Cancer in pregnancy

For some women, the happiest time in their lives is complicated by the scariest events in their lives. Cancer in pregnancy is generally a rare occurrence but it is a shocking concept that, at a time when advice is to avoid coffee, wine, and some cheese for a healthy baby, you may need X-rays and even chemo- or radiotherapy for diagnosis and treatment of cancer. The incidence of invasive cancer in pregnancy is about 1:1000 to 1:2000 pregnancies. About 3500 new cases are diagnosed during pregnancy in the United States every year. Breast cancer is the most common pregnancy-associated malignancy and 7–15% of all breast cancers in premenopausal women occur during pregnancy. There is some evidence that there is an increase in incidence of pregnancy-associated breast cancer with one large cohort study from Sweden, reporting an increase from 16 to 37 per 100,000 deliveries from 1963 to 2002. Of the reported cancers, breast cancer is by far the most common at 46%, followed by haematological malignancies, dermatological malignancies, cervical cancer, brain tumours, and ovarian tumours. Recent observations from Belgium seem to suggest that a pregnant patient should not have a poorer outcome of their cancer management when they are cared for by a multidisciplinary team with necessary input from obstetricians, oncologists, surgeons, paediatricians, and pharmacologists. Oncological treatment is possible during pregnancy, often without significantly endangering fetal safety.