What Erika Vandiver went through she wouldn’t wish on anyone.
But looking at her fearless and spirited 2-year-old daughter, Rachel, she wouldn’t have done anything differently.
|Erika Vandiver shows off Rachel to her husband, Andrew, and son, Simon, shortly after the baby’s birth in 2009. Courtesy photo
Vandiver was diagnosed with Stage 2 breast cancer when she was almost 20 weeks pregnant with Rachel. She already had a son, Simon, at home, and recently had suffered two miscarriages. She searched options and chose to have chemotherapy while pregnant. She wants to share the story of her treatment so other women in her situation know there is hope.
“My heart breaks for the women who have made the selfless choice to refuse treatment in order to have their babies,” she wrote in an email interview. “However, my heart is torn apart knowing that some of these women should NOT have had to choose — they could seek treatment while pregnant as I did.”
Indeed, the course of action Vandiver chose is now the standard treatment for women who are diagnosed with breast cancer while they are pregnant, said Dr. Angela Lanfranchi, co-director of the Steeplechase Cancer Center’s Breast Care Program in Somerville, N.J. But many doctors don’t recommend it to their patients, Lanfranchi said, recommending abortion or waiting to start treatment.
“The standard textbooks are clearly saying there is no need for that,” Lanfranchi said. “The data is that you live longer if the pregnancy goes to term.”
Vandiver, a forensic biologist for the state of Kentucky, was about 12 weeks pregnant with Rachel when she felt a small lump under her left arm, at the edge of her breast. She knew she had a high risk of cancer because of her family history, but her obstetrician thought the lump had formed either because of her pregnancy or because she had recently stopped breastfeeding Simon.
By the time she returned for her 16-week checkup, the lump seemed larger and was painful, she said.
At that point, her obstetrician ordered an ultrasound and biopsy. The surgeon who did the biopsy still believed it was benign, and persuaded her to let him remove the whole lump.
Then the diagnosis came back three days before Vandiver, then 28 years old and 20 weeks pregnant, learned she was carrying a baby girl.
Seemingly few options
Vandiver’s situation is not unique. According to published studies, breast cancer occurs in one in 3,000 pregnancies, and doctors expect that number to grow as women have children later in life and breast cancer is increasingly diagnosed in younger women.
“My local doctors didn’t know what to tell me,” Vandiver said. “My options seemed limited. Even searching the Internet didn’t yield any good options. One was to wait until after I delivered the baby, hoping the cancer didn’t progress too far, to have treatment. The other option was to terminate the pregnancy so I could have treatment sooner rather than later. My OB knew me well enough that the second option wasn’t really an option at all.”
But the first option — to forgo treatment for months — could lead to her death.
It was Vandiver’s own mother, Birgit Jones, who had been diagnosed with breast cancer four years earlier, who helped her find what she needed. She told Vandiver about the University of Texas MD Anderson Cancer Center in Houston. Vandiver was able to get a referral to be seen there, and she and her husband, Andrew, set off to find out what could be done.
“We found that they have been doing chemo on pregnant women for more than 20 years with no effects on the baby. The doctor told us that research had actually shown that women who kept their babies had a better prognosis than those who aborted or weren’t pregnant. Somehow, this information wasn’t widely available. When we heard that there was absolutely NO question about what we’d do,” Vandiver said.
Jennifer Litton, a doctor at MD Anderson, is the lead author of an article that was published in the London-based journal Women’s Health in May 2009, detailing the diagnosis and treatment of breast cancer in pregnant women. The treatment protocol in the paper is now commonly listed as the standard of treatment by organizations such as the American Cancer Society and references like WebMD.com, although they also suggest that ending the pregnancy be considered.
The doctors at MD Anderson set Vandiver up with a doctor of maternal-fetal medicine. They did very in-depth scans of Rachel to be certain she was growing appropriately. Then they sent her and Andrew home with instructions for their doctors in Kentucky. Both her oncologist and obstetrician were thrilled to have a path to follow.
“Neither of them pressured me to do anything contrary to life. They were excited to know of this ‘new’ option for mothers in my position,” she said.
Liability fears, ignorance
It doesn’t always work that way, said Dr. Patrick Johnston, who is in family practice in Zanesville, Ohio. In his experience, oncologists don’t want to treat pregnant women because they are afraid of the liability if something goes wrong.
Johnston, founder of the Association of Pro-Life Physicians, said one of his own patients aborted her baby after an oncologist told her that she could not be treated for breast cancer while pregnant.
“When they say something like that is a therapeutic abortion to save the life of the mother, it’s really to protect the doctor,” Johnston said.
According to Lanfranchi, fear of liability may play a role, but so does ignorance. “It’s not very common,” she said. “And OB/GYNs are usually very ignorant of what happens to breasts when you are pregnant.”
For Vandiver, the search for options was over, but not the adversity. Every three weeks she had chemo. After four rounds of chemo, it was time to stop and let her blood levels build up for the delivery, but there were still weekly ultrasounds to check Rachel’s development.
“Neither of us had any trouble. She chose to make her debut exactly in her due date that coincided with her daddy’s birthday and Thanksgiving Day,” Vandiver said.
Two weeks after giving birth, Vandiver started chemotherapy again, and three months later, she had both breasts removed and implants put in. However, after suffering chronic pain, she had surgery in October to remove the implants and replace them with her own tissue.
She has gotten through it all with the support of her family and her “church family” at St. Elizabeth’s Catholic Church in tiny Curdsville, Ky.
Even connections from Facebook and her blog (erikasmiraclejourney.blogspot.com) offered prayers. “This journey has opened my eyes to the good that’s still present in society,” she said. “With the news like it is — focused on all the evil in the world — it was reassuring to know that most people were not only supportive of me in my situation, they were selfless in giving their aid to us.”
Michelle Martin writes from Illinois.