Pregnant for the first time, Madam Roslina’s joy was crushed when she found out she had stage 4 breast cancer. APRIL CHONG reports
Motherhood was bittersweet for Madam Roslina Abdul Rahman, 35. Her ecstasy at finding out she was
pregnant for the first time in 2008 was soon mixed with grief when she realised in her first trimester that she had stage 4 breast cancer. It was a recurrence of cancer she first had in 2007, when she had a lump in her right breast removed followed by surgery to reconstruct the breast.
“I was living in denial but decided I would go through anything just to have my baby. I was persistent and confident that everything would go well with the support and prayers of family and friends,” said Madam Roslina. About one in every 3,000 pregnant women will get breast cancer. Most are in their 30s.
Pregnancy itself may not cause breast cancer but for women who are genetically predisposed or have had cancer before, as in Madam Roslina’s case, it may be a trigger. As more than 75 per cent of breast cancers are hormonally sensitive, it is believed that the surge of female hormones during pregnancy can “stimulate” cancer
recurrence, said Dr Esther Chuwa, a consultant at the KK Breast Department of the KK Women’s and Children’s Hospital.
However, recent studies have also shown that this is not the case, she added. Madam Roslina had rejected
chemotherapy and hormonal therapy during her first bout with breast cancer, as she planned to get married and have children. But her joy at finding herself pregnant was short-lived when she had skin metastases or patches on her right chest, a sign that the cancer had returned.
Cancer vs pregnancy
Breast cancer can be hard to detect during pregnancy because changes to the breasts make small lumps hard to detect, said Dr Chee Jing Jye, medical director of The Obstetrics and Gynaecology Centre. Then the question arises of what to do next.
Whether or not the woman keeps her baby makes no difference to the survival rate, said Dr Wong Seng Weng, medical director of The Cancer Centre. But if she decides to continue with the pregnancy, she has to accept there are risks associated with the cancer treatment. Abortion is only legal up to the first 24 weeks of pregnancy, unless the mother’s life is at stake. The prognosis for the mother’s survival is also an issue. “If the mother is doing badly, would you leave behind a child with no mother?” said Dr Wong.
However, these are very personal questions that patients and their families have to think through. In general, most women would keep the baby if the treatment does not harm the foetus, observed Dr. Chuwa. Treatment options for breast cancer depend on the stage of the cancer and pregnancy.
Surgery to remove the breast, or a mastectomy, is generally safe during all stages of pregnancy. Lumpectomy or removing just the cancerous lump is not recommended, especially for first trimester pregnancies, because radiotherapy has to be done soon after to prevent cancer recurrence, said Dr Chuwa.
Radiotherapy could harm the foetus. Chemotherapy is used only after the first trimester when the baby’s organs are formed and, even then, it could lead to smaller babies and premature birth. Some women are tempted to put off treatment until after the baby is born. But generally, patients do follow the doctor’s advice to put the mother’s welfare first, said Dr Chee.
For Madam Roslina, chemotherapy was the only option because her cancer had spread. She began treatment in her second trimester and went into labour at just 31 weeks. Little Qurratu’aini, who was born in November 2008, weighed only 1.5kg at birth and was in hospital for a month. Madam Roslina, who quit her administrative job earlier this year, had a double mastectomy in February when doctors found that the cancer had spread to her other breast and was increasing in size.
She is still undergoing treatment to control the cancer, which has also spread to her bones. But she is thankful for her baby girl, who is now almost two. “When I see her, the feeling is delightful. Unexplainable. Indescribable,” she said.