US abortion ban may increase death risk in pregnant women with cancer

The repercussions of the recent banning of abortion by the US Supreme Court could be potentially catastrophic for a subset of women who face a life-threating diagnosis of pregnancy associated cancers (PAC), researchers have warned.

In a perspective, published in the JAMA Oncology, a team from University of California San Francisco discussed the unique challenges PAC poses for women and their care teams, who must balance both the safety of the mother and that of the foetus or embryo.

Approximately 1 in 1,000 pregnancies are affected by a concurrent cancer diagnosis. The most common cancers include breast cancer, cervical cancer, lymphoma, ovarian cancer, leukaemia, colorectal cancer and melanoma. Termination of the pregnancy occurs in 9 per cent to 28 per cent of cases, with many occurring in the first trimester.

"Restrictions on pregnancy termination will primarily impact cases in which oncologic therapy is urgently needed but contraindicated in pregnancy, and the foetus is not yet viable," writes senior author Katherine Van Loon, UCSF associate professor of clinical medicine.

"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 indication."

In 2020, there were a total of 3.6 million births in the US, and 1.5 million of them (41 per cent) were in the 26 states that will likely ban abortions.

The team estimates that at least 1,500 women will be diagnosed with PAC 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 PAC 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 researchers note that the Supreme Court decision will impact oncologists' ability to deliver optimal care in these complex cases.

Particularly in cases in which the foetus is considered viable but still pre-term and therapy for the mother cannot be safely administered during pregnancy, physicians will have to balance risks of preterm delivery versus risks of delayed cancer treatment for the mother.

"If a woman needs oncologic therapy to save her own life, physicians should not be criminalised for a decision to provide her with the best possible care," said Van Loon.