess this possibility in specific cases.
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