Opinion: Cancer patients are often pressured to end a pregnancy early. They shouldn’t be

Nov. 2, 2026 Cardonick is a maternal fetal medicine physician and founder of the Cancer and Pregnancy Registry. Early in my career as a maternal fetal medicine specialist, I met two pregnant women who had ovarian cancer. One of them was expecting twins. They were introduced to be each other’s support network during and after the pregnancy, often meeting for coffee with their newborns and comparing wigs after hair loss from the chemotherapy they received. The mother of twins is still alive today. The other didn’t survive beyond her child’s second birthday. When I spoke with the one who is still alive, she was distraught that her new friend died of her disease. “Why did she die and I am still alive?” she asked. I didn’t know how to answer her out loud, but in my head, I thought: “Your doctor went to the library and researched managing ovarian cancer during pregnancy, and her doctor didn’t.” The woman who lived was treated as if she were not pregnant. Without delay, she underwent a CT scan and workup of her ovarian cyst, and even received chemotherapy while pregnant. Her twins are now 28 years old, and all are thriving. For the woman who died, treatment was electively delayed until her third trimester. I do not know if removing her mass or giving chemotherapy earlier in pregnancy would have made a difference in her case, but I can’t help wondering. Patients diagnosed with cancer are often advised to terminate their pregnancies without discussing the very real option of treating cancer during pregnancy. Other women diagnosed in their second or early third trimesters, after the fetal organs have developed, are advised to have an elective preterm birth. But much of the time, chemotherapy can be safely administered during pregnancy and the infant delivered at term. Compounding the problem, cancer is diagnosed significantly later in pregnant women. This is partly due to common symptoms between certain types of cancer and pregnancy, but also because physicians (and patients) are reluctant to perform imaging during pregnancy, which delays biopsies and management. Why are doctors not offering cancer treatment to their pregnant patients? Is it fear of litigation, as obstetrics is one of the most litigated of all medical specialties? Lack of medical investigation? Or just paternalistic advice? I recall a patient diagnosed with Hodgkin lymphoma in pregnancy. When I discussed starting chemotherapy in the second trimester, another physician told me: “She already had two kids. She should terminate.” People often assume that ending a pregnancy, whether through termination or early delivery, improves the mother’s outcome. But that is not the case. When compared with non-pregnant women with the same cancer, pregnant women have similar survival rates. No study has shown an improvement in a woman’s survival if she terminates her pregnancy compared to if she continues. When I observed during my fellowship that oncologists and obstetricians very infrequently faced a pregnant woman with cancer, I realized the medical community needed a way to pool all of the scattered cases into a central database to track these pregnancies and follow the outcomes for women and their babies. Six hundred and fifty cases later, I am still asking the same questions I asked when I encountered that very first pregnant cancer patient: How would the cancer be treated if the patient were not pregnant? How long can we safely delay this treatment without compromising her prognosis? Has this treatment been tried during other pregnancies? If so, what were the outcomes for mother and child? Understandably, giving chemotherapy to a woman during pregnancy sounds dangerous, but the longitudinal research closely examining children exposed to chemotherapy backs up this approach. Children exposed to chemotherapy perform as well on standardized tests for development as unexposed children. This has been repeated at ages 18 months to 3 years, 6 years, 9 years, and 12-15 years of age. We did find that children exposed to chemotherapy are three times more likely to need eyeglasses. And guess which children didn’t do as well? The ones electively delivered preterm to avoid maternal cancer treatment. No options in such cases are without risk: an elective preterm birth to avoid cancer treatment, delaying cancer treatment until after delivery, or starting chemotherapy during pregnancy so the fetus can develop longer in utero and reach term. As any treatment in medicine, it is a balance between risks and benefits. I understand many physicians are afraid to do something wrong when it comes to a pregnant woman. But denying cancer therapy by withholding or underdosing chemotherapy doesn’t serve her well, either. You can do everything to protect the fetus during the remainder of the pregnancy and forget that if their mother dies too young, due to delayed diagnosis or treatment, the child will still be affected. What is best for the mother/baby unit as a whole is a healthy mother. I’ve worked with the Society of Maternal Fetal Medicine and the American Society of Clinical Oncology to publish guidelines to help other physicians handle this medical dilemma. These guidelines address avoiding delays in pregnant women and discuss the safety to perform MRIs without contrast and CT scans with contrast. They also discuss performing necessary surgeries at any gestational age in pregnancy when this would be the clinical solution if the patient were not pregnant. And they lay out how to give chemotherapy during the second and third trimesters and time treatment for safe delivery for mother and child. I am honored to have participated in the development of these guidelines to increase the chances that when cancer and pregnancy collide, saving both lives will be considered. Elyce Cardonick is a maternal fetal medicine physician and founder of the Cancer and Pregnancy Registry. She has spent nearly three decades caring for women diagnosed with cancer during pregnancy and advocating for mothers and their babies.