Content area
Full Text
Fortunately, cancer rarely complicates pregnancy, with a cancer diagnosis in approximately 1 of 1000 pregnant women. Thus, for busy obstetrical care providers who deliver 125 babies per year, the odds that they will have a patient with cancer are about one in every 8 years. Given the variety of cancers that are diagnosed during pregnancy, it is unlikely that most obstetrical care providers will see more than two or three cases of any given type of maternal cancer in their careers. For similar reasons, most oncologists have limited familiarity with cancers that occur during pregnancy, as do most pediatricians who treat the babies of these women. Thus, all specialty care providers find themselves in unfamiliar territory when cancer is diagnosed in a pregnant woman. Much of the care of patients with cancer, including exposure to ionizing radiation at diagnostic and therapeutic levels and antimitotic chemotherapy, seems inimical1 to the healthy development of a rapidly growing fetus. These factors give all care providers pause and result in the dispensing of only tentative advice.
In 2012, the National Toxicology Program of the National Institute of Environmental Health Sciences led a literature review of approximately 1050 publications dating back 50 years. This effort took nearly 18 months and resulted in a monograph describing the effects of scores of medications that are used for cancer chemotherapy during pregnancy.2 The data that are available in the literature are from case reports or small case series. The quality and...