The abortion ban has put the health of many women at risk, but some groups of women, including Black women, may experience worse health outcomes. Now the abortion ban may affect the lives of cancer patients. America’s leading cancer societies warn that the U.S. Supreme Court’s decision to overturn Roe v. Wade will limit cancer treatment options for pregnant women and put lives needlessly at risk.
About one in every 1,000 women who are pregnant will wind up being diagnosed with cancer, says Lisa Coussens, president of the American Association for Cancer Research.
“It’s not a trivial number, and rapid and well-informed decisions about care with a cancer diagnosis is critical,” Coussens adds. “Rapid access to quality care is also absolutely essential and lifesaving.”
Unfortunately, last month’s decision in Dobbs v. Jackson Women’s Health Organization is expected to make cancer treatment much more complicated for pregnant women.
As you can probably guess, many treatments and therapies that cure cancer can cause either miscarriage or birth defects, particularly early in pregnancy.
Radiation therapy and chemotherapy in particular can do terrible damage to a developing fetus, says Dr. Julie Gralow, chief medical officer for the American Society of Clinical Oncology.
“Chemotherapy for the most part impacts cell division, right? I mean, that’s one of the main ways it kills cancer cells, because they just can’t go on and divide and replicate and grow and spread. And that’s what a fetus is all about, right?” Gralow shares. “You’ve got developing cells that need to divide and grow and differentiate. And that’s exactly what chemotherapy blocks.”
Radiation therapy is also never given to pregnant patients, no matter where the cancer is located, notes Karen Knudsen, CEO of the American Cancer Society.
“This is putting women in really an awful, untenable situation,” Knudsen notes. “A woman with a cancer diagnosis would not be able to consider a therapeutic abortion, and then would have to make the decision about potentially not receiving lifesaving treatment against her cancer because of the impact on the fetus.”
RELATED: Why Black Women Will be Most Affected by Roe v. Wade Being Overturned abortion ban
Pregnant cancer patients might also be denied access to certain cancer drugs that are known to cause miscarriages, like methotrexate or imatinib (Gleevec), Coussens and Gralow says.
Pharmacy chains like Walgreens, CVS and Walmart have all started to limit access to
methotrexate in states where that drug’s prescription could run afoul of abortion restrictions, according to news reports.
That’s led to objections from the American College of Rheumatology, the Lupus Foundation of America and the Arthritis Foundation, since methotrexate is also used to treat autoimmune disorders.
“It’s the legal teams at hospitals and pharmacies that are making some of these decisions, not doctors,” Gralow points out. “We’re hearing about cases of people not getting their drugs renewed at the high doses we give.”
Another concern is the effect that newer cancer treatments might have on the fetus, Knudsen says.
“We are in an unprecedented time in cancer care, with an onslaught of new discoveries that have allowed us to reduce cancer mortality by 32% since 1991,” Knudsen adds.
However, while targeted therapies and immunotherapies have revolutionized treatment for cancer, it’s not known how those treatments could affect the fetus.
“Pregnant patients are not included in clinical trials, so we actually have no data on which to say whether or not it would be safe for someone who is pregnant,” Knudsen shares. “If the goal is to maintain a successful pregnancy, we don’t know whether those new therapies could have an unintended consequence of inducing a spontaneous abortion [miscarriage].”
Because of all these questions, cancer groups are concerned that doctors might be more timid in
treating pregnant cancer patients, for fear of lawsuits or criminal charges.
“Not just oncologists, but doctors everywhere are feeling they could be at legal risk if they even mention the possibility of a termination of pregnancy, much less cause one with the therapies that they’re giving,” Gralow notes. “We’re interfering with the doctor-patient relationship, which should be private and where we should be able to discuss all options.”
Ironically, these laws might also limit a cancer patient’s chances of future fertility, Gralow adds.
Some cancer treatments can drastically affect a patient’s future fertility, according to the American Cancer Society. More than 60,000 young adults aged 20 to 39 are diagnosed with cancer each year, and some might wish to preserve their eggs prior to treatment and use in vitro fertilization (IVF) to conceive later.
“In some states, there are laws or at least proposals that life begins at the union of the sperm and egg,” Gralow says. “Think about the implications of that with respect to fertility treatment and a lot for cancer patients who might preserve embryos so they can undergo IVF after their treatment, or who may need IVF to achieve fertility after treatment.”
Another unintended consequence of the Supreme Court’s ruling could be a reduction in access to cancer screening for women, particularly for poor women and women of color, Coussens notes.
“Health care facilities that provide reproductive health counseling, they do more than offer abortions,” Coussens explains. “They provide very important cancer prevention access with regards to mammograms, Pap smears, etc. And many of these clinics are being forced to close, and access to that preventative care is now being restricted.”
The American Cancer Society intends to do everything it can to limit the impact of the court ruling on pregnant cancer patients, Knudsen shares.
“We will be working in the states that are considering restrictions on reproductive care to ensure that they truly understand the impact that the proposed legislation may have on cancer patients and families,” Knudsen adds.
For more information about treating cancer during pregnancy, visit The U.S. National Cancer Institute. abortion ban
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