Pregnant with Cancer: One Patient’s Remarkable Journey
August 15, 2018
| by Alison Shore
In the summer of 2007, the wait for their international adoption nearly over, Stephanie Hosford and her husband, Grant, were flush with excitement at the prospect of bringing their little girl home to Southern California, where she would join brother Ethan, then 6.
Joy turned to disbelief and fear when Hosford was diagnosed with breast cancer
in September. Then, three days after the diagnosis, their lives were upended by yet another piece of news: Hosford was pregnant. The couple had tried for a while to have another baby, but had given up.
When I found out I had breast cancer, I was scared and sad and mad, “ says Hosford. And then, when I found out I was pregnant, it was a whole new level of confusion, and I was even more terrified about what to do. Cancer is scary enough. I thought, ‘Why now?’”
No Good Time
Of course, there is no good time to be diagnosed with cancer, said I. Benjamin Paz, M.D.
, an esteemed oncology surgeon who has worked at City of Hope for 23 years. “What if your mother dies and you have to take care of your father? What if your daughter is getting married? Life is a continuum, and everyone’s life is disrupted. I try to understand the context of people’s lives and goals, and I work to make the goals achievable.”
Still, Paz recognizes the unique dilemma of cancer during pregnancy because mapping the treatment course must consider two lives. And therein lay the quandary for the Hosfords.
A New Chapter
After they consulted four doctors, all of whom recommended terminating the pregnancy, a determined Grant convinced his weary, resigned wife to visit one more place: City of Hope.
“I didn’t want to go,” recalled Hosford. “I didn’t want to hear the same thing again. And I had already resolved I would end the pregnancy.” In fact, when they met with Paz, one of Hosford’s first questions was, “When would be the best time to terminate?”
His answer surprised her. “You don’t have to terminate,” said Paz.
“I thought he had misheard me,” said Hosford.
“We’ve done this before and you can handle it,” said the doctor.
Paz’s approach is one of pragmatism and promise. “Once they hear you, you eliminate the anxiety and focus on the treatment. Helping them understand that their disease is curable and their child will grow is the first thing I do. A woman doesn’t need to make a choice between her life and the baby’s.”
Rare but Devastating
Although the co-existence of pregnancy and cancer is relatively uncommon, in Paz’s experience and indeed statistically, breast cancer is the most prevalent cancer in pregnant women (cervical
is second), with about one in 3,000 women being affected. Generally, this combination may be attributable to the preponderance of this particular cancer in fertile women.
In Hosford's case, Paz informed her that they would have to make adjustments in the treatment regimen but that she could be treated and the baby could be saved, without adverse outcomes for her health (remarkably, in Paz’s practice, he has managed to treat all pregnant patients without terminating the pregnancies).
For Hosford's diagnosis, triple-negative breast cancer (i.e. her cancer did not rely on estrogen or progesterone to proliferate, nor was it related to a surplus of HER2 receptors), the appropriate treatment entailed a lumpectomy and chemotherapy; she also had the option to undergo radiation therapy, which is potentially harmful to a fetus. Hosford chose additional surgery — a double mastectomy with breast reconstruction.
Timing Is Everything
No two cases are alike, and Paz emphasized the necessity to think about a woman’s challenges and options. With some women, waiting to administer chemotherapy or performing breast-preserving surgery after the baby is born is prudent. If treatment during pregnancy is viable, the timing of administration varies among patients.
Paz’s thoughtful manner surfaced early in his professional trajectory, when he made a pivotal decision. His plan to become a biomedical engineer by way of medical school — having passed the tough standards for admission to medical school in his native Chile, he figured he could then easily switch easily to engineering — was revised when he discovered surgery.
“The specialty immediately appealed because of the scientific and intellectual challenges and the need to think in a logical way. Many aspects of surgery require systematic, step-by-step solutions similar to engineering problems.” Paz added that oncology, too, is very logical: "What is your patient’s objective through treatment and what tools do you have to achieve it?"
Hosford said that Paz’s serene, enlightened outlook changed everything for her.
“He, along with my oncologist (Lucille Leong, M.D., who has since retired from City of Hope), is my hero. He understood me and supported me. He still does.”
Ten years out, Hosford is healthy and her children (Ethan, 16; Naomi, 11; Samantha, 9) are thriving — all in all, she says, hers is a normal, busy life. “Dr. Paz told me that cancer doesn’t have to be this thing that defines you.” When she looks back, she says that it was her confidence in City of Hope and Paz that made the experience bearable. “They didn’t blink an eye. Their attitude was the difference.”
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