Goregaon-based software engineer Shikha Khandelwal was diagnosed with stage-three breast cancer in the sixth month of her first pregnancy. Months before she was diagnosed, she noticed a lump, but her gynaecologist dismissed it as hormonal changes.
Khandelwal is among a rising number of Indian women getting diagnosed with pregnancy-associated cancers, or PACs. These cancers are diagnosed either during pregnancies or one year after delivery. However, as the condition remains poorly understood, caregivers often recommend abortion.
Now, for the first time, doctors at Tata Memorial Hospital (TMH) in Parel are trying to understand PACs, and are collecting data so that they can set treatment guidelines.
The doctors are focussing on pregnancy-associated breast cancer, which is most common among Indian women.
Dr Jyoti Bajpai, a professor of medical oncology at the hospital and her colleagues have started a registry and a study to record the incidence of PACs. In two months, the hospital plans to launch a national registry.
“We know nearly a third of Indian women are diagnosed with breast cancer in their thirties, and the now simultaneous trend of late pregnancies has resulted in more women getting diagnosed with the disease during their pregnancies,” Dr Bajpai said. “It is a known fact that late pregnancies are risk factors for cancers, while early pregnancies are protective,” she added.
Internationally, pregnancy-associated breast cancer accounts for approximately 2% of primary breast cancer patients. So far, 80 women were been enrolled in the registry, and Dr Bajpai and her team are treating them based on international guidelines set by the National Comprehensive Cancer Network. “While the focus is to cure the mother, we pay equal attention to save the pregnancies,” said Dr Shylashree TS, professor, gynaecology, TMH, who is co-leading the study.
The Goregaon-based software engineer, Khandelwal, is a part of the registry. Since her diagnosis in 2016, she took treatment at the Tata Memorial Hospital, where she underwent chemotherapy and radiotherapy, and eventually had a normal delivery. “I was reluctant to start treatment before delivery as this was my first child. But after doctors assured me it was safe, I went ahead,” she said. Doctors said chemotherapy can be safely administered after the second trimester but radiotherapy and hormone therapy should be given only after delivery.
As a part of their study, the doctors will also follow up on the long-term health of the child after delivery. “For now, most babies of women who underwent chemotherapy are fine. For six women, we had to terminate pregnancies as they were metastatic,” Dr Bajpai added.
Dr Ashwini Bhalerao Gandhi, a gynaecologist at PD Hinduja Hospital & Medical Research Centre in Mahim called the study a much-needed initiative to understand this subset of patients. “With late marriages, women are getting pregnant late. Often there is a dilemma among doctors to decide a course of action when pregnant women are diagnosed with cancer, so we do need standardised guidelines.”