Whilst for most women pregnancy is a time of great happiness and joyful anticipation, in some women this may coincide with a diagnosis of cancer. The cancer diagnosis might precede the pregnancy (with an unplanned pregnancy, a recurrence or a diagnosis in early pregnancy prior to diagnosis) or be a new unexpected diagnosis during the pregnancy. This chapter will discuss the incidence of cancer in pregnancy, problems with diagnosis, controversies regarding treatment and timing of delivery and touch on psychological support for both the woman (and her partner) and the staff looking after her.
The reported incidence and type of cancer in pregnancy varies depending on the time-frame reported and the geographical variation of cancer (e.g. more melanoma in the Australian reports). The overall incidence of cancer in pregnancy is of the order of 1–2 per thousand, with breast cancer, melanoma, cervical cancer and haematological malignancies being the most common (see Table 4.1).
Table 4.1Incidence of cancer types diagnosed in pregnancy. |Favorite Table|Download (.pdf) Table 4.1 Incidence of cancer types diagnosed in pregnancy.
| ||Australia n = 1798 1994–2008 BJOG 2012 Lee et al.1 ||International study n = 1170 Lancet oncology 2018 De Haan et al.4 ||Swedish study n = 564 1963–2007 Cancer 2015 Anderssen et al.5 ||England n = 3272 2012–14 PHE publication 20183 |
|Breast ||28% ||39% ||15% ||24% |
|Melanoma ||45% ||Not Given ||25% ||15% |
|Cervix ||8% ||13% ||15% ||15% |
|Haematological ||11% ||16% ||Not given ||9% |
|Ovarian ||4% ||6% ||6% ||7% |
|Total ||137 per 100,000 ||Not given ||Not given ||130 per 100,000 |
Increasing maternal age only accounts for around 14% of the increased incidence of cancer (1994–2008).1 An Italian study in 20172 demonstrated that the incidence of pregnancy associated breast cancer in women <30 years age was 6 per 10,000 and in women >40 years of age, the incidence was 26 per 10,000.
Public Health England published a report in June 2018 on cancer and pregnancy in England between 2012 and 2014.3 The definition of ‘in pregnancy’ used was relatively wide and included from 1 year prior to pregnancy, during pregnancy and up to 1 year after pregnancy. Out of 2,503,174 pregnancies, there were 3,272 cancers reported (using International classification of disease 10th revision coding), which gives an associated age-standardized incident rate (ASIR) of 173 cancers per 100,000 pregnancies which is 48% higher than the non-pregnant ASIR of 117 per 100,000 (i.e. having standardized for the age of the woman, pregnancy increases the chance of a cancer diagnosis by 48% compared with a woman who is not pregnant).
For some women, a diagnosis of pregnancy was made after the diagnosis of cancer with a ‘routinely’ performed pregnancy test prior to an operation, investigation or starting/continuing ...