- Up to 1 in 1,000 pregnant women are diagnosed with cancer each year in the United States, reports the ACS.
- Patients in states with anti-abortion laws may have difficulty accessing radiation therapy, chemotherapy, or other treatments that can negatively affect fetal development and potentially cause miscarriage.
- Several organizations, including the American Cancer Society, have released statements urging lawmakers to protect access to cancer care for pregnant patients.
In June 2022, the Supreme Court of the United States (SCOTUS) reversed the landmark decision Roe v. Wade which granted a constitutional right to abortion. Since then, many states have implemented new laws to restrict access to abortion or ban it almost entirely.
Not only do these laws limit reproductive autonomy, but they can also affect some people’s ability to access treatment for certain health conditions, including cancer.
“Legislation that Restricts Reproductive Rights Affects Cancer Care,”
“In addition to the cancer patient and the oncologist, we now have a third party in discussions about cancer care, and that’s the government,” she said.
In particular, patients in states with anti-abortion laws may have difficulty accessing radiation therapy, chemotherapy, or other treatments that can negatively affect fetal development and potentially cause miscarriage.
Several organizations, including the ACS and the American Society of Clinical Oncology, have issued statements urging lawmakers to protect access to cancer care for pregnant patients.
“We are non-partisan and our only focus is on the cancer patient and their family,” Knudsen said. “Our goal is only to do what we believe is essential to improve the lives of cancer patients and families. For this to happen, we believe there should be no barriers to timely and adequate cancer care at any time.
Up to 1 in 1,000 pregnant women are diagnosed with cancer each year in the United States, reports the ACS.
Early treatment is often essential to prevent death from cancer, especially for fast-growing cancers that can spread quickly from one part of the body to another.
Cancer that is diagnosed early is often treated with surgery, which is generally although not always considered safe during pregnancy.
However, many people need other types of cancer treatment that may not be safe for a developing fetus.
For example, radiation therapy can limit fetal growth, cause fetal malformations, and increase the risk of miscarriage.
Chemotherapy can also harm the fetus, especially during the first trimester of pregnancy.
Certain targeted therapies and immunotherapies may also have harmful or unknown effects on the developing fetus. The effects of many new cancer treatments on the fetus are unknown because pregnant women are excluded from clinical trials.
In states where pregnant women can access abortions, those who need care for cancer that could harm the fetus often face a difficult decision: terminating the pregnancy and getting treatment right away, getting a immediate treatment while risking harm to the fetus or delaying treatment until later in the year. pregnancy or following childbirth.
“The majority of pregnancy terminations occur during the first trimester of pregnancy,” said Dr. Katherine Van Loon, MPH, associate professor and oncologist at the University of California, San Francisco. “The mother requires therapy that is not compatible with viability of the first trimester or early second trimester fetus and the cancer is aggressive enough to require urgent treatment.”
Delays in treatment increase the risk that the cancer will spread and become more difficult to treat.
If a pregnant person does not have access to abortion, their cancer treatment options are reduced.
Cancer care providers may be reluctant or unwilling to provide treatment that could harm a developing fetus or result in miscarriage, particularly if they live in a state where abortion has been restricted or banned.
“We hear stories where people are being denied medical care because they are pregnant and the doctor is concerned that they will be criminalized for providing the care that person needs,” Van Loon said.
“If the threat is that by providing this care and doing what is right for the patient, you are going to be taken to jail and separated from your own children or family? It’s terrifying,” she added.
Some anti-abortion laws provide exceptions for cases where a pregnant person’s health or life is at risk, but it’s not always clear when these exceptions apply.
“Part of the challenge is the obscurity of the language in some laws,” Knudsen said. “We’re of the view that cancer is considered a medical emergency, but there needs to be some assurance that states would agree.”
Recent court filings in Ohio show that concerns about disruptions in cancer care are not just hypothetical. Abortion restrictions have already affected care.
After the cancellation of Roe v. Wade, Ohio implemented a bill prohibiting abortion after a fetal heartbeat is detected, which typically occurs around 6 weeks of pregnancy.
This law is currently pending, due to a legal challenge from abortion providers.
But the suit’s affidavits report that while the bill was in effect, several pregnant women were denied cancer treatment until they could travel out of state to have abortions.
Some types of cancer grow so quickly that even traveling out of state can lead to life-threatening delays in care.
Beyond cancer therapies themselves, fertility preservation is another aspect of cancer care that can be negatively affected by laws that limit access to reproductive health care.
Certain types of cancer treatment can cause infertility.
As a result, young cancer patients who wish to have children in the future can undergo fertility preservation.
The most effective method of fertility preservation is to create an embryo through in vitro fertilization and freeze it until a patient is ready to become pregnant.
“While you can freeze sperm and freeze eggs, that’s much less likely to preserve someone’s fertility than creating and storing an embryo,” Knudsen said.
Typically, more embryos are created and frozen than can actually be used, which means some embryos may be destroyed.
ACS is concerned that current or future laws that restrict reproductive health care may create legal barriers to fertility preservation methods that create embryos that may be destroyed later.
“Fertility preservation is an essential component of cancer care for patients diagnosed with cancer of reproductive age,” the ACS said in a September press release. “The SCOTUS decision could potentially interfere with the preservation of the fertility of [adolescent and young adult] cancer patients due to new restrictions on genetic testing, storage and disposal of embryos, including those created in vitro.
Laws that restrict cancer patients’ ability to terminate a pregnancy can make an already difficult situation more difficult, said Dr. Katie McHugh, MD, an obstetrician-gynecologist and abortion provider in Indiana.
“Abortion is safe, evidence-based, and compassionate health care for those who choose it,” McHugh told Healthline. “This is especially true for patients facing life-threatening conditions whose state legislatures prioritize potential fetal life over that of the patient.”
“Telling a patient that the state prohibits abortion, even for cancer and other dangerous medical conditions, causes deep rage and grief. For some it is a death sentence,” she added.
Speaking from California, Van Loon told Healthline she is grateful to practice oncology in a state where abortion is still legal and unrestricted up to the point a fetus becomes viable. She described a recent encounter with a patient that would have gone differently in a state where abortion was banned.
“I had a patient last week who was due for treatment on Monday and had a positive pregnancy test. She looked at me and said, ‘If I was in a different state, this treatment wouldn’t happen, would it? And she was 100% right,” Van Loon said.
“It was her life on the line, and I’m grateful that she was able to make an empowered choice. She and I were able to have a conversation about her priorities, and it was clear that protecting her life so she could continue to being the mother of three children she already has was her priority,” she continued. “It’s devastating to think that there are women in states who have lost that right to make an autonomous choice to protect their own lives.”