by Kathy Sena
MELANOMA AND PREGNANCY: DO HORMONES MAKE A DIFFERENCE?
Nearly a third of all cases of melanoma, the most serious form of skin cancer, are diagnosed in women during their childbearing years. At the recent annual meeting of the American Academy of Dermatology, Marcia S. Driscoll, M.D., clinical associate professor of dermatology at the University of Maryland School of Medicine, presented evidence on the prognosis for women who become pregnant after surviving melanoma and for those who develop melanoma during pregnancy.
"Over the years, there has been ongoing controversy concerning the effect of hormones on melanoma," says Driscoll. "While we know that hormones may impact other types of cancer, such as breast and ovarian cancer, a review of the research on pregnancy and melanoma shows there is no evidence that pregnancy has an adverse influence either on the prognosis of melanoma or the risk of developing melanoma."
Three small studies compared the prognosis of a total of 530 women who became pregnant after being diagnosed with melanoma to 2,340 control subjects who gave birth before their melanoma diagnosis. The studies "found no significant difference between the prognoses of these two groups of women, indicating that hormones did not have a negative effect on melanoma," says Driscoll. "Having researched this topic for 15 years, I personally have not found a solid link between hormones and melanoma," she adds.
What happens if a melanoma is diagnosed during pregnancy? Driscoll says there are additional data demonstrating that pregnancy does not affect the prognosis for women diagnosed with melanoma before, during or after pregnancy. Six case-control studies and two large population-based studies have found no effect on prognosis when melanoma is diagnosed during pregnancy.
"While being diagnosed with melanoma at any time can be scary, it can cause great anxiety if it develops while a woman is pregnant," says Driscoll. "However, when you look at the whole body of evidence, there is nothing to suggest that pregnancy adversely affects the patient's outcome. Likewise, it is extremely rare for the baby to be affected. This is only seen in cases of women with advanced melanoma where spreading has occurred throughout the body."
If a pregnant woman is diagnosed with a melanoma that has not spread (localized), then she typically would receive the same treatment as any other person - mainly a wide local excision to remove the tumor. Driscoll explains that this procedure should not be delayed and can be safely performed under local anesthesia during pregnancy. In cases where a wide local excision must be performed in a later stage of pregnancy, the patient's obstetrician may collaborate with the dermatologist to monitor the fetus during the procedure.
However, if a melanoma is deeper than 1 mm, Driscoll advises that a procedure known as sentinel lymph node mapping and biopsy should be considered. This procedure has not been studied in a large number of pregnant women, and both when and how the procedure should be performed during pregnancy is controversial. (In other melanoma patients, this has become a routine procedure.)
Driscoll adds that patients with a history of melanoma should discuss any concerns regarding the timing of future pregnancies with their dermatologist.
HERE'S ONE MORE REASON TO TAKE FOLIC ACID
If you're a woman of child-bearing age, you've no doubt heard all the reminders about getting enough folic acid in your diet. Doctors advise women to make sure they get enough of this nutrient before they even become pregnant, as this can reduce the risk of spina bifida and related birth defects.
Now here's another reason to be vigilant about getting enough folic acid: a lower risk of serious heart defects in babies. Using government databases, researchers from Victoria Hospital in Montreal tracked serious heart defects among babies born in Quebec, Canada in the nine years before folic acid was added to grain products and in the seven years after.
They didn't find much variation in the annual rates of serious heart problems before folic acid was added, with around 1.64 babies in every 1,000 having these defects. In the years following, however, serious heart defects decreased, affecting around 1.47 babies in every 1,000.
Just one more reason to make sure you're getting enough of this important nutrient.
A NEW KIND OF BREAST SCREENING ON THE HORIZON
Molecular breast imaging (MBI), a new screening method for breast cancer, identifies tumors in dense tissue that often aren't visible with mammography.
In a recent issue of Mayo Clinic Women's HealthSource newsletter, Deborah Rhodes, M.D., a Mayo Clinic researcher who helped develop the technology, notes that X-ray imagery doesn't differentiate between tumors and dense breast tissue. On a mammogram, they both appear white. "With MBI, a tumor is easy to see, even if it's in dense breast tissue," she says.
With MBI, a woman is given an injection of a short-lived radioactive agent. This material accumulates in tumor cells more than it does in normal cells. Using a radiation-detecting camera, tumors show up as hot spots on the resulting image.
In a recent Mayo Clinic study comparing MBI with mammography, MBI detected three times as many cancers in women with dense breast tissue and an increased risk of breast cancer. Another advantage over mammography: MBI also demonstrated fewer false positives (when results appear abnormal but are non-cancerous).
For now, MBI use is limited to research. The focus is on reducing the dose of radiation needed to perform the imaging. The risk from the radiation dose of one or two MBI scans is extremely low. But to safely use MBI annually or every few years, the radiation dose needs to be reduced.
"Our goal is to have a dose that's no higher than that from a routine mammogram," says Rhodes. "If we get results that are similar to, or better than, our last study, we'll be well on our way to supporting MBI as an option for women with dense breast tissue."
Kathy Sena is a freelance journalist specializing in women's health issues. Her writing has appeared in Newsweek, USA Today, Woman's Day and many other publications. Visit her blog on our site.