Breast cancer and pregnancy: How to treat the mom and not harm the baby

It’s just a lump.

That’s what Juliette Graziano thought when she first felt it on her left breast.

It had to be a sign of motherhood, she thought — a consequence of weaning her then 1-year-old son off breast milk or a hint of the newborn who had just begun developing in her womb.

At the request of her primary doctors, she went in a month later for tests she thought were precautionary. During the first week of September last year, Graziano called from work to hear about her results.

“Your results are positive,” the nurse said.

Graziano paused, in shock.

“What does that mean?” she asked.

Friday marked one year since Graziano, a Miami researcher, first began working with doctors at Sylvester Comprehensive Cancer Center at U-Health to fight gestational breast cancer, a type of breast cancer developed during pregnancy. Since then, the 42-year-old has had two rounds of chemotherapy and a C-section, giving birth to a healthy baby girl in between treatments.

“There are choices you have to make along the way,” she said. “But for the most part, I think I’ve been able to feel really grateful.”

Limited information

Little is known about breast cancer in pregnant women.

One out of every 3,000 pregnant women is diagnosed with breast cancer either during pregnancy or within the first year of delivery, according to the American Cancer Society. It’s a diagnosis that’s often delayed because the symptoms of pregnancy can mask the symptoms of breast cancer.

“I have had patients who felt a lump, but they thought it was a part of pregnancy, so unfortunately they were diagnosed late,” said Dr. Sayeh Lavasani, a breast medical oncologist with Memorial Cancer Institute, part of Memorial Healthcare System in Broward. The pregnancy fluctuates in risk, she said, depending on the timing of the diagnosis and the development of the baby.

Because she noticed the lump early, Graziano was lucky.

“From the minute she got the diagnosis, she got super proactive,” said Leslie Gaddard, Graziano’s partner. “Her thought was just, ‘I want to have this child.”’

In her eight-year medical career, Dr. Carmen Calfa, a medical oncologist at Sylvester, has seen four pregnant women with gestational breast cancer. Graziano was the first one she treated in her first year working at Sylvester.

“We’re not dealing with one life; we’re dealing with two lives,” she said.

Even after a year of treatment, questions remain. Graziano doesn’t know what stage of cancer she has because the traditional tests would have been harmful to the baby, and data about gestational breast cancer, Calfa said, are limited because so few women have been diagnosed with it.

“There are options, several options, to treat a woman and a baby with excellent outcomes,” Calfa said. “You just have to look for a team that is comfortable doing this.”

Drugs and chemotherapy are available, although they’re usually administered later on in the pregnancy to avoid potential birth defects. Anthracycline-based chemotherapy, which is administered after the second trimester, is the most common type of chemo. Radiation can cause birth defects if used during the first trimester.

A few weeks before Graziano’s scheduled C-section, she finished the first round of chemotherapy.

“I welcomed the treatment,” she said. “I was like, ‘This chemo is going to heal me.’ My baby is protected.”

Even then, with one treatment left, Graziano said she could see a difference in the size of her breast.

On Feb. 6, her healthy daughter was born.

Strength through adversity

For Graziano, recovery has just begun.

After a double mastectomy in July, she will begin radiation by the end of the month.

The cancer, she said, has taught her to let go of the minor stresses that used to plague her — traffic, arguments, disagreements.

“It’s the gift; there are countless gifts,” Graziano said. “There’s a strength that has come because of this experience. I’m not the same person.”

And while in an ideal world, she said, she would be able to breastfeed her daughter the way she did with her son, Graziano is grateful for the time she has with her children.

“We go through it,” she said, “and at the end, we get the best gift.”

This story was originally published September 22, 2016 at 4:09 PM with the headline "Breast cancer and pregnancy: How to treat the mom and not harm the baby."