Christina, a former teacher, was 32 years old when she found out she was pregnant with her second child. Two weeks later, she received the shocking news that she had breast cancer.
Christina's journey began after feeling a lump on her breast during a self-exam. She knew something wasn't right, and went to her doctor to get it checked out. From there, she spoke with her family obstetrician-gynecologist, who was supportive and recommended she get a mammogram. Typically, mammograms are recommended for breast cancer screening for women age 40 and older, with options to start earlier in those with a family history of breast cancer or who have certain genetic mutations that increase a person's risk.
However, Christina advocated for her health, knowing her own body and what felt right and what felt wrong. She underwent imaging and a biopsy that revealed she had breast cancer. Her family doctor knew she needed a specialized team of experts to help her navigate this diagnosis during her pregnancy to give her the best possible chance of recovery.
Breast cancer treatment while pregnant is possible, but it's particularly complicated early on during the first trimester. After being told by other institutions that they could not treat her cancer without first terminating her pregnancy, Christina got a recommendation to seek out breast surgical oncologist Mary L. Gemignani, MD, MPH, and medical oncologist Elizabeth Comen, MD, at NYU Langone's Perlmutter Cancer Center.
There, a multidisciplinary team of doctors explained the need to wait until she was out of the first trimester but took Christina on as a patient and developed a care plan. Fertility and pregnancy concerns are becoming more common among patients diagnosed with breast cancer, as doctors are seeing greater instances among younger women. Her doctors discussed all the options, and factors related to the cancer treatment as well as avoiding harm to the baby and how to maximize the outcomes for both her and the baby and developed a treatment plan.
"My husband and I turned to NYU Langone, and they welcomed us, made me feel comfortable, and helped refine my diagnosis and treatment," said Christina. "It was a whole team effort. It was never about one doctor's opinion, but about my needs as a patient."
Treatment for breast cancer in pregnant patients requires close collaboration across disciplines. In this case, the diagnosis occurred in the first trimester, when chemotherapy is generally avoided. The maternal-fetal medicine team worked with oncology to begin with surgery, allowing the transition into the second trimester when chemotherapy could be safely initiated.
Cancer in pregnancy is not common, but as more women delay fertility and childbearing for personal or professional reasons, a diagnosis of cancer before completion of childbearing can occur. In addition, doctors are seeing more women diagnosed with breast cancer at a younger age.
The median age for breast cancer is 62. Over the last two decades, there's been an increase in diagnoses in ages 20 to 29 and 30 to 39. At NYU Langone, we are committed to providing younger cancer patients with personalized care that addresses their individual needs and gives them the best quality of life possible. Survivorship has really evolved into a holistic, individual, and personal experience, and our program honors that."
Mary L. Gemignani, MD, MPH, chief of breast surgery, and director of the Early Onset Cancer Program, Perlmutter Cancer Center
At the end of her first trimester, after a lot of consultation and testing, Christina got a mastectomy to remove the cancer. After recovering from that surgery, she went on to receive chemotherapy. All the while, her team worked together to ensure her health and the health of her pregnancy.
"Christina's story is an important reminder that multidisciplinary cancer care is so important," said Dr. Comen, co-director of the Mignone Women's Health Collaborative at NYU Langone. "We are uniquely equipped here at Perlmutter Cancer Center to care for patients with complex cases like hers, providing a range of experts that treat the patient, not just the disease."
Perlmutter Cancer Center has a strong multidisciplinary approach to cancer care, with doctors from different services speaking regularly and in real time. Because the health of her pregnancy needed regular monitoring, Justin S. Brandt, MD, division director of maternal-fetal medicine, was in touch with Dr. Comen and had several conversations about holding or continuing her chemotherapy during various points. This multidisciplinary approach allowed for seamless care based on Christina's needs.
There was understandable concern about both surgery and chemotherapy during pregnancy. Dr. Brandt's team in Maternal-Fetal Medicine Services provided evidence-based guidance, drawing on data from cancer-in-pregnancy registries and their own institutional experience. Intensive maternal and fetal monitoring was essential to support treatment while maintaining pregnancy health. It was also important to time the delivery of Christina's baby and avoid prematurity. They consulted and collaborated with the entire multidisciplinary team, and delivery occurred at 39 weeks, which is optimal for fetal maturity. Christina had a successful birth.
"We do a lot of extra monitoring for pregnant patients who have cancer in pregnancy," said Dr. Brandt. "In addition to routine care, we monitor the fetal growth closely with monthly ultrasounds. At 32 weeks, we start biophysical profiles, which are weekly assessments of fetal wellbeing."
Christina attributes her positive attitude during treatment to her strong support system at home, including her husband, Jeremy, and family and friends, many of whom went to appointments with her, helped take care of her 4-year-old son, and provided moral support throughout the entire process.
Christina and Jeremy welcomed their new baby girl, Isabella, at the end of September, and she is finishing her treatment. Her prognosis is positive, and she continues to work closely with her doctors on the road to becoming cancer-free.
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