Last April, Rachel Brown’s oncologist called with bad news. When she was 36, she had an aggressive form of breast cancer. The next day she learned that she was pregnant for nearly a year trying to give birth to a baby with her fiancé.
She always said she would never have an abortion. But her choices she faced were disastrous. If she receives the chemotherapy needed to prevent the spread of the cancer, she can harm her baby. If she didn’t have it, she could spread the cancer and kill her. She had two children, two and eleven years old, who could lose her mother.
For Brown and others in the unfortunate grief of a woman diagnosed with cancer during pregnancy, the June Supreme Court’s decision to end the constitutional right to abortion seems to have slammed her face. You may see it. If fetal life is paramount, pregnancy can mean that a woman is unable to receive effective treatment for her cancer. One in 1,000 women who become pregnant each year is diagnosed with cancer. That is, thousands of women are facing serious and deadly illness while expecting a baby.
Before the Supreme Court’s ruling, Dr. Clifford Hudis, chief executive officer of the American Society for Clinical Oncology, said pregnant women with cancer were already “entering a tremendous world of unknowns.” Currently, not only patients, but also doctors and hospitals who treat them are involved in the additional complications of abortion bans.
“If doctors can’t administer the drug without fear of damaging the fetus, does that hurt the outcome?” Dr. Hudis asked. “It’s a whole new world.”
Antineoplastics are dangerous for the fetus in the first semester. Older chemotherapeutic drugs are safe in the second and third semesters, but the safety of newer and more effective drugs is unclear and doctors are hesitant to give them to pregnant women.
About 40 percent of women who are pregnant and have cancer have breast cancer.However Other cancers It also occurs in pregnant women with blood cancer, cervical cancer, ovarian cancer, gastrointestinal cancer, melanoma, brain cancer, thyroid cancer, pancreatic cancer, etc.
Women with certain types of cancer, such as acute leukemia, are often unable to continue their pregnancy if the cancer is diagnosed in the first semester. They need to be treated immediately within a few days and the medicines needed are toxic to the fetus.
“In my view, the only medically acceptable option is to end the pregnancy so that the mother can be given life-saving treatment,” said Dr. Eric Winner, director of the Yale Cancer Center. I am.
Some oncologists say they don’t know what is allowed if a woman lives in a state like Michigan. Michigan criminalizes most abortions, but allows them to save their mothers’ lives. Is Leukemia Eligible as a Reason for Abortion to Save Her Life?
Dr. N. Linhenry, an oncologist at the University of Michigan, said: “We can’t prove that the medicine caused problems for the baby, nor can we prove that withholding the medicine has bad consequences.”
In other words, according to doctors, pregnancy complications such as miscarriage, preterm birth, birth defects, and death can occur regardless of whether a woman with cancer is taking medication. If she was untreated and her cancer was struck by a malignant tumor that killed her, it could have happened, even if she had been given a cancer drug.
“Medical decisions and management are between doctors and patients,” said the University of Michigan medical system administrator, who did not intervene in cancer treatment decisions regarding how to treat cancer in pregnant women.
I. Glencohen, a law professor and bioethicist at Harvard University, has serious concerns.
“We put doctors in a terrible position,” Cohen said. “I don’t think signing up to be a doctor means signing up to do prison time,” he added.
According to Cohen, oncologists are usually part of the hospital system and are an even more annoying problem for doctors treating cancer in states that ban abortion. “What are the risks facing the hospital system, whatever their personal feelings?” He asked.
“I don’t think the oncologists expected this day to come,” Cohen said.
Behind the confusion and concerns from doctors lies the story of a woman like Mr Brown.
She had a large tumor in her left breast and cancer cells in the lymph nodes under her armpits. The cancer was HER2-positive. Such cancers can spread rapidly without treatment. About 15 years ago, the prognosis for women with HER2-positive cancer was one of the worst breast cancer prognosis.Then targeted treatment, trastuzumab, or Herceptin, completely Changed the photo.. Currently, women with HER2 tumors have the best prognosis compared to other breast cancers.
However, trastuzumab cannot be given during pregnancy.
Mr Brown’s first visit was with a surgical oncologist. She said, “If you continue to get pregnant, you will not be able to receive treatment until late in pregnancy, which puts my life at risk.” He told her that if she waited for those months to pass, her cancer could spread to her distant organs and become fatal.
Her late treatment was a mastectomy to remove all the lymph nodes in her left armpit, which increased her risk of lymphedema, which caused incurable fluid in her arms. She was able to start chemotherapy later in her life, but she was not able to receive trastuzumab or radiation therapy.
Her next consultation was with Dr. Lisa Carrie, a breast cancer specialist at the University of North Carolina. She told her she was able to have a mastectomy in her first semester before her chemotherapy, but that wasn’t optimal. Oncologists usually administer anticancer drugs before mastectomy to shrink the tumor and allow less invasive surgery. If the treatment does not eradicate the tumor, oncologists try more aggressive drug treatment after surgery.
However, if she had a mastectomy before receiving chemotherapy, it is impossible to know if the treatment helped. And what if the medicine doesn’t work? She was worried that her cancer could be fatal without her knowledge.
She was afraid that if she tried to continue her pregnancy, she would sacrifice her own life and destroy the lives of her children. And if she delayed her decision and had an abortion later in her pregnancy, she feared that her unborn baby would feel pain.
She and her fiancé discussed her options. This pregnancy will be his first biological child.
With great sorrow, they made their decision — she will have an abortion. She took medicine one morning during her 6 weeks and 1 day of pregnancy and cried all day long. She wrote her compliment for the baby who might have been. She was convinced that her baby would be a girl, and she named her hope. She saved the ultrasound of Hope’s heartbeat.
“I haven’t downplayed that little life,” Brown said.
After she finished her pregnancy, Brown was able to begin treatment with trastuzumab with a cocktail of chemotherapeutic drugs and radiation. She had a mastectomy and there was no evidence of her cancer at the time of her surgery. This is a sign of great prognosis, Dr. Carrie said. She did not have to remove all the lymph nodes and did not develop lymphedema.
“I feel like it took a lot of courage to do what I did,” Brown said. “Your first instinct as a mother is to protect your baby.”
But after receiving that rigorous treatment, she also wondered how she could handle caring for her newborn baby and her two other children.
“My bones hurt. I couldn’t walk more than a few steps without breathing out. It was difficult to get nutrients because of nausea and vomiting,” she said.
The Supreme Court ruling hit her hard.
“I felt it didn’t matter why I did what I did,” she said. “My life didn’t matter, and my children’s lives didn’t matter.”
“It didn’t matter if I died because I was forced to get pregnant,” she said.
