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Is it safe to have a baby after cancer treatment?

The answer to this question comes in several parts. Is there an increased risk of birth defects, miscarriage, or cancer in the offspring of people who have been treated for cancer? Is it safer to carry a baby after treatment for cancer?

Is there an increased risk of birth defects, miscarriage or stillborns after treatment for cancer?

The answer to this is probably not. Of course, treatment of cancer during pregnancy would be expected to be a serious risk to the developing fetus. But for men and women who have completed their treatment some time before pregnancy, there does not seem to be an increased risk of birth defects, miscarriages or stillborns as a result of cancer treatment. Some cancers are known to run in families and it is likely that the offspring of these cancer patients could be at increased risk of having the cancer also. This is something to discuss with your oncologist. Other than those cancers known to run in families, the risk of cancer in the offspring of cancer patients does not seem to be increased.

Is it safe to carry a baby after treatment for cancer?

Again, the answer to this is generally yes. Women with cancers that are responsive to hormones, particularly breast and uterine cancer may be an exception to this rule. Although breast cancer is believed to be stimulated by estrogen and there are high levels of estrogen in pregnancy, there is currently no evidence that pregnancy after breast cancer increases the risk of recurrence or spread. This is still a controversial area and women with breast cancer should consider their options very carefully. A prudent thing to do is wait at least three years after cancer treatment to be certain the cancer is not one that will recur quickly before considering pregnancy. Women with early uterine cancers may still be candidates for pregnancy if the cancer can be controlled without a hysterectomy. Uterine cancer is responsive to estrogen, but also inhibited by progesterone and progesterone levels that are extremely high in pregnancy. Pregnancy may still be possible in a few very early cases of uterine cancer.

Women who have had radiation to the pelvis or lower abdomen require special consideration with regard to pregnancy. If the uterus has been exposed to high doses of radiation, the endometrium or inner lining of the uterus may be destroyed. In this case periods will have stopped and it will not be possible for the uterus to support a pregnancy. In addition, women who have had radiation to the uterus do have a higher risk of miscarriage, early delivery, fetal growth restriction, etc., because the blood supply to the uterus is compromised and may not be able to increase as much as is necessary to support a pregnancy.

Another situation requiring special consideration is women who have received high doses of adriamycin and/or radiation to the chest. In pregnancy, the heart has to work considerably harder to pump an increased volume of blood to the baby. If the heart muscle has been damaged, it may not be apparent until an increased stress (like pregnancy) is placed on the heart and then heart failure can develop. Women who have had adriamycin treatment and/or radiation to the chest require careful evaluation by a cardiologist and careful follow-up in pregnancy to avoid serious complications.