Pregnant with Cancer: Saving Two Lives
Lisa Landrum's awful and wondrous odyssey began last Dec. 5 at a Wal-Mart not far from her home in Kirbyville, Texas. "I'd been feeling that certain sickness, you know?" she says. Christmas shopping with her husband, Tim, she bought a pregnancy test kit and rushed to the ladies' room. "It was a surprise," says Landrum, a mother of two. "But it was a good surprise."
Two months later Landrum suffered a shock of an entirely different sort. For four months she had been seeing doctors for what they thought was an infection in her left breast. When antibiotics brought no relief, Landrum, 38, had a mammogram—but only after doctors assured her it wouldn't harm the baby. A former X-ray technician, she could read the results for herself—breast cancer. Worse, it was in an advanced stage.
Landrum wept, though her tears weren't solely for herself. Worried about what would become of the baby, she soon learned that most women are given a grim choice. She could end the pregnancy and start chemotherapy or have the baby and delay treatment for months, possibly at the cost of her life. For the diminutive Landrum, a devout Christian, the decision was easy. "I've lived 38 years," she said, "but this baby hasn't even had a chance to live at all."
Until recently, pregnant women diagnosed with breast cancer faced the same wrenching decision. Although the number of women affected each year is small—perhaps 100—some doctors believe it is growing as more women put off childbearing into their late 30s and 40s, the age when the risk of breast cancer also starts to rise. What's more, some of the very signs of breast cancer (a lump, for example) are similar to changes that occur in pregnancy, and some doctors simply dismiss them. "Cancer is way down on the list," says Dr. Richard Theriault, a professor of medicine at the University of Texas M.D. Anderson Cancer Center in Houston. "They say it's a plugged duct or mastitis [inflammation]."
Even once they identify cancer, many doctors are reluctant to treat pregnant patients for fear chemotherapy—a standard treatment after a mastectomy or lumpectomy—will harm the baby. Indeed, until recently, ending the pregnancy as early as possible, for all its emotional cost, had seemed the sensible thing. "My doctor's basic message was that my health was more important," recalls patient Monique Webb of Houston, diagnosed early in her pregnancy this year. "If we chose to have an abortion, we could try again for another baby."
But conventional wisdom is changing at large cancer hospitals—in part because of pioneering research by Theriault and his colleagues at M.D. Anderson. Doctors there have found that chemotherapy after the first trimester can fight—and sometimes eradicate—breast cancer while leaving the baby healthy. The conclusion comes after a 15-year study, which will be published later this year. The study focused on breast cancer, Theriault explains, because it is a common cancer among pregnant women, and because in most cases it has proved safe to delay aggressive treatment during the first trimester—the fetus's most vulnerable time. Of 57 babies born in the course of the study, only one suffered a genetic disorder, Down syndrome, which doctors feel was unrelated to the chemotherapy.
The Landrums, of course, knew nothing of these breakthroughs last winter, as they grappled with matters of life and death. An engineer with the Merchant Marine, Tim, 42, was on a ship in the English Channel when he phoned home to learn how Lisa's mammogram had gone. "My world fell under my feet," he recalls. With Tim at sea for another 12 days, relatives and friends pitched in to help with the kids as Landrum underwent a lumpectomy she hoped would be the end of the disease. Instead, one day she collapsed from back pain; a subsequent MRI revealed the cancer had spread to her spine, all but disintegrating two vertebrae. On her surgeon's advice, Landrum was taken to M.D. Anderson, where, under the care of Theriault's partner, Dr. Karin Gwyn, she began chemo—though it took several doctors to talk the cautious patient into it. Even then, the plainspoken Landrum didn't leave everything up to medical science. "When I had my treatments," she says in a light Texas drawl, "I'd lay my Bible on my belly and pray, 'God, please protect my baby' ".
In subsequent weeks her fear and skepticism melted away. Landrum made rapid progress over four courses of chemo. Through it all, her pregnancy progressed trouble-free until the point at which doctors felt the baby would thrive outside the womb. At 1:30 p.m. on June 10, Isaac Lee Landrum, weighing in at 5 lbs. 9 oz., arrived five weeks prematurely by cesarean section. With green eyes and a crown of red hair, "he turned out just perfect," says Landrum. "All three of our children are miracles, but Isaac is an extra-special miracle."
That joy has helped buoy them in the challenging days since. A test found a new spot of cancer on Landrum's skull, though for now doctors say radiation is unnecessary. These days Landrum occasionally gets a moment to relax in a recliner, while her kids roam the family's seven-acre spread and fish in the pond. Acutely aware of her own fragile state, she wakes every morning with deeply felt gratitude as she holds Isaac and gives him his bottle. "That's when I'm happiest," she says, "with my family around me and the day beginning."
Monique and Lum Webb await just such a day. Webb, 39, was diagnosed with cancer in her left breast in mid-February, days after her doctor confirmed she was pregnant. The double-barreled news "was overwhelming," she says. She'd barely had time to absorb it when her ob-gyn delivered another blow. "He said we might want to terminate the pregnancy," recalls Webb, quick to cry at the memory. "I nearly had a nervous breakdown." But having suffered a recent miscarriage, Webb, a customer service rep with two children from a first marriage, was determined to have the baby. Lum, 35, a Coca-Cola serviceman, shared her resolve. "I felt God put the baby here," he says. "We should let it do its thing."
Monique's brother suggested she search for a specialist. She then called M.D. Anderson and was quickly seen by Dr. Theriault. "He assured me we could make this work," says Webb. She went through five rounds of chemo, battling fatigue, body aches and hair loss. "I've always been kind of proud of my hair, and had a lot of it," Webb says. "I've worried that Lum won't see me in the same way." At this, her easygoing husband drapes a reassuring arm around her.
There's more tough treatment ahead. Doctors are awaiting her Oct. 12 due date, after which Webb will undergo weeks of radiation. Still, with the baby—a boy they plan to name Quinston—at 37 weeks and counting, Webb is upbeat. "He's very active, kicking all the time," she says. "At the first ultrasound, I saw he had all his fingers and toes. And I thought, 'We can do this!' "
For inspiration Webb can look to another woman whose child was saved at M.D. Anderson. Jennifer Finder, 33, a willowy mother of two from Lincoln, Neb., discovered a lump in her right breast in 2003 just as she began to suspect her third child was en route. Because she has a family history of cancer, she called her ob-gyn right away. But, recalls Finder, "a nurse said, 'We get this all the time—pregnant women with breast lumps.' " Calmed, she waited until her two-month checkup to see the doctor, who felt the lump and sent her for an ultrasound. That doctor then took a biopsy. The diagnosis: invasive ductal breast cancer. "I went numb," says Finder. "It was bizarre to imagine my body feeding life and death at the same time." After a partial mastectomy in July 2003, she got some unsolicited advice from the surgeon's nurse, who told her no doctor would give chemo to a pregnant woman. "She said, 'It's either you or the baby,'" Finder recalls with irritation.
Doctors at M.D. Anderson didn't see it that way. Referred by her ob-gyn, Finder and her husband, Bob, 37, a financial consultant, met Dr. Gwyn in August 2003. Under Gwyn's guidance, Finder struggled through five rounds of chemo. The results were mixed. The cancer hadn't spread, but was still present in her breast. "I felt like I was walking a tightrope," she says. "I thought, If I live, it's wonderful, because I get to be a wife and mother and raise my family. If I die, I'll be with the Lord in Heaven.'"
Happily, she remains very much with the living. On Dec. 8, 2003, Finder gave birth to a 5-lb. 5-oz. boy named Jackson. She opted to have the remainder of her breast removed and plans to have reconstructive surgery. Having struggled through an intense chemotherapy regimen, she is so far cancer-free and takes particular pleasure in watching Jack chase his high-spirited siblings through the house. "I worked very, very hard to give Jack life," she says. "But once he was born, he gave me life. Every time I held him, every time he smiled at me. He filled me with the will to live. That was his gift to me."
Richard Jerome. Anne Lang In Houston, Michael Haederle in Albuquerque and Jenny Achilles in Austin, Texas
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