New Delhi [India], August 26 : A 35-year-old woman, five months pregnant, was diagnosed with triple-positive breast cancer in July 2024, highlighting the complexities of treating cancer during pregnancy. Mammography was avoided due to fetal radiation risks, and a whole-body MRI revealed a tumour in her left breast with axillary lymph node involvement but no distant spread.
A biopsy confirmed invasive breast cancer that was estrogen, progesterone, and HER2neu positive.
"The patient was counselled extensively about three options: terminate the pregnancy and begin cancer therapy, undergo surgery first, followed by chemotherapy, or start with chemotherapy and then have surgery. After detailed counselling, she chose surgery first," said the hospital.
Dr. Rakesh Kr. Koul, Co-Chairperson of Surgical Oncology at Sir Ganga Ram Hospital, successfully performed a mastectomy. Post-surgery, positive axillary lymph nodes indicated the need for additional treatment.
Dr. Shyam Aggarwal, Chairperson of Medical Oncology, noted that "Chemotherapy is safe for pregnant women after the first trimester, with minimal risk of abortion and no adverse effect on fetal development."
However, anti-HER2neu therapy is contraindicated in pregnancy. The patient underwent 12 weekly cycles of Paclitaxel chemotherapy during pregnancy, which she tolerated well, with no adverse impact on fetal growth. By January 2025, she delivered a healthy baby via normal vaginal delivery.
Following delivery, she received adjuvant anthracycline-based chemotherapy, radiotherapy to the operated site, one year of targeted anti-HER2neu therapy with Trastuzumab and Pertuzumab, and a planned eight-year course of hormonal therapy. Both mother and child are currently healthy with no reported complications.
"This case underscores the importance of a Multidisciplinary approach, which is key to success in the majority of cancers," said Dr.Aggarwal.
He added, "We successfully saved both lives by combining surgical, medical, and supportive care in a carefully coordinated manner."
Dr. Rakesh Koul added, "With timely intervention and collaboration, breast cancer treatment during pregnancy can be both safe and effective, ensuring optimal outcomes for both mother and child."
This case reaffirms that surgery and chemotherapy are safe during pregnancy (post-first trimester), though anti-HER2neu therapy must be deferred until after delivery.