You are addressing an extremely important issue, one of pregnancy in cancer: what you do about the pregnancy, what you do about the treatment of the patient, for instance. First of all, you’ve done a couple of studies, one on what happens to the foetus when the mother had chemotherapy and also radiotherapy. Give me the data on those trials please.

We have two trials that we provided interim data. The first is on the antenatal exposure to chemotherapy where we have a case controlled study where we compared 38 children who were antenatally exposed to chemotherapy with 38 children from the normal population. The age was between 18 months and 42 months and it appears that actually the outcome, the mental developmental index is actually the same for study children and controls. We did see that the number of chemotherapy cycles did not influence the outcome but we did see that antenatal birth resulted in a worse outcome, both in the group exposed to chemotherapy and in the controls. So from that study it appears that premature birth is a problem but chemotherapy is not a problem during pregnancy.

So if the mother has chemotherapy while she has the baby in utero it is not a hazard to the baby.

There is no hazard as far as we have the data on these 38 children. You cannot differentiate a child who has been exposed to chemotherapy from another child.

Now you’ve got another study on the use of radiotherapy, what happened there?

It’s a similar study, all the children have basically had the same examinations done but the children were also older so we had 16 children with a median age of 6 years and we have 10 adults of a median age of 33 years. We have looked into their attention, to their behaviour and to their general health and we see that antenatal exposure to radiotherapy does not impair their outcome.

Now what, then, is the clinical bottom line to this issue of pre-birth exposure to radiation or chemotherapy?

The clinical message for chemotherapy is that after the first trimester of pregnancy, chemotherapy can be administered to pregnant women and will result in less terminations, adequate maternal treatment and avoidance of prematurity. For radiotherapy it is the reverse, radiotherapy when the pregnancy is far advanced then the developing foetus comes closer, too close to the radiation field, so in the third trimester radiotherapy is not possible but radiotherapy is possible of upper parts of the body during the first and the second trimesters of pregnancy.

Now, you’re also building up expertise in a different area and that is on pregnancy and the use of sentinel node biopsy. Because this has been avoided in pregnancy, hasn’t it, but you’re now challenging this.

We are challenging this. We are not only focused on foetal safety but we also look into maternal safety, how safe is a standard procedure which is standard in non-pregnant women, how safe is this in pregnant women. There we show in 97 women who are pregnant with breast cancer during pregnancy in whom a sentinel lymph node has been done, we only saw one recurrence, that was a recurrence in axilla. So we believe that this procedure which is standard in the non-pregnant population can also be used from a maternal perspective in pregnant women.

So, despite the present guidelines, you’re reassuring that these women who are pregnant don’t have to have axillary dissection necessarily.

Definitely. We can use the same criteria as in non-pregnant to decide whether or not to do a full axillary dissection.

You’ve also done research on avoiding pregnancy during cancer treatment and remarkably I heard from your talk here at ESMO that there has been a small incidence of pregnancy in patients being treated. What are your findings?

We saw that in cancer patients who are young that 3% of our population, that was 29 women, became pregnant where pregnancy was not on purpose. So despite chemotherapy, hormone treatment, Herceptin or radiotherapy, there was an unplanned pregnancy. And the main message for clinicians is that in young women when they get cancer treatment that contraception should be discussed and if it’s not discussed by the medical oncologist he should refer the patient to a gynae or to a general practitioner.

And finally could I ask you about your work in cervical cancer, the prognosis for mothers? What have you been doing there?

In the framework of the International Network on Cancer, Infertility and Pregnancy we have a registry and there looked into cervical cancer cases that have been diagnosed and treated during pregnancy. There we have done a case controlled study with cancer patients who were not pregnant and it appears that the prognosis of cervical cancer during pregnancy is comparable to the prognosis in non-pregnant women. So even in cervical cancer, which is the most difficult situation to handle because the pregnant organ itself is involved, cancer treatment during pregnancy is possible without comprising the maternal prognosis.

Up to now doctors have been very cautious about the whole issue of pregnancy and cancer treatment. What are the simple statements that you might like to make at this point, you’ve got quite a lot of data in, you’d like to get more, but how would you wrap it up at this point?

That despite the fact that it is a complex situation, that we should not panic, we should take time for a second opinion, time to go to a centre where people have sufficient expertise to handle this and to appropriately stage the patient and treat the patient in an inter-disciplinary setting where surgery, chemotherapy and radiotherapy can be considered. So we do believe that we can come very close to standard treatment, what we use in non-pregnant women, that we can also use this in pregnant women.

But there is quite a lot of reassurance here. What’s your bottom line message?

That also pregnant cancer patients deserve treatment which is as good as possible and as close as possible to non-pregnant women.