After Roe, pregnant women with cancer may face heartbreaking choices

Urgent questions arise about how care for pregnant women with cancer will change in states where women are unable to terminate their pregnancies

In April last year Rachel Brown's oncologist called with bad news - at 36 she had an aggressive form of breast cancer. The very next day, she found out she was pregnant after almost a year of trying with her fiancé to have a baby.

She always said she didn't would never abort. But the choices she faced were heartbreaking. If she received the chemotherapy she needed to prevent the spread of her cancer, she could harm her baby. If she didn't have it, the cancer could spread and kill her. She had two children, ages 2 and 11, who may lose their mother.

For Mrs. Brown and others in the Unlucky Sisterhood of Women Diagnosed cancer while pregnant, the Supreme Court's decision in June ending the constitutional right to abortion may seem like a slap in the face. While the life of a fetus is paramount, pregnancy can mean a woman cannot get effective treatment for her cancer. One in a thousand women who become pregnant each year is diagnosed with cancer, which means that thousands of women face a serious and life-threatening illness while expecting a baby.

Before the Supreme Court ruling, a pregnant woman with cancer was "already entering a world of huge unknowns," said Dr. Clifford Hudis, chief executive of the American Society of Clinical Oncology. Today, female patients and the doctors and hospitals that care for them are caught up in the added complications of abortion bans.

"If a doctor cannot administering a drug without fear of harming a fetus, is that going to compromise the results?" Dr. Hudis asked. "It's a whole new world."

Cancer drugs are dangerous to fetuses in the first trimester. Although older chemotherapy drugs are safe in the second and third trimesters, the safety of newer, more effective drugs is unknown and doctors are hesitant give them to pregnant women.

About 40% of pregnant women with cancer have breast cancer. But other cancers also occur in women pregnant, including cancers of the blood, cervix and ovarian cancer, gastrointestinal cancer, melanoma, brain cancer, thyroid cancer and pancreatic cancer.

Women with some types of cancer, such as acute leukemia, often cannot continue a pregnancy if the cancer is diagnosed in the first trimester. They must be treated immediately, within a few days, and the necessary drugs are toxic to the fetus.

"In my opinion, the only medically acceptable option is the interruption of pregnancy. so lifesaving treatment can be given to the mother,” said Dr. Eric Winer, director of the Yale Cancer Center.

Some oncologists say they don't know which is allowed if a woman lives in a state like Michigan, which has criminalized most abortions but allows them to save the life of the mother. Is leukemia grounds for abortion to save her life?

"It's so early that we don't know the answer," said Dr. N Lynn Henry, an oncologist at the University of Michigan. "We cannot prove that the drugs caused a problem for the baby, and we cannot prove that refusing the drugs would have a negative outcome."

ImageCancer drugs are dangerous for fetuses in the first trimester. Although older chemotherapy drugs are safe in the second and third trimesters, the safety of newer drugs is unknown and doctors are reluctant to give...