Can the Oral Contraceptive Pill Protect Against Cancer?

Drugs

Pcos

Article

I Have PCOS; Should I Take Metformin?

* [PCOS](https://nabtahealth.com/glossary/pcos/) is sometimes treated with metformin, a drug for [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/). * 60-70% of women with [PCOS](https://nabtahealth.com/glossary/pcos/) are insulin resistant which is why metformin may be prescribed. * Clinical studies exploring metformin and [PCOS](https://nabtahealth.com/glossary/pcos/) symptoms have been small and inconsistent, but there is some evidence metformin increases [ovulation](https://nabtahealth.com/glossary/ovulation/) rate in women with [PCOS](https://nabtahealth.com/glossary/pcos/) when compared to treatment with a placebo. * Other studies have found that there is no consistent evidence that metformin improves the signs of hyperandrogegism (such as hairiness from excess male hormones). * However, metformin should not be completely discounted as an option for the management of [PCOS](https://nabtahealth.com/glossary/pcos/) [Metformin](https://nabtahealth.com/what-is-metformin/) is the first line treatment approach for type 2 diabetes mellitus (T2DM). It works by improving the way in which the body responds to insulin, preventing blood sugar levels from getting too high. Metformin is not licensed for the treatment of [](https://nabtahealth.com/what-is-pcos/)[PCOS](https://nabtahealth.com/glossary/pcos/), but as many women with the condition are [insulin resistant](https://nabtahealth.com/treating-the-associated-symptoms-of-pcos/), it is often prescribed ‘off label’ to help manage the symptoms. This article aims to address some questions regarding the use of metformin in the management of [PCOS](https://nabtahealth.com/glossary/pcos/). Is there justification in its use? Can it help to improve the symptoms of the condition, or are there alternative options that will be more effective? Will there ever be a time when metformin is prescribed as standard for all women with [PCOS](https://nabtahealth.com/glossary/pcos/) and to treat [PCOS](https://nabtahealth.com/glossary/pcos/) side effects? #### **Why metformin and [PCOS](https://nabtahealth.com/glossary/pcos/)?** Metformin is safe and cost effective, hence it’s widespread use in the management of T2DM. [Insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) is not one of the three diagnostic criteria used in defining [PCOS](https://nabtahealth.com/glossary/pcos/), however it is recognised as a common feature. In fact, 60-70% of women with [PCOS](https://nabtahealth.com/glossary/pcos/) will be insulin resistant and it is thought that the higher than normal levels of insulin contribute to many of the phenotypic traits of the condition. Thus, it makes sense that treating the [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) might help to alleviate other [PCOS](https://nabtahealth.com/glossary/pcos/) side effects, for example regulating the menstrual cycle and improving signs of unwanted hair growth and acne. #### **What does the science say about [PCOS](https://nabtahealth.com/glossary/pcos/) and metformin?** Unfortunately metformin has not turned out to be the wonder drug that some anticipated. The clinical studies to date have largely been small in sample size and results have been inconsistent. In 2017, the American Society for Reproductive Medicine published guidelines on the use of metformin for the treatment of [infertility](https://nabtahealth.com/glossary/infertility/) in women with [PCOS](https://nabtahealth.com/glossary/pcos/). They based these guidelines on the results of a comprehensive literature review. The main conclusions reached were: * There is some evidence that metformin increases [ovulation](https://nabtahealth.com/glossary/ovulation/) rate in women with [PCOS](https://nabtahealth.com/glossary/pcos/) when compared to treatment with a placebo. **However:** * Clomiphene citrate is more effective at inducing [ovulation](https://nabtahealth.com/glossary/ovulation/) than metformin. * Metformin plus clomiphene citrate is more effective than metformin alone. * There is insufficient data on pregnancy and live birth rates following metformin treatment. Thus, the longer term overall reproductive benefit cannot currently be established. **Furthermore:** * There is insufficient evidence to recommend metformin as an option to [reduce the risk of](https://nabtahealth.com/pcos-and-pregnancy/) [miscarriage](https://nabtahealth.com/glossary/miscarriage/) in women with [PCOS](https://nabtahealth.com/glossary/pcos/). * Preliminary work suggesting that preventative treatment with metformin reduces the risk of [](https://nabtahealth.com/gestational-diabetes-8-things-you-should-know/)[gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) has not been replicated in newer studies. The final conclusion reached by the Society was that they would not recommend metformin as the first line treatment approach for [ovulation](https://nabtahealth.com/glossary/ovulation/) induction. Medications such as clomiphene citrate, known to be an [ovulation](https://nabtahealth.com/glossary/ovulation/) inducer, are generally more effective than metformin for women who are experiencing [PCOS](https://nabtahealth.com/glossary/pcos/)\-related fertility issues. In addition to these findings, other studies have found that there is no consistent evidence that metformin improves the signs of [](https://nabtahealth.com/masculine-hormones-in-women/)[hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/). #### **The outlook for metformin as a [PCOS](https://nabtahealth.com/glossary/pcos/) treatment** Metformin should not be completely discounted as an option for the management of [PCOS](https://nabtahealth.com/glossary/pcos/). Whilst less effective than other options, metformin has been shown to restore [ovulation](https://nabtahealth.com/glossary/ovulation/) in some women with [PCOS](https://nabtahealth.com/glossary/pcos/). For women with [PCOS](https://nabtahealth.com/glossary/pcos/) clomiphene citrate is commonly used to induce [ovulation](https://nabtahealth.com/glossary/ovulation/), however, not all women respond to treatment with this drug. For the women that do not respond, it is possible that combination therapy with metformin may be more successful at inducing [ovulation](https://nabtahealth.com/glossary/ovulation/). However, the work on this to date is limited. There is a need for longer term studies on metformin, as most studies have only explored short course treatment approaches. [PCOS](https://nabtahealth.com/glossary/pcos/) varies considerably from woman to woman. The presenting symptoms differ in both type and severity, which is why [diagnosing it can be so challenging](https://nabtahealth.com/problems-with-traditional-diagnosis-of-pcos/). Women with [PCOS](https://nabtahealth.com/glossary/pcos/) are prone to other conditions such as obesity and [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/); they are also at greater risk of developing T2DM and [endometrial cancer](https://nabtahealth.com/a-guide-to-endometrial-cancer/). Whether metformin can be given prophylactically to reduce these risks remains unclear and once again highlights the need for longer-term studies with extensive follow-up periods. #### Will metformin be prescribed as standard to all women that receive a diagnosis of [PCOS](https://nabtahealth.com/glossary/pcos/)? Unlikely. A more valuable course of action would be for doctors to better understand the various [PCOS](https://nabtahealth.com/glossary/pcos/) phenotypes and thus, take a more individualised approach to treatment, deciding which of their patients could genuinely benefit from treatment with the drug. As a final note, the value of [lifestyle modifications](https://nabtahealth.com/is-it-possible-to-reverse-pcos/) should not be understated. Adopting lifestyle changes and losing weight has proven to be, by far, the best approach for managing the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/). It is also the most effective way for women with [PCOS](https://nabtahealth.com/glossary/pcos/) to reduce their risk of developing T2DM. Medication should remain a contingency strategy for use in those who do respond adequately to lifestyle alterations. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#a0d9c1ccccc1e0cec1c2d4c1c8c5c1ccd4c88ec3cfcd) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Lashen, Hany. “Review: Role of Metformin in the Management of Polycystic Ovary Syndrome.” Therapeutic Advances in Endocrinology and [Metabolism](https://nabtahealth.com/glossary/metabolism/), vol. 1, no. 3, June 2010, pp. 117–128., doi:10.1177/2042018810380215. * Practice Committee of the American Society for Reproductive Medicine (Penzias, Alan, et al.) “Role of Metformin for [Ovulation](https://nabtahealth.com/glossary/ovulation/) Induction in Infertile Patients with Polycystic Ovary Syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)): a Guideline.” Fertility and Sterility, vol. 108, no. 3, Sept. 2017, pp. 426–441., doi:10.1016/j.fertnstert.2017.06.026. * “Summary of Possible Benefits and Harms: Information for the Public: Polycystic Ovary Syndrome: Metformin in Women Not Planning Pregnancy: Advice.” NICE, Feb. 2013, [www.nice.org.uk/advice/esuom6/ifp/chapter/Summary-of-possible-benefits-and-harms](http://www.nice.org.uk/advice/esuom6/ifp/chapter/Summary-of-possible-benefits-and-harms). * “Treatment. Polycystic Ovary Syndrome .” NHS Choices, NHS, [www.nhs.uk/conditions/polycystic-ovary-syndrome-](http://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/)[pcos](https://nabtahealth.com/glossary/pcos/)/treatment/. * Yarandi, Razieh Bidhendi, et al. “Metformin Therapy before Conception versus throughout the Pregnancy and Risk of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus in Women with Polycystic Ovary Syndrome: a Systemic Review, Meta-Analysis and Meta-Regression.” Diabetology & Metabolic Syndrome, vol. 11, no. 1, 23 July 2019, doi:10.1186/s13098-019-0453-7. * Zhou, Joseph, et al. “Metformin: An Old Drug with New Applications.” International Journal of Molecular Sciences, vol. 19, no. 10, 21 Sept. 2018, p. 2863., doi:10.3390/ijms19102863.

Dr. Kate DudekJanuary 29, 2023 . 6 min read

Will Taking the Pill Increase my Risk of Developing Cancer?

Will taking contraceptive pill increase developing cancer risk, It is estimated that as many as 140 million women worldwide take the [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/). It is a simple, effective way for a female to control her own fertility and has also been utilised as a treatment for heavy periods, [acne](https://nabtahealth.com/why-do-i-get-acne-breakouts-before-my-period/) and [](https://nabtahealth.com/what-medications-are-recommended-for-endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/). However, safety concerns over its usage persist, and one of the major issues is a suspected link between the pill and cancer. So, what does the science say? Does taking the pill increase your risk of developing cancer, or can it actually serve a protective role? **The pill as an anti-cancer agent** ------------------------------------ **The pill reduces the risk of ovarian, endometrial and colorectal cancer.** * **Ovarian cancer**. Ever-users of the pill are significantly less likely to develop [ovarian cancer](https://nabtahealth.com/the-diversity-of-ovarian-cancer/) than never-users. In fact, studies have suggested that for every 5 years of pill use there is a 20% reduction in ovarian cancer risk. Furthermore, these protective effects are maintained for at least 30 years after discontinuation of pill use. * **Endometrial cancer**. The pill exerts a substantial protective effect against the development of [endometrial cancer](https://nabtahealth.com/a-guide-to-endometrial-cancer/). The risk is thought to be reduced by between 30 and 50%, depending on the duration of use. Protection lasts for at least 20 years after cessation of treatment. * **Colorectal cancer**. Ever-users of the pill are approximately 15% less likely to develop colorectal cancer than those that have never taken it. Whether increased duration of use has a beneficial effect is difficult to know as the quality of data from these studies is poor. **The pill’s carcinogenic effects** ----------------------------------- Oral contraceptive use is a risk factor for breast and cervical cancer. * **Breast cancer**. The association between breast cancer and the oral contraceptive pill is small, but significant. Studies suggest that those women who are currently on the pill are 20% to 24% more likely to receive a breast cancer diagnosis. The increased risk is lost once the pill is discontinued and, after ten years, prior pill users are at no greater risk than never users of getting breast cancer. The risk also falls significantly once a woman goes through the [menopause](https://nabtahealth.com/glossary/menopause/). Pill use is associated with clinically challenging types of breast cancer, including the [triple negative form](https://nabtahealth.com/breast-cancer-staging/), which usually has a worse prognosis and higher mortality rate. The exact mechanisms linking the two are unclear, although many breast cancers have a hormonal component. It is thought that increased lifetime exposure to oestrogens increases the risk of breast cancer, primarily because the hormone promotes or initiates tumour growth. Studies have failed to find an elevated risk of breast cancer in pill users with a family history of the disease. However, the data may be skewed by the fact that these women are less likely to use the pill due to their already increased susceptibility. The established link between [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and breast cancer may [lead](https://nabtahealth.com/glossary/lead/) you to wonder whether using the progestin-only ‘mini pill’ would be a safer option. There have been very few studies on this form of contraception, probably because it is not as widely used as the combined pill (which contains [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and progestin). The work that has been performed has suggested that women who take the mini pill still have a higher risk of breast cancer than those who have never used oral contraceptives, perhaps by as much as 21%. The link between progestins and breast cancer is poorly understood and likely to be complex. However, it is validated by studies on postmenopausal women who take hormone replacement therapy. Those on combined [oestrogen](https://nabtahealth.com/glossary/oestrogen/) plus progestin therapy have a higher breast cancer risk than those who take just [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Thus, the mini pill should no longer be considered a safer contraceptive option for those with an elevated risk of developing breast cancer. * **Cervical cancer**. Taking the pill for five or more years is associated with a significantly increased risk of developing cervical cancer. The duration of use increases the risk, so that women who take the pill for 5 years have a 10% increased risk, but those who take it for longer, are more than 60% more likely to be diagnosed. Ten years after stopping the pill there is no increased risk of developing cervical cancer. One important thing to note is that as a risk, oral contraceptives will always be cofactors that interact with high risk [human papillomavirus](https://nabtahealth.com/when-should-i-get-a-pap-smear/) ([HPV](https://nabtahealth.com/glossary/hpv/)) strains to induce cervical carcinogenesis. This means that oral contraceptives in isolation are not a risk factor in women who are [HPV](https://nabtahealth.com/glossary/hpv/) negative; however, for those who are [HPV](https://nabtahealth.com/glossary/hpv/) positive, the pill can exacerbate the risk. Steroid hormone receptors (mainly [progesterone](https://nabtahealth.com/glossary/progesterone/)) are found in cervical tissue and are thought to enhance the expression of high risk [HPV](https://nabtahealth.com/glossary/hpv/), contributing to cancerous changes in the [cervix](https://nabtahealth.com/glossary/cervix/). **Conclusion: the pill and cancer** ----------------------------------- It is very difficult to state conclusively whether the pill should be used or avoided based on its associations with cancer. The net effect is likely to be positive, with one long-term, UK-based study finding that taking the pill resulted in a 12% reduction in overall cancer risk. It is also challenging to assess the absolute risk posed by oral contraceptive use. Cancer can have a long latency period, meaning the time between exposure to a particular risk factor and cancer diagnosis can span many years. Most women who develop cancer will have been exposed to multiple risk factors during their lifetimes, including [parity](https://nabtahealth.com/is-pregnancy-linked-to-developing-cervical-cancer/) (the number of times she has been pregnant and carried the baby to term), [obesity](https://nabtahealth.com/the-link-between-obesity-and-cancer-in-women/) and whether or not she has breastfed (breastfeeding can exert [protective effects](https://nabtahealth.com/benefits-of-breastfeeding-for-the-mother/)). Ascertaining how much of a role each of these factors plays in a later cancer diagnosis is likely to be extremely difficult. One final thing to consider is that the pill has changed in formulation over the decades since it was first utilised as a type of contraception. The specific synthetic hormones in use have changed, as has their concentration. Today, a triphasic pill is commonly used, whereby the hormone concentration changes across the month. This is designed to more closely mimic the normal ovulatory cycle. These different formulations will have differing risks and benefits. The consequence of this is that women who were prescribed the pill in its infancy, in the 1950s and 1960s should certainly not be compared to those taking it today in the 21st Century. Perhaps the advent of the mini pill came with initial optimism that the risks associated with the combined pill would be alleviated by removing the [oestrogen](https://nabtahealth.com/glossary/oestrogen/) component. Unfortunately, it appears that women taking this form of contraceptive have a comparable cancer risk to those taking the more commonly prescribed combined oral contraceptive pill. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#5f263e33333e1f313e3d2b3e373a3e332b37713c3032) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Brynhildsen, Jan. “Combined Hormonal Contraceptives: Prescribing Patterns, Compliance, and Benefits versus Risks.” Therapeutic Advances in Drug Safety, vol. 5, no. 5, Oct. 2014, pp. 201–213., doi:10.1177/2042098614548857. * “Does the Contraceptive Pill Increase Cancer Risk?” Cancer Research UK, 4 Mar. 2019, [https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk](https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk). * Gierisch, J. M., et al. “Oral Contraceptive Use and Risk of Breast, Cervical, Colorectal, and Endometrial Cancers: A Systematic Review.” Cancer Epidemiology Biomarkers & Prevention, vol. 22, no. 11, Nov. 2013, pp. 1931–1943., doi:10.1158/1055-9965.epi-13-0298. * Knowlden, Hilary A. “The Pill and Cancer: a Review of the Literature. A Case of Swings and Roundabouts?” Journal of Advanced Nursing, vol. 15, no. 9, Sept. 1990, pp. 1016–1020., doi:10.1111/j.1365-2648.1990.tb01981.x. * Li, Li, et al. “Association between Oral Contraceptive Use as a Risk Factor and Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis.” Molecular and Clinical Oncology, vol. 7, no. 1, 12 May 2017, pp. 76–80., doi:10.3892/mco.2017.1259. * Murphy, Neil, et al. “Reproductive and Menstrual Factors and Colorectal Cancer Incidence in the Women’s Health Initiative Observational Study.” British Journal of Cancer, vol. 116, no. 1, 29 Nov. 2016, pp. 117–125., doi:10.1038/bjc.2016.345. * Mørch, L S, et al. “Contemporary Hormonal Contraception and the Risk of Breast Cancer.” New England Journal of Medicine, vol. 377, no. 23, 7 Dec. 2017, pp. 2228–2239., doi:10.1056/NEJMoa1700732. * “Oral Contraceptives (Birth Control Pills) and Cancer Risk.” National Cancer Institute, [https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet](https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet). * Roura, Esther, et al. “The Influence of Hormonal Factors on the Risk of Developing Cervical Cancer and Pre-Cancer: Results from the EPIC Cohort.” Plos One, vol. 11, no. 1, 25 Jan. 2016, doi:10.1371/journal.pone.0147029. * Schairer, Catherine. “Menopausal Estrogen and Estrogen-Progestin Replacement Therapy and Breast Cancer Risk.” Jama, vol. 283, no. 4, 26 Jan. 2000, pp. 485–491., doi:10.1001/jama.283.4.485. * Smith, Jennifer S, et al. “Cervical Cancer and Use of Hormonal Contraceptives: a Systematic Review.” The Lancet, vol. 361, no. 9364, 5 Apr. 2003, pp. 1159–1167., doi:10.1016/s0140-6736(03)12949-2. * Soroush, Ali, et al. “The Role of Oral Contraceptive Pills on Increased Risk of Breast Cancer in Iranian Populations: A Meta-Analysis.” Journal of Cancer Prevention, vol. 21, no. 4, 30 Dec. 2016, pp. 294–301., doi:10.15430/jcp.2016.21.4.294.

Dr. Kate DudekDecember 19, 2022 . 8 min read

Diagnosing and Treating Breast Cancer During Pregnancy

Despite being the second most common malignancy affecting pregnancy, breast cancer during pregnancy is rare. Known as Pregnancy-Associated Breast Cancer (PABC), it affects approximately one in 3000 pregnancies. PABC is, in fact, defined as breast cancer that is diagnosed during pregnancy or in the first year postpartum. The aim with diagnosis and treatment of breast cancer during pregnancy is to follow, as closely as possible, the normal standards of care for patients of the same age who are not pregnant. That being said, some modifications may be required in order to minimise risks to the developing baby. **Diagnosis** ------------- Most breast cancers are diagnosed following self-examination and [identification of a lump](https://nabtahealth.com/is-the-first-sign-of-breast-cancer-always-a-lump/) in the breast tissue. During pregnancy, the breasts change in shape and size as they prepare for breastfeeding. It is not uncommon for them to feel lumpy and inconsistent as the milk producing ducts and glands start to fill with milk. This can make it difficult for women to establish which changes are normal and which are a cause for concern. All abnormal masses should be investigated, although, fortunately, 80% will be [benign](https://nabtahealth.com/glossary/benign/) in nature. The first diagnostic test a doctor will use is ultrasound. This uses soundwaves and is entirely safe for the unborn baby. It will characterise any unusual masses and identify whether there are features of concern within the mass. At around the same time a needle aspiration and/or core [biopsy](https://nabtahealth.com/glossary/biopsy/) may be taken. This enables doctors to explore the cells of the breast in more detail. Particular care will need to be implemented for analysing the results as, during pregnancy, it is not unusual for cells to become more proliferative in nature. Rapidly proliferating cells under normal conditions can serve as a warning sign that something is amiss. Mammograms will be used, however, they are known to lack sensitivity in pregnant or lactating females. As a mammogram involves radiation, doctors will endeavor to shield the baby from exposure. Newer digital mammograms might improve the sensitivity of the technique in women under 40 years of age. CT scans and bone scans, which are a normal part of the diagnostic process in non-pregnant females, are avoided during pregnancy, due to the dangers of radiation to the developing foetus. These methods are normally employed to check for [metastasis](https://nabtahealth.com/glossary/metastasis/), and thus, metastatic disease can be harder to detect in pregnant women. **Treatment** ------------- Most women with PABC will undergo surgery as the first-line treatment option, usually in the form of a modified radical mastectomy. It is generally safe to undergo anaesthesia whilst pregnant, but in order to limit the time you are under general anaesthetic, your doctor will probably recommend postponing reconstructive surgery until after delivery. [Radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) is not recommended during pregnancy and wherever possible your doctor will attempt to delay this type of treatment until after delivery. This is because it increases the risk of [foetal malformations](https://nabtahealth.com/glossary/foetal-malformations/) and can delay [neurocognitive](https://nabtahealth.com/glossary/neurocognitive/) development. If breast preservation is desired, the disease is not advanced and diagnosis has occurred towards the end of pregnancy, it may be possible to treat with immediate lumpectomy and [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) after delivery. It has been shown that a six week window between lumpectomy and commencement of [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) does not have a detrimental effect on outcome. [Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) should not be given during the first [14 weeks of pregnancy](https://nabtahealth.com/articles/week-by-week-pregnancy-weeks-14-26/). It can cause severe [teratogenicity](https://nabtahealth.com/glossary/teratogenicity/) during organ development, which primarily occurs in the first trimester. In the second and third trimester, [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) can be administered. There have been no reports of later ill effects in children born to mothers who had [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) at this stage of their pregnancy. Most doctors will recommend stopping [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) at about week 36 to reduce the risk of infection or bleeding during delivery. Hormone therapy is not recommended for women who are pregnant or breastfeeding. Whilst, there are treatment options for women with PABC, additional work is required to establish a more effective treatment approach for these women. Certainly, as women postpone having children, the rates of PABC are likely to increase over the next few years. **Prognosis** ------------- The prognosis for women with PABC is generally lower than for women with breast cancer who are not pregnant. This is likely due to: * Less aggressive therapy being used due to concerns over the effect of harsher regimens on the developing baby. * Later stage of diagnosis because of difficulty in distinguishing physiologically-relevant changes from normal pregnancy-related changes. * The pregnancy having a direct effect on outcome, although knowledge regarding the exact mechanisms relating to this is currently lacking. * An increased percentage of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) receptor negative cases. This is known to be associated with an increased risk of metastatic disease, which has a poorer prognosis. In terms of the developing foetus, women with PABC should be reassured that there are no reports of breast cancer spreading from the mother to the baby during pregnancy. In rare cases cancer cells will be found in the [placenta](https://nabtahealth.com/glossary/placenta/), so the doctor will always check this immediately after delivery. During pregnancy, a woman should remain under observation by a multidisciplinary team of healthcare professionals, including gynaecologists and oncologists to ensure that the support she receives is optimal for both her and her baby. Growth scans will be performed regularly to ensure that the baby is developing as he or she should be. If possible, the medical team will try to ensure that the woman delivers her baby as close to her due delivery date as possible. After delivery, treatment options will be reassessed. Get yourself the [post-surgery pack](https://nabtahealth.com/product/post-surgery-selfcare-pack-copy/) Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#99e0f8f5f5f8d9f7f8fbedf8f1fcf8f5edf1b7faf6f4) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Breast Cancer.” Breast Cancer during Pregnancy | Cancer Research UK, 21 Nov. 2017, [https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/breast-cancer-during-pregnancy](https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/breast-cancer-during-pregnancy). * “Breast Cancer, Pregnancy and (Green-Top Guideline No. 12).” Royal College of Obstetricians & Gynaecologists, [https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg12/](https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg12/). * Johansson, A L V, et al. “Diagnostic Pathways and Management in Women with Pregnancy-Associated Breast Cancer (PABC): No Evidence of Treatment Delays Following a First Healthcare Contact.” Breast Cancer Research and Treatment, vol. 174, no. 2, Apr. 2019, pp. 489–503., doi:10.1007/s10549-018-05083-x. * Keyser, E A, et al. “Pregnancy-Associated Breast Cancer.” Reviews in Obstetrics & Gynecology, vol. 5, no. 2, 2012, pp. 94–99.

Dr. Kate DudekDecember 19, 2022 . 6 min read

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