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INTRODUCTION

With changes in demographics in society, the average age for first pregnancy is increasing in Europe and the Western world. The Office for National statistics recorded the average age of mothers and fathers in England and Wales in 2018 as 30.6 and 33.6 years respectively.1 Multidisciplinary cancer teams are seeing an increasing number of women who have cancers during pregnancy. The most common of these is breast cancer, for which it is estimated that up to 3.8% of cases may occur during pregnancy.

Haematological malignancy, gynaecological malignancy and melanoma all occur during pregnancy and, given the change in age-related incidence, there are also more patients with lung and colorectal cancer.2 It is recognized that female cancer survivors have 40% less chance of becoming pregnant than the general population, therefore, if diagnosed with cancer during pregnancy, careful attention needs to be taken of the outcome for the mother, baby and extended family particularly if this is the only chance that the family concerned have to go ahead with a pregnancy.

Decisions regarding systemic anticancer treatment (SACT) are based on retrospective analyses, case reports and a small number of prospective studies as this is not a population in whom randomized control studies are feasible.

POTENTIAL RISKS OF SYSTEMIC ANTI-CANCER TREATMENTS DURING PREGNANCY

The potential adverse effects of administered drugs on the baby and mother must always be considered during pregnancy (summarized in Table 5.1).

Table 5.1Potential adverse effects of systemic anti-cancer treatment on pregnancy.

It is important to be aware that 1 in 40 children who are born have a birth defect (2–3%) and 10 to 20 of every 100 pregnancies end in a miscarriage (10–20%). Birth defects and miscarriages can happen in any pregnancy, even to those who have not taken any medication or been exposed to chemicals. The timing of the exposure is also critical for assessing the risk to the fetus. Structures are most vulnerable during organogenesis (mostly up to week 12 gestation) but other organs mature later such as CNS, teeth and gonads.

In the first trimester, there is an increased risk of spontaneous miscarriage together with a significant risk of congenital malformation. In the second trimester congenital malformation is uncommon because fetal ...

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