The repercussions of overturning Roe v Wade—and the failure of the Supreme Court to provide any guidance on exceptions related to the life and health of the mother—are potentially catastrophic for a subset of women who face a life-threating diagnosis of pregnancy-associated cancers. In a perspective piece published in JAMA Oncology on August 11, Katherine Van Loon, MD, and Jordyn Silverstein, MD, both of the University of California, San Francisco (UCSF), discuss the unique challenges pregnancy-associated cancers pose for women and their care teams, who must balance both safety of the mother and that of the fetus or embryo.
Katherine Van Loon, MD
Jordyn Silverstein, MD
Approximately 1 in 1,000 pregnancies are affected by a concurrent cancer diagnosis. The most common pregnancy-associated cancers include breast cancer, cervical cancer, lymphoma, ovarian cancer, leukemia, colorectal cancer, and melanoma. Termination of the pregnancy occurs in 9% to 28% of cases, with many occurring in the first trimester.
“Restrictions on pregnancy termination will primarily affect cases in which oncologic therapy is urgently needed but contraindicated in pregnancy and the fetus is not yet viable,” wrote the authors. “Determinations of whether a termination can occur in a medical emergency, or with a life-threatening physical condition, will be determined by individual state laws…. Oncologists who provide care in states with laws in place restricting abortion access will find themselves in precarious situations in terms of navigating recommendations for termination based upon medical indications."
Compromised Cancer Care
In 2020, there were a total of 3.6 million births in the United States, and 1.5 million of them (41%) were in the 26 states that will likely ban abortions. The authors estimate that at least 1,500 women will be diagnosed with pregnancy-associated cancers in the next year in states that will impose restrictions on the right to terminate a pregnancy. Based upon the occurrence rate and estimated rates of termination, they project that between 135 and 420 women with pregnancy-associated cancers will face compromises in their cancer care and potential loss of life.
Because of the complexity and multidisciplinary nature of cancer treatment during pregnancy, the authors note that the Supreme Court decision will impact oncologists’ ability to deliver optimal care in these complex cases. Particularly in cases in which the fetus is considered viable but still preterm, and therapy for the mother cannot be safely administered during pregnancy, physicians will have to balance risks of preterm delivery vs risks of delayed cancer treatment for the mother.
“If a woman needs oncologic therapy to save her own life, physicians should not be criminalized for a decision to provide her with the best possible care,” said Dr. Van Loon.
Dr. Van Loon, UCSF Associate Professor of Clinical Medicine and Director of the UCSF Global Cancer Program with the Helen Diller Family Comprehensive Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
