Rising Cancer Rates in Pregnancy: New Guidelines Offer Hope and a Path Forward
The landscape of prenatal care is shifting. As more individuals are diagnosed with cancer during pregnancy – approximately one in every 1,000 pregnancies are now complicated by cancer – the Society for Maternal-Fetal Medicine (SMFM) has released its first evidence-based clinical guidance for navigating this complex intersection of health challenges. The SMFM Consult Series #76: Cancer in pregnancy, endorsed by the American College of Obstetricians and Gynecologists (ACOG), offers a much-needed framework for clinicians.
Why the Increase? A Multifaceted Issue
Several factors contribute to the rising prevalence of cancer during pregnancy. An increase in the average maternal age is a significant driver, but improved cancer screening rates and increased exposure to environmental triggers also play a role. Notably, the expanded use of cell-free DNA prenatal genetic screening is leading to the detection of both preclinical and metastatic cancers more frequently.
A Shift in Approach: Prioritizing Both Mother and Baby
Historically, a lack of research surrounding maternal and infant health after cancer treatment during pregnancy led to a cautious approach, often involving avoiding therapy during gestation. However, recent data demonstrate reassuring health outcomes after treatment for many cancer types. This has spurred a critical shift towards a more proactive and individualized approach.
“Guidance has been limited until now,” explains Moti Gulersen, MD, MSc, a maternal-fetal medicine subspecialist at Sidney Kimmel Medical College of Thomas Jefferson University and a key member of the SMFM Publications Committee. “This document brings together the best available evidence to help manage pregnant patients with cancer while supporting both maternal health and pregnancy goals. Advances in oncology and multidisciplinary care mean that many patients can safely receive treatment during pregnancy, allowing us to prioritize both effective cancer therapy and fetal well-being.”
Key Recommendations from the SMFM Guidance
The new guidance covers a range of cancers, including breast, cervical, colorectal, Hodgkin lymphoma, leukemia, melanoma, non-Hodgkin lymphoma, ovarian, and thyroid cancers. Here are some key takeaways:
- Treatment Shouldn’t Be Withheld: Cancer treatment should not be withheld based on pregnancy status alone, and patients should have access to all reproductive options.
- Imaging First: Ultrasonography and noncontrast magnetic resonance imaging are recommended as first-line imaging techniques when cancer is suspected.
- Surgery Shouldn’t Be Delayed: Surgery for cancer should not be delayed or withheld at any stage of pregnancy.
- Blood Clot Prevention: Thromboprophylaxis (treatment to prevent blood clots) is recommended for patients with active hematologic or gynecologic cancers, and should be considered for other cancer types based on individual risk.
- Chemotherapy Timing: Chemotherapy is generally recommended after 12 weeks of gestation, but decisions should be made in consultation with oncology, considering the potential impact of delaying treatment.
- Fetal Surveillance: Serial fetal growth surveillance every 3 to 4 weeks is recommended for all pregnancies with an active cancer diagnosis.
The Growing Impact: Specific Cancer Statistics
The overall incidence of cancer before age 50 has been increasing since 2010, disproportionately affecting females. Consider these statistics:
- Breast cancer affects up to 1 in 3,000 pregnancies.
- Ten percent of thyroid cancers are diagnosed during pregnancy or within one year postpartum.
- Approximately 3% of individuals with Hodgkin lymphoma are pregnant at the time of diagnosis.
Future Trends: Personalized Medicine and Enhanced Data Collection
Looking ahead, several trends are poised to shape the future of cancer care during pregnancy. Personalized medicine, tailoring treatment plans based on an individual’s genetic makeup and cancer characteristics, will turn into increasingly important. The development of more targeted therapies with fewer side effects will also be crucial.
improved data collection and research are essential. Historically, limited research has focused on the long-term health outcomes for both mothers and children following cancer treatment during pregnancy. Establishing comprehensive registries and conducting long-term follow-up studies will provide valuable insights and refine clinical guidelines.
Pro Tip
FAQ
Q: Is chemotherapy always harmful to the developing fetus?
A: Not necessarily. While chemotherapy does carry risks, the timing and type of chemotherapy can significantly impact fetal outcomes. Treatment is often possible, especially after the first trimester, with careful monitoring.
Q: What imaging techniques are safe during pregnancy?
A: Ultrasonography and noncontrast magnetic resonance imaging are generally considered safe and are recommended as first-line imaging options.
Q: Should I delay cancer treatment if I become pregnant?
A: This is a complex decision that should be made in consultation with your oncology and maternal-fetal medicine teams. The potential benefits of treatment must be weighed against the risks to the pregnancy.
Q: Where can I find more information about cancer in pregnancy?
A: Visit the Society for Maternal-Fetal Medicine and American College of Obstetricians and Gynecologists websites for resources and guidelines.
Did you understand? The SMFM is actively involved in advocacy efforts to improve perinatal and reproductive health at both the federal and state levels.
Have you or someone you know been affected by cancer during pregnancy? Share your experiences and questions in the comments below. Explore our other articles on women’s health and prenatal care for more information.
