Breast cancer and pregnancy
Mrs. S, a 35-year-old woman in her second pregnancy, was diagnosed with breast cancer. She was then four months pregnant and was offered a termination of pregnancy by a gynaecologist. But she delayed her decision to abort the baby. She told her husband: “I am going to take my chance and let my baby live,”
She came to see me in her sixth month of pregnancy and said that she had felt a painless lump in her right breast while bathing. She was then in her third month of pregnancy.
The lump was firm to the touch and grew rapidly from the size of a small fishball to a golf ball within a month. Soon, there were lumps appearing in the right armpit. She consulted a surgeon who told her that she had advanced breast cancer and she was referred to a gynaecologist for an abortion prior to surgical removal of the cancer.
Breast cancer is the most common cancer among women in Singapore. One in five cancers occurring in Singaporean women is breast cancer. Every year, about 1,100 new cases of breast cancer are diagnosed.
That means three women are diagnosed with breast cancer each day. And about 270 die from the disease each year.
Breast cancer occurs in about one in every 3,000 pregnancies and most often when the mother is between the ages of 32 and 38, as in the case of Mrs. S. It usually appears as an innocuous lump and may cause retraction of the nipple as it grows.
Breast cancer is usually difficult to detect early in pregnant women, whose breasts are often tender and swollen. By the time the patient presents herself to the doctor, the cancer is usually at the advanced stage. This is what happened in Mrs. S, whose cancer had spread to the lymph nodes in the armpit.
When I examined her, she appeared anxious, but was firm about her decision to continue with her pregnancy even though this was contrary to the surgeon’s advice. She knew very well that the cancer would grow more rapidly during pregnancy due to the increase in female hormones. This would make the management of her condition difficult.
After many sessions of prolonged discussion with her and her husband, I was moved by her willingness to risk her life for the sake of her baby.
A holistic approach was required in this unique case as I worked closely with my surgical colleagues. Mrs. S underwent removal of her breast with clearance of the lymph nodes in the armpit during the seventh month of her pregnancy. The cancer was found to be aggressive in nature.
A baby boy was delivered in the eighth month of her pregnancy by Caesarean section. He was discharged after a week in the neo-natal intensive care unit.
Soon after the delivery, Mrs. S had radiotherapy and adjuvant chemotherapy. This was more palliative than curative as the cancer was found to have spread to the brain. This information was passed on to patient’s husband. It was to prepare him for the inevitable.
A difficult time
Three months later, I received a phone call from her husband and was informed that she had passed away in her sleep. At that juncture, I could only be reminded of the brave decision she had made and her love for her unborn son.
It was difficult time for me as I thought of the days when we journeyed together during her pregnancy. I constantly encouraged her and affirmed her determination to proceed with her pregnancy even though the odds were against her.
When I attended the funeral, I met the patient’s admirable husband who was looking after the two children.
I was surprised when he approached me and put a note in my hands. He said that Mrs. S wrote this note about a week before her death. It took me a while before I decided to read it. I was on verge of tears after reading the touching note which said:
“Dear Doctor Chew, I appreciate your concern and care. You have certainly provided me with the opportunity of motherhood even though it may be a short one.”
As an obstetrician, I have encountered numerous cases but it is these instances that render the fruits of my labour worthwhile and continue to inspire me as a health-care professional. I have kept the note till this day and it has been a source of motivation when the going gets tough.