Another highlight at the National Medical Association’s 2010 conference was a lecture on cancer and pregnancy given by Dr. Kevin Holcomb, of Weill-Cornell Medical College.

According to Dr. Holcomb, approximately 1 in 1500 pregnancies is affected by cancer. However as women delay childbearing to ages 30 and 40, there is an increased incidence because the peak age of cancer occurs at age 40. Cervical cancer is the most common cancer found during pregnancy and usually presents as vaginal bleeding. A Pap smear done during the first prenatal visit will reveal the diagnosis. A colposcopy procedure done during pregnancy is extremely important to detect invasive disease which would then require aggressive treatment. In my own clinical practice, I had a patient who had a low grade abnormal PAP during a previous pregnancy but unfortunately the disease has now progressed to a high-grade Pap smear three years later with her current pregnancy. She is being watched very closely with repeated colposcopy  procedures and has been encouraged to stop smoking which is a risk factor for cervical cancer.

If microinvasive cervical cancer is detected, the pregnancy may continue to term and a c. section is only necessary for obstetrical reasons. A post-partum hysterectomy is not necessary if the patient desires to have more children. If invasive cervical cancer is detected before 24-weeks, radiation therapy will cause a miscarriage 35 days after treatment in the first trimester and 45 days after treatment in the second trimester. If invasive cervical cancer is detected after 24-weeks, delivery is done by a cesarean section at term, and the patient then receives radiation therapy. The lower the stage of cervical cancer detected during pregnancy, the higher the survival rate. PAP smears save lives.

Breast cancer is the second most common malignancy detected during pregnancy and affects 1 in 3,000 women. Twenty percent of women will have breast cancer before age 35 and 1-2 percent are pregnant at the time of diagnosis. The later the diagnosis, the worse the prognosis. A modified radical mastectomy is well tolerated during pregnancy. If the patient has a lumpectomy, therapeutic abortions do not improve the prognosis. Chemotherapy is used in advanced cases after the first trimester. If future children are desired, a 2-3 year waiting period is recommended. Actress Christine Applegate is an example of a breast cancer survivor who is now pregnant with her first child.

Melanoma is the third most common cancer diagnosed during pregnancy and ovarian cancer is the fourth. Ovarian cancer presents more danger to the mother than the fetus. An ovarian cyst greater than 5 centimeters detected during pregnancy requires surgery to rule out cancer, preferably done at 18 weeks. Most ovarian cancers found during pregnancy are stage 1 which has a good prognosis.

Although rare, cancer can occur during pregnancy.  Early detection can save lives. A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.