What do you do when treatment to save your life could kill your unborn child? More and more women who've left motherhood late find themselves battling breast cancer Of nearly 500 younger women, one in ten who developed breast cancer first spotted the signs while she was pregnant or breastfeeding Maria Hopkins, 33, a former home economist from South Wales, was diagnosed with breast cancer at 12 weeks Amanda Maclean, 42, a programme director from Ashford, was told she had cancer at 22 weeks Maria Hopkins was diagnosed with breast cancer on the day she had her 12-week pregnancy scan. Fate, it seems, really can be that cruel. ‘My husband Rhys and I went for the scan in the morning and we were so nervous,’ says Maria, 33, a former home economist from South Wales. ‘After four years of trying for a baby I thought I’d never get pregnant. But as the sonographer scanned my stomach and there was a perfectly healthy baby doing somersaults, we were both so happy.’ Maria Hopkins, 33, was diagnosed with breast cancer on the day she had her 12-week pregnancy scan. Devastated by the news, Maria and Rhys, 34, a civil servant, assumed that she would have to terminate the pregnancy Their joy was soon cut short. ‘That afternoon, we returned to the hospital for biopsy results on a suspected cyst in my left breast,’ says Maria. ‘I’d discovered it just before I found out I was pregnant and the consultant was confident it was nothing to worry about, although cancer did cross my mind. ‘When we were told it was a tumour, I went into shock. Rhys was deathly pale and silent. My mind shut down and it took several moments before we could take it all in.’ A cancer diagnosis at any time in a woman’s life is traumatic. To hear those dreaded words when you’re pregnant must be devastating. Yet according to new research by the Breast Cancer Care charity, which surveyed nearly 500 younger women, one in ten who developed breast cancer first spotted the signs while she was pregnant or breastfeeding. She had a mastectomy when she was 13 weeks pregnant, then started chemotherapy at 18 weeks. Despite fears Maria was able to carry her baby to full term and little Jack arrived naturally in March 2013 The number of women aged 45 and under with breast cancer is said to be on the rise, with an estimated 5,600 cases in this age group each year. Studies suggest that the longer women delay motherhood, the higher the chance they will develop cancer in their lifetime. The average age of mothers in 2014 rose to 30, about four years older than in the Seventies. ‘Women who have their first child after the age of 35 are 40 per cent more likely to get breast cancer than those who have one at 20 or before,’ says consultant obstetrician Shazia Malik at London’s Portland Hospital. Amanda Maclean, 42, a programme director from Ashford, Kent, who is married to Jamie, 43, a business manager. She was told she had breast cancer at 22 weeks pregnant ‘Why there is this increased risk is not absolutely clear, but it is likely to relate to increased hormone levels in pregnancy which stimulate rapid breast growth. ‘If you’re older, the cells are more likely to have genetic defects and this then gets replicated. The increased genetic damage in the cells can lead to breast cancer.’ Devastated by the news, Maria and Rhys, 34, a civil servant, assumed that she would have to terminate the pregnancy. And she winces with guilt when she remembers how her first instinct was not for her unborn baby but for herself. Amanda’s chemo failed to shrink the tumour, though, and she needed a mastectomy and yet more chemotherapy. At 34 weeks, the doctors decided to deliver baby Aengus by Caesarean. She had a mastectomy six days later ‘Of course, I didn’t want to lose this baby but if I’m completely honest, my first thoughts were about surviving. It’s only recently that I’ve felt any guilt about that. But at the time my focus was on getting through it, even if that meant losing the pregnancy. I said to Rhys: ‘What if the treatment harms the baby?’ and he replied: ‘What’s a baby if it hasn’t got a mother?’ Luckily, their consultant said it wouldn’t be necessary to abort and that Maria could be treated while the pregnancy progressed. But there would be risks. She had a mastectomy when she was 13 weeks pregnant, then started chemotherapy at 18 weeks. They let me listen to the baby’s heartbeat and I was so grateful each time. Initially, the doctors said they might deliver him at 30 weeks but as that time approached, he was doing so well, that they decided to keep him in there longer ‘Every time I went for chemo I had to sign a consent form to acknowledge that I might miscarry the child. It was awful,’ she says. ‘While other mums-to-be were shopping for their baby and decorating nurseries, I couldn’t because I thought I could lose the baby at any point. ‘Mum would come with me to the hospital and I saw the horror on people’s faces when they realised that it was me - the lady with the baby bump, not my mum in her 60s - going through chemo. I’d see the fear in their eyes and think: “Please don’t look at me like that.” ‘Plus, I looked and felt dreadful. I had mouth ulcers, my hair fell out, I had thrush, I was exhausted. By this point we knew it was a boy and he had started moving inside me. I was so worried the chemo could kill him but I thought, “I’ve got to do this”.’ The thought of pumping toxic drugs into a pregnant woman may go against doctors’ every instinct but according to consultant medical oncologist Dr Medy Tsalic, at Birmingham Heartlands Hospital, the risks of cancer treatment to the unborn baby are small, depending on how advanced the pregnancy is. Police officer Andrea Roberts discovered a pea-sized lump in her left breast in November 2013, the day before her 20-week scan, which turned out to be cancer She says: ‘Pregnant women with cancer are treated in exactly the same way as other breast cancer patients. Often this means surgery first, either lumpectomy or mastectomy, followed by chemotherapy four to six weeks after surgery and possibly radiotherapy, although we’d wait until the baby was born before we started radiotherapy, as we assume that can harm a foetus. ‘Although the chemotherapy drugs do pass through the placenta to the baby, the general consensus is that it’s safe in the second and third trimester, when the risk of foetal malformation is less than 2 per cent, the same as for those not exposed to chemotherapy. However, chemo during this period may increase the risk of low birthweight and stillbirth.’ Maria had a foetal scan once a month. ‘They let me listen to the baby’s heartbeat and I was so grateful each time. Initially, the doctors said they might deliver him at 30 weeks but as that time approached, he was doing so well, that they decided to keep him in there longer.’ Andrea had a mastectomy while 31 weeks pregnant and her daughter Matilda (pictured) was born safely via Caesarean four weeks later In fact, Maria was able to carry her baby to full term and little Jack arrived naturally in March 2013. ‘He was absolutely perfect, weighing 6lb 3oz,’ says Maria. ‘I’d lost all my hair but he had a full head of red hair - we joked it was from the red drugs in the chemo - and perfect nails. I held him and said: ‘I would go through chemo 100 times again for you. It’s all fine now and it’s going to be OK.’ Today, Jack is three years old and, according to his mother, ‘an absolute character’. Maria, meanwhile, had to have radiotherapy and the drug Herceptin - which helps to stop uncontrolled cell growth - after the birth, and is on Tamoxifen, which decreases the risk of recurrence for the next seven years. She now wonders if the pregnancy might have saved her life. Andrea’s husband Guy was able to take several weeks’ paid leave from the Army to take care of his family while Andrea underwent four courses of chemo (pictured, the family on Matilda's first birthday with her sisters) ‘When I found the lump it was so large and obvious, and the doctors say it’s possible that with all the hormonal changes going on in my body because I was newly pregnant, it suddenly became more noticeable. Who is to say I would have discovered it soon enough, or at all, if I hadn’t been pregnant? We’ll never know. While Maria thinks pregnancy may have helped to reveal her cancer, many women only discover a lump when it is fairly advanced because they mistake it for a symptom linked with pregnancy ‘As for having another child, I thought the chemo would kill off my eggs but the doctors say there is a small chance I could get pregnant again. I’m very maternal and would love another. ‘But the fear of carrying a second baby after everything that happened feels very real. For now I’m so grateful that I’m still here for Jack.’ Yet while Maria thinks pregnancy may have helped to reveal her cancer, many women only discover a lump when it is fairly advanced because they mistake it for a symptom linked with pregnancy. That was the case for Amanda Maclean, 42, a programme director from Ashford, Kent, who is married to Jamie, 43, a business manager. ‘When I discovered a lump in my left breast in December 2014, three months into my first pregnancy, I wasn’t unduly worried because I’d suffered from lumpy breasts and mastitis before,’ she says. Andrea said: ‘If I have the occasional niggle, such as in my knee, I can’t help but think: “Has it come back in my bones?” But all I can do is keep as fit and healthy as I can' ‘My GP thought it could be mastitis again and prescribed antibiotics. When they didn’t help I was referred for an ultrasound, then a biopsy, but cancer never crossed my mind. ‘It was only when a breast cancer nurse came to talk to me at the follow-up appointment that I thought: “This can’t be good”. ‘I was right. I had what’s called a “metaplastic triple negative” breast cancer, a particularly aggressive and quite rare form of the condition, affecting less than 0.02 per cent of breast cancer sufferers. ‘The news took a while to sink in. By then I was 22 weeks pregnant and I became racked with fear and guilt over how my treatment would affect my baby. I also became very scared that I might not be there for him as he grows up. I still have waves of terror about this.’ Andrea is now the mother to Matilda and her twin daughers Amanda was referred to a doctor in London who specialises in cases such as hers. ‘My new oncologist told me that the tumour was aggressive and growing rapidly and we’d need to start chemotherapy straight away. That left me shellshocked. ‘I had my first round of chemotherapy at 26 weeks and suffered the side-effects: hair loss, nausea, joint pain and fatigue. This didn’t go very far in reassuring me that the baby would be OK. How could he be healthy when I felt so wretched? ‘I panicked with each round of treatment and every change in the baby’s behaviour. ‘On one occasion, after a round of chemo, I couldn’t feel him moving at all. I dashed to the hospital in a panic, but they scanned me and he was fine.’ ‘I cry every time I think about leaving my little girls without their mum. I had to do whatever it took to get through this for them. That night, I kept waking in a panic, feeling like I’d been punched in the face when I remembered the consultant’s words Amanda’s chemo failed to shrink the tumour, though, and she needed a mastectomy and yet more chemotherapy. At 34 weeks, the doctors decided to deliver baby Aengus by Caesarean. She had a mastectomy six days later. ‘Aengus was born weighing 5lb 5oz and was absolutely gorgeous. Fortunately I was able to breastfeed him for the two weeks between the mastectomy and the second course of chemo, which felt like a small victory. ‘Today the doctors keep a very close eye on me. I have been told the chances of the cancer recurring are highest in the first two-and-a-half years and if it does recur, it could kill me within six months. ‘Despite this I remain positive most of the time. We have a lovely, bubbly baby boy who fills us with optimism and joy.’ Police officer Andrea Roberts discovered a pea-sized lump in her left breast in November 2013, the day before her 20-week scan. ‘I was in the bath and felt something like a ball bearing,’ says Andrea, 40, who already had twin daughters Amelia and Francesca, now four, with husband Guy, 40, a colour sergeant in the Parachute Regiment. ‘I was advised to see my GP and both she and a nurse reassured me that it was probably only a cyst. She is now on Tamoxifen for the foreseeable future, has yearly mammograms and, with three healthy daughters, is looking forward. But she admits there are days when it can be a struggle. ‘But by the time I had my biopsy at 24 weeks, I had convinced myself it was bad news. The surgeon said he was 95 per cent certain it was cancer and my first thought wasn’t for the unborn baby but for Amelia and Francesca, who had only just turned two. ‘I cry every time I think about leaving my little girls without their mum. I had to do whatever it took to get through this for them. That night, I kept waking in a panic, feeling like I’d been punched in the face when I remembered the consultant’s words.’ Andrea had a lumpectomy in January 2014. ‘I woke up from the anaesthetic and my first thought was for the baby. Someone from the maternity unit immediately checked the heart rate and everything was fine.’ Amanda's son Aengus was born weighing 5lb 5oz and was 'absolutely gorgeous' But Andrea then faced a dilemma. The tumour had been aggressive and doctors wanted to buy more time for the baby - so they suggested a full mastectomy on the affected breast, to be 100 per cent sure that the disease had been eradicated. ‘That was a shock but I realised I had no choice,’ she says. ‘I had to have the operation to ensure it was completely gone. It’s a decision I regret now because there was no sign of cancer but we couldn’t have known that at the time.’ Andrea had her mastectomy while 31 weeks pregnant and her daughter Matilda was born safely via Caesarean four weeks later. ‘She was so tiny at 5lb 4oz and I was scared to hold her at first,’ she says. ‘But she was perfect and my overwhelming feeling was relief that she was finally here. ‘The worst part of the whole thing was not being able to breastfeed her. I tried but I couldn’t get her to latch on, so I expressed for a couple of weeks before chemo started. But I still felt guilty about that for a long time. Today, Jack is three years old and, according to his mother Maria, ‘an absolute character’ ‘When I started chemo, a lady in the waiting room saw me bottle- feeding Matilda and said: “Oh, we didn’t need bottles in our day.” I felt like saying: ‘No, but with all the drugs in my body, do I want to be feeding her my breast milk? You shouldn’t nurse babies while on chemo and I wish people would think before being so insensitive.’ Andrea’s husband Guy was able to take several weeks’ paid leave from the Army to take care of his family while Andrea underwent four courses of chemo. She is now on Tamoxifen for the foreseeable future, has yearly mammograms and, with three healthy daughters, is looking forward. But she admits there are days when it can be a struggle. ‘If I have the occasional niggle, such as in my knee, I can’t help but think: “Has it come back in my bones?” But all I can do is keep as fit and healthy as I can. ‘My aim is to be around for my girls as long as possible. Some mothers aren’t as lucky.’ Source
