A funny thing happened yesterday with the Mass and Fast for Ireland facebook page: http://www.facebook.com/irishunborn. Facebook rejected boosting the posts/ blogs for day 41 and 42 on Professor Frédéric Amant’s articles / expert evidence at the International Symposium on Maternal Health. No apparent explanation was given other than something called ‘mixed values’. After much time spent trying to discover what the problem was, all that appeared to emerge as being problematic in the wee small hours was that the titles were too similar (assuming that was the reason why….). So, we’ve re posted it with a different title as we think it’s critical to the debate at present in light of arguments that women die because of the 8th amendment.
The kids are o.k.: Day 42 of our countdown campaign citing a 2015 article by Professor Frédéric Amant, focused mostly on outcomes in children of women who went ahead with pregnancies, despite being diagnosed with cancer and treated for it while pregnant. It was reassuring in that it showed there was no evidence of ill-effects in the areas of the children’s general health or mental development, cardiac problems in those exposed to chemotherapy in the womb.
No advantage to terminating pregnancy in women with cancer:
it’s official: Day 41’s (and repeated today for the above reasons) article is from the prestigious medical journal: ‘The Lancet‘ on Professor Amant’s major impact on this area of research and on how there is no advantage to terminating a pregnancy in a woman being treated for cancer in terms of outcome / prognosis . The video is from the end of a talk he gave in Dublin at the International Symposium on Maternal Health 2012, where he again articulates that women can be treated as successfully for cancer while pregnant as not pregnant and termination is no advantage.
Abortions that do happen in pregnant women with cancer are not medically necessary or indicated by doctors:
Even in the following article where he refers to individual cases where a mother ends up having an abortion because the father does not feel he could cope with a newborn alone, this is not a decision directed by the medical profession but a decision made by the couple. “In other cases, the parents may decide to terminate the pregnancy because the father cannot go on alone.”
Of interest in the current debate in Ireland on the 8th amendment , the article states: “In other advanced cases, the dying mother is kept alive, for example with a brain tumour in a coma—to enable the baby to be born to term”, says Amant.” One of the cases cited by the Irish pro-abortion movement, is the 2014 case of a brain dead pregnant woman who was kept alive on a ventilator before it was shut off following a high court decision. Obviously it may have been the case with Professor Amant, that the next of kin actively wished for the continuation of intensive care treatment despite brain-death compared with the Irish case and whereas the Irish patient was just 18 weeks pregnant, the above may have been a later pregnancy, we don’t know.
In other words, whereas Saturday’s article was focused on how children of women who go to term having been treated for cancer in pregnancy, have shown no ill effects to date, this article, shows that the women themselves are no worse off for having cancer treatment while pregnant and that termination of pregnancy / abortion does not improve outlook / prognosis.
http://www.thelancet.com Vol 379 February 11, 2012 511
“Usually obstetricians and oncologists don’t spend much time together”, Frédéric Amant told The Lancet. “And this meant a certain group of women were not getting the care they needed: pregnant women with cancer.” Providing the right care for these women is a key focus of Amant’s work as Professor in the Department of Obstetrics and Gynaecology at the Catholic University of Leuven, Belgium.
For Amant, an early experience of caring for a pregnant woman with cervical cancer was pivotal in shaping the course of his career: “She told me her early diagnosis was thanks to the pregnancy. So she wanted to give her baby the chance he had given her.” Amant’s patients are a major influence on his work, but his first interest in medicine came much earlier during his childhood on his family’s farm near Leuven, Belgium. Two of his uncles were training to be doctors as he grew up, “so I found myself buried in advanced medical texts well ahead of my years. I can’t really remember wanting to be anything other than a doctor”, he says.
Although he retains an interest in nature that reflects his rural upbringing—heis a co-founder of a non-profit organisation that promotes forestation in Belgium—Amant followed his uncles into the profession and completed his medical degree at theCatholic University of Leuven. After training in obstetrics, gynaecology, and surgery, he specialised in gynaecological oncology. It’s a specialty that he finds continually motivating because of “the challenges of complex surgery for a life-threatening disease, combined with personal contact with patients and research opportunities”.
Amant is a lead author of The Lancet’s Series on malignancy in pregnancy. About one or two per 2000 pregnancies are complicated by cancer, with the most common being breast cancer (40%) and blood cancers (20%). Amant, who is Chair of the European Society of Gynaecological Oncology’s task force on cancer in pregnancy, says that “this simply reflects the normal range of cancers in women of reproductive age, and there is nothing to suggest the pregnancy causes the cancers”. The biggest challenge is educating the public that chemotherapy is possible in pregnancy without harm to the baby.
“Women find it hard to believe they shouldn’t have an aspirin, but can take these very strong chemotherapy drugs during pregnancy”, Amant says. “At first, we did not have much evidence regarding the unborn children. But now more than 120 children have been born to women treated with chemotherapy in our ongoing international
collaborative study, and they are doing as well as the general population, so that offers reassurance.” Most of the babies who didn’t do so well were born preterm after being induced early, rather than as a result of exposure to the drugs.
“Fear of chemotherapy should not be a reason to terminate pregnancy”, Amant says, adding that “there is no evidence termination improves outcomes for the mother”. And while it’s true that radiotherapy poses more of a danger during pregnancy, especially later in the gestation, Amant says that “in most cases, especially breast cancer, women are started on chemotherapy (as they would be if not pregnant) and can then be treated with radiotherapy postpartum if necessary”. The key messages Amant wants to come from the Series, and a related paper in Lancet Oncology, are “that it’s rarely necessary to change the standard chemotherapy treatment regimen for pregnant women with cancer, and that chemotherapy does not harm the unborn child”. He adds that “Staging scans shouldbe limited to avoid overexposing the fetus to radiation, and radiotherapy of upper body parts with fetal shielding is possible during first and second trimester only.”
Day to day, Amant’s working life is an emotional roller coaster. While in most cases, mother and baby can be helped through this difficult time, there are always heartbreaking tales. As the father of four children himself, Amant recognises how painful these decisions can be for expectant parents. “Sometimes, a mother-to-be’s cancer is so far advanced it kills her and her unborn child before anything can be done. In other advanced cases, the dying mother is kept alive, for example with a brain tumour in a coma—to enable the baby to be born to term”, says Amant.
“In other cases, the parents may decide to terminate the pregnancy because the father cannot go on alone. It is impossible to imagine how difficult such a decision would be”, acknowledges Amant. Alongside this clinical work, Amant has a strong research record. While still a registrar, his 1999 publication in the British Journal of Obstetrics and Gynaecology of a randomised trial of misoprostol for the prevention of post-partum haemorrhage lay the foundation for larger scale trials.
As well as driving forward the agenda on cancer in pregnancy, he is an expert on uterine cancer. “It is Frédéric’s ability to respectfully balance strong personalities as Principal Investigator in groundbreaking projects, as well as his generous contributions in
other collaborative studies, that make him to a true leader”, says Helga B Salvesen, from the University of Bergen, Norway, who co-founded the European Network for Individualized Treatment in Endometrial Cancer with Amant. Eric de Jonge,
from the Department of Obstetrics and Gynaecology at Ziekenhuis Oost-Limburg, Belgium, agrees. “Frédéric’s vision, work ethic, and his ability to establish durable contacts based on mutual professional respect have enabled him to build a remarkable research network. Supported by unconditional cooperation from his peers he drives ‘his’ pioneering project: cancer and pregnancy.”
Frédéric Amant: leading the agenda on cancer in pregnancy
See Series pages 558,
570, and 580
See Lancet Oncol Online/Articles
For the University Hospitals
Leuven site on cancer in
pregnancy see http://www.
For European Society of
Gynaecological Oncology’s task
force on cancer in pregnancy