A breast cancer diagnosis 11 days before Christmas

We shall call the women Thoko Puone (28), Ma Lindi Nhlapo (60) and Tshiamo Gunase (38) to protect their medical confidentiality.

 

Tears, shock and indifference gripped their faces, each struggling to comprehend their new breast cancer diagnosis. Tshiamo sat clutching  her belly as tears streamed down her cheeks and the newly trained Breast Buddies were there to comfort and hold her but they felt completely overwhelmed. 

 

Tshiamo is a mother of four and 3 months pregnant. Unlike, Thoko and Ma Lindi, she has had some formal education and is therefore better able to understand her new diagnosis. She eloquently recounts her discusssion with the medical consultant.  

 

Diagnosis: T1 Estrogen receptor positive malignancy of the right breast. Three treatment options were indicated mindful of her early pregnancy: (1) Defer chemotherapy at the risk of the cancer being fed to spread quicker by estrogen hormones flourishing in her body due to the pregnancy. (Risk to her life)

 

(2) Start chemotherapy immediately to curb the oestrogen hormone driven uninhibited malignant cell growth and place the foetus at 33 per cent risk of chemo damage. (Risk of deformed live birth or loss of life for the baby)

 

(3) Terminate the pregnancy. (This on the basis of "the mother's versus "foetus' life conflict). During our discussion Tshiamo kept emphasis that the doctor advised her to weigh the value of saving her life so she can raise her four other children versus opting to defer treatment until she is post partum - at risk of losing her life to breast cancer).

 

This is a huge moral dilemma and an untold burden for a woman still reeling from a new breast cancer diagnosis. Tshiamo "reached her decision" to terminate an hour post diagnosis. She had not spoken to her husband or family and she felt the decision needed to be made before her mastectomy scheduled for five days later.

 

Medical View Breast carcinoma is one of the most commonly diagnosed cancers during pregnancy. There is almost always a perceived conflict between the optimal therapy of the mother with breast carcinoma and the well-being of the fetus. The pregnant breast carcinoma patient, her family, and her medical team may be in conflict, because treatment of the cancer may compromise the fetus. However, insufficient treatment of the breast carcinoma, presumed to protect the fetus, may compromise the health of the mother.

 

An interdisciplinary team of obstetrician gynecologists, medical oncologists, radiation oncologists, surgeons, pediatricians, geneticists, psychologists, and other members of the medical team is required to formulate and implement the treatment plan.

An advocate's view:

In light of the last paragraph of the medical opinion, I cannot help but wonder if patient Tshiamo's treatment options are not  determined by her geography (the lack of adequate evidence-based cancer control and care public healthcare services in South Africa - and other African/ Low Medium Income countries. What role is the global cancer control and care resource allocation divide playing in her "choice?"),  economic status  (lack of financial access to medical insurance) and multi-parity (the view that she has "enough" children). Sounds like “forced” versus informed consent to me.

Question to our Advocate Forum: Is there a way her breast cancer can be managed without her having to terminate?

Responses and resources from fellow advocates:

 

Kat LoJacono Werner YES!!! If you can look up MD Anderson in the US they really specialize in breast cancer treatment while pregnant. Once she reaches 2nd trimester she can do chemo while pregnant if need be. (Facebook friend of BreastSens Advocate)

 

Marjorie Gallece http://pregnantwithcancer.org/

Hope for Two: The Pregnant With Cancer Network is an organization dedicated to providing information, support and hope to women diagnosed with cancer while pregnant. 
 

 

 

 

 

 

 

 


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