My miracle came on a Monday two years ago, howling his lungs out.
I couldn’t see my husband’s tears as our newborn, Scott Michael, was placed on my chest. I could only feel the tight grip of his hand, just as I did in 1994 at this very hospital, Northwestern Memorial, where I was treated for breast cancer when our first son was a toddler.
New motherhood and cancer are rarely spoken about in the same breath, even though many women, like me, have a young child or children when they are diagnosed. Battling a life-threatening illness often meant abandoning any thought of one day giving life again.
But with advances in cancer detection and treatment, more young women are surviving cancer, and even under the shadow of possible recurrence of the disease, we are embracing life again.
For Catharine Bell, a melanoma survivor; Sally Sommer Flynn, a survivor of Hodgkin’s disease and soft-tissue cancer; and me, that included new babies.
As the healthy years pass since diagnosis–15 for Bell, 6 for Flynn and 7 1/2 for me–we begin to forget about the health notes in our medical charts that set us, and hundreds of survivors like us, apart from other new moms. But the memories rush back, the sting dulled by time, when we hear that someone else is grappling with the same fear: “I was just diagnosed, I have to go through chemo. If I get better, will I ever be able to have a child?”
Increasingly, depending on the type of cancer and the number of disease-free years since diagnosis, the answer is yes.
Today, the dream of motherhood is not only quietly nurtured by thousands of young cancer patients, but in a growing number of cases it is being cautiously encouraged. Fertility specialists work in tandem with oncologists before the first chemo or radiation treatment.
“It’s a huge issue right now,” says Dr. Mary Wood Molo, reproductive endocrinologist at Rush-Presbyterian-St. Luke’s Medical Center. “The [cancer] patients now say, ‘What about having kids?’ You can’t take away their dream.”
More than ever, there is reason for hope. The National Cancer Institute recently reported that the death rate for all types of cancer nationwide fell by 1 percent a year from 1992 to 1998. The institute estimates that 8.4 million Americans have a history of cancer and that many are considered cured.
“People are surviving cancer, and they are surviving longer,” says Dr. Marc Laufer, chief of gynecology at Children’s Hospital in Boston and a reproductive endocrinologist at Brigham and Women’s Hospital, who counsels some 200 cancer patients a year about their fertility. “We want to provide them with the best quality of life possible, and in many cases, that includes children.”
An estimated 7 percent of breast cancer survivors of childbearing age go on to have children. Experts don’t have a breakdown for other types of cancer, although some short-term studies based on doctor recollections suggest that up to 11 percent of women who had chemotherapy later become pregnant. A registry is expected to start as more “miracle moms” give birth.
The trend is buoyed by studies showing that pregnancy does not affect the likelihood of relapse for some cancers. A 1997 Danish study of breast cancer patients who went on to give birth even mentions a “healthy mother effect,” meaning that women who had a child after treatment did slightly better than women who did not.
In February 1994, I tucked future baby dreams away in a safe spot while I coped with my cancer diagnosis.
I was 32, with a 17-month-old child. In five years, I told myself, I would be 37, still young enough to possibly have another baby. Throughout four months of chemotherapy and five weeks of radiation after a lumpectomy, I quietly kept that hope alive. I wanted to be a healthy mom–and God willing, or was it too much to ask?–a new mom again.
The heightened awareness that cancer survivors can be mothers is evident among oncologists, obstetricians and fertility specialists.
A recent article in Fertility and Sterility, a medical journal, suggested that all female cancer patients, especially those under 30, be told about their fertility options. And informational pamphlets are now given out to young girls at Children’s Hospital in Boston, explaining how chemotherapy affects the ovaries and suggesting what questions they might want to ask their doctors about having babies some day.
Research is suggesting new ways to protect the ovaries from chemotherapy’s disruption of chemical signals that govern women’s monthly reproductive cycle, including a hormone-inhibiting drug that temporarily puts the ovaries in a dormant state.
Another fertility-saving measure is to bank mature eggs or fertilized embryos before chemotherapy begins. Wood Molo estimates that she has harvested eggs for 20 cancer patients and extracted and preserved ovarian tissue for four. She counsels about one cancer patient a month, and in her 12-year practice, roughly 30 have gone on to have babies.
In an experiment at New York Methodist Hospital in Brooklyn, doctors removed ovarian tissue from a cervical cancer patient and inserted it under the skin of her arm, where the tissue could establish a blood supply. The strips could later be reimplanted in the pelvis, or doctors could harvest eggs from the tissue under the arm.
Researchers are also studying how altering a gene in female mice allows them to produce mature eggs well into old age. The therapy could help cancer patients extend their fertility after chemotherapy and radiation.
Women who have survived many different types of cancer have gone on to give birth, according to Laufer and Wood Molo. During a consultation, the doctors screen patients, explaining to those who have tumors that “feed” on hormones that fertility treatments and pregnancy might worsen their chances of recovery.
“I’ll tell them, ‘With your cancer, I would be uncomfortable’ ” recommending fertility treatment, said Wood Molo. “If I think that delaying the onset of chemotherapy [for egg harvesting] would not be advisable for her type of cancer, I will tell her.”
She will also encourage cancer patients to pursue other avenues of having a family, such as adoption. “It’s not just about ovarian preservation,” Wood Molo said. “It’s the emotional preservation. My definition of a happy ending is having the number of children they want.”
Wood Molo bristles at the thought that cancer survivors should be discouraged from having or adopting children.
“In my mind, I could go out tomorrow and get hit by a bus. You don’t know from one month to the next what’s going to happen,” said the doctor, who is the mother of four. “If you have in your heart the capacity and desire to have children, you should be able to try. Children are magic, and everything in life is a risk.”
Youth can be a double-edged sword in cancer. Young people have vigorous immune systems that can withstand tough cancer treatments, and they usually have no other health problems to complicate matters. But cancer can be more aggressive in younger patients, and their disease is often discovered in its later, less treatable stages. Both patients and doctors might attribute the warning signs in young people to other, more benign ailments.
I am a born worrier, so I ignored the advice of my former gynecologist not to worry about the breast lump I found when Matt was a toddler.
It was probably a blocked lymph node from breast-feeding, he said, suggesting I try putting warm water on it.
But I had stopped nursing 9 months earlier, and I know now that my health history should have raised a red flag. Although I had no family history of breast cancer, I had spinal X-rays as an adolescent, which some studies suggest carries an increased risk of the disease.
Despite his reassurances, the worry quickly returned as I tried in vain to flatten the lump out. It was near my armpit, and I could palpate it so that it seemed flat, but when I took my hand away, the lump would spring right back.
Three months after my gynecologist visit, and at the urging of my husband and sister Maureen, I finally went to a surgeon for “peace of mind.”
This doctor scared me into reality as soon as he felt the mass.
“Mrs. Stevens, if you were my daughter, I would have this removed immediately,” he said.
“Let’s get it out then,” I told him. “It doesn’t belong there.”
The very words, “You have cancer,” propel patients into a decision-making tunnel that leaves little room for visions of pink and blue. We don’t know where the tunnel leads, at least not right away.
Fear of the unknown, and a warning from her diagnosing doctors never to become pregnant, kept 40-year-old Catharine Bell from even broaching the subject with her oncologist for more than a decade.
She was a young law student named Catharine Kleiman in late 1985 when she went to a dermatologist for what she thought would be a routine mole removal. “My mother didn’t like the way something looked on my lower left leg, near my shin,” she says. Her mom, Tribune columnist Carol Kleiman, nagged her daughter for nearly a year to get the mole removed.
“To humor her–for no other reason than to humor my mother–I came home during Christmas vacation to have it taken off.”
One week later, when she returned to get her two stitches removed, “Everything came down.”
The doctor hadn’t looked at her chart before entering the room, and Cathy watched in horror as he silently read the pathology report. “A shadow passed over him,” she remembers. “He said, ‘I have bad news for you.’ “
A few days later, I was in an anesthetic haze on a gurney at Palos Community Hospital, where the doctor removed a tumor about 1 inch across.
“Mrs. Stevens, I’m sorry. It was cancer. You have cancer,” he said.
Was this really happening to me? I never smoked, I ate turkey and broccoli, and I exercised. I hadn’t even told our parents that I was having a surgical biopsy. I was that certain it would be OK.
It wasn’t until I saw my husband’s face, right next to the doctor’s, that I understood nothing was OK anymore. The smile he wore to reassure me was trembling.
At the age of 24, Cathy Kleiman listened in disbelief as the doctor told her the mole was malignant melanoma, one of the most swift and deadly cancers, and that there was more malignant tissue that had to be removed. “He was scared for me,” she says. “I could see it in his eyes.
“I drove home by myself, totally shook up.” Her mind was reeling from what she had been told: two-year mortality, more surgery as soon as possible. Yet, she says, “I felt too good to fall into their fear. Some people might call it denial.”
Cathy had the second surgery, and doctors removed a tumor the size of a golf ball. Even before the second surgery, the doctors were predicting that she would probably need a leg amputated from the knee down.
“I accepted the seriousness, but I didn’t believe half the predictions coming out of their mouths,” she remembers. “I felt fine.”
Soon, the dire predictions tapered off dramatically. When doctors studied the removed tissue, they found benign tissue. “They were shocked that the tumor appeared to be in regression, meaning it had been bigger at one time, but was shrinking,” she says.
In other words, it was likely that her immune system had recognized the tumor as cancer and was killing it off. “They told me that the tumor behaved in an opposite way of everything they understood about the disease,” she says. “It was extremely rare, but my body kept it at bay.”
Doctors were so astonished that she was asked to be part of a UCLA research project headed by Norman Cousins, who had written a best-selling book about how laughter helped him heal from a heart operation.
Her diagnosis helped refocus her priorities. She left law school to pursue a journalism career. She was closely followed, but after about five years, she could tell that her doctors had begun to relax about her prognosis. She never asked them about her other physicians’ earlier orders never to get pregnant. “They told me it could cause [the cancer] to come back,” she says. “It could reoccur during the pregnancy.”
She plunged into her new career and fell in love with Kevin Bell, now director of Lincoln Park Zoo. They married in 1991 and settled in a spacious Chicago brownstone with Casey, their golden retriever.
Life was complete–she even started her first book project, a three-volume world encyclopedia of zoos–but something nagged at her. She yearned to have a child.
The doctors’ old warnings echoed, so the Bells started looking into adoption. “But that biological clock I heard ticking was louder than their words,” says Bell. “That’s what gave me the inclination to look into it after more than 10 years.”
She began to ask her doctors pointed questions. What was the data on melanoma and pregnancy? What were her chances of recurrence now? How risky would this be?
“I didn’t hit a wall with them,” she says. “They were cautiously encouraging.”
Bell describes her pregnancy as “the happiest and healthiest time in my life.” Joseph Carroll Bell was born last December.
“Now that we have Joey I could never have imagined what I might have missed out on,” she says. “I literally went from being told my life was being taken away, to it’s not only not being taken away, I have new life in my arms. I have a new life as a mother.”
My husband, Mike, and I clung to each other in the weeks after my diagnosis, researching the disease, invasive ductal carcinoma, a common form of breast cancer that starts in the milk ducts.
We chose our medical team, deciding on Northwestern Memorial Hospital because of the reputation of my doctors, surgeon Monica Morrow, oncologist William Gradishar and radiation oncologist Krystyna Kiel.
Then, finally, some hopeful news. After a lumpectomy, we learned that the disease had not spread to my lymph nodes. Morrow removed 28 nodes, and each one was clean. But because of the tumor’s size, it was possible that some cells had escaped and might settle and grow in a vital organ. Gradishar recommended chemotherapy in addition to radiation, which was overseen by Kiel, after my lumpectomy.
Although even a short course of chemotherapy can throw women into premature menopause, patients under 35 usually have enough “ovarian reserve,” or viable eggs, to maintain or restart their monthly cycles. The younger the patient, the more likely her fertility will return without medical intervention, as was the case for me.
For Sally Sommer Flynn, even three bouts with cancer that required months of chemotherapy and radiation could not deter her from pursuing motherhood with a passion.
Her first life-threatening battle began in 1975, when she found a lump in her neck that later turned out to be Hodgkin’s disease. She was only 20 years old, a nursing student at DePauw University in Indiana.
“I was so young and only stage 2A,” Flynn says as she sits in her gracious Northfield home. “They gave me a 90 percent chance of recovery. I thought, this is like a blip in the system.”
She had her spleen removed and received radiation to her neck and chest area to ensure that no other cancer cells were lurking. Her doctor had the foresight to protect her fertility by pinning her ovaries in a more protective spot, away from the radiation, a procedure even more common today.
Sally had been dating Kevin M. Flynn, a philosophy and pre-law student. They married two years after her diagnosis and moved to Lincoln Park. The couple knew they wanted children some day, but didn’t feel rushed. Kevin started a law practice while Sally got a master’s degree and settled into a career in health-care management.
She was 32, and thinking about starting their family, when she faced another health crisis in 1987. She was having trouble swallowing, and doctors removed a rare form of cancer, leiomyosarcoma, which attacks soft tissue in the body. She would need heavy does of chemotherapy, in addition to surgery on her esophagus and stomach.
“They blasted me for 10 months,” she says. “I was very angry that I had to go through this again, but I still felt determined that I was going to be healthy again. I still wanted to have a child. I knew I could do it.”
My body reacted strongly to four doses of a combination chemotherapy, Cytoxan and Adriamycin. I would lose my hair and get hospitalized for an infection I got after my white blood cell count bottomed out.
I took a leave from my job, and concentrated on my health and family. Often, I would pray. When I felt stronger, I would try to spend even more time with my son to make up for my frequent doctor and hospital trips.
He had a favorite book, an illustrated alphabet that showed silly cartoons with each letter.
One page featured a walrus with bright red hair, in a Cleopatra style, similar to the auburn wig I had picked out with my sisters.
“W” is for walrus, I read.
“And Mommy’s wig,” said my early-talking Matt, smiling up at me while he pointed earnestly at the page. I knew he understood that I was different from other moms, but I was grateful that he was too young to really understand what his dad and I were fighting.
Shortly after Sally Flynn finished her grueling chemotherapy treatments, she pestered her oncologist about her chances for having a baby. “He said, ‘You can try if you wait two years,’ ” Flynn recalls. “The doctor was just amazed that after all that chemotherapy, my periods came back.”
She took it as a sign that her body could give life again, but she knew it would not be easy. After waiting the two years, she went to see Mary Wood Molo, the Rush fertility specialist. “She believed in me,” says Flynn, who was then 35.
She underwent three in-vitro fertilizations but did not become pregnant. On the fourth try, she became pregnant but miscarried shortly afterward.
She and Kevin began the adoption process, and were delighted when a birth mother picked them out of 25 possible families. Even as the process was being completed, Flynn’s father urged her to try in-vitro one more time, offering to pay for the expensive procedure.
“I couldn’t believe it, but it worked,” she says.
Flynn was three months pregnant when her adopted daughter, Gen, was born in May 1992. Gen’s sister, Katherine, arrived six months later, just two weeks after the family had moved to Northfield.
“Here were these two beautiful babies,” Flynn said, looking at pictures. “We worked hard for that gift, to be parents, and God certainly blessed us. I thought, finally, now it’s going to be OK.”
But less than two years later, she got another blow, this one with knockout potential. The leiomyosarcoma had spread to her liver, seven years after her original diagnosis. “The doctors gave me a 30 percent chance of living one year. . . . I was disgusted and scared,” she says, her voice wavering slightly. “Who was going to take care of my babies?”
She shows pictures of that difficult time. Gen, 2, and Katherine, 1 1/2, are dressed in matching floral dresses, and Sally in a floral hat that barely covers her baldness. Chubby baby photos, Gen dressed as a clown for Halloween, with Katherine a brown, smudged-cheeked lion. Their mother appears fragile next to their on-camera exuberance.
While her sister-in-law cared for the girls, Flynn plunged back into chemotherapy, staying in the hospital for nearly a week each time she had a treatment.
“The girls knew I wasn’t feeling good,” she says. “They have seen the pictures of me bald and they get very scared.”
To the amazement of doctors, and even Flynn, the chemo put the cancer into remission. There were no signs of tumors in the liver, and she has been cancer free since ending treatment in 1995.
Now 46, she has worked hard on staying strong, concentrating on her physical and spiritual health. She has an easy rapport with her daughters, now 8 and 9. They show a visitor the things they love to do with their mother: drawing, tennis, reading. Katherine loves art and Irish dancing, while Gen has a passion for animals.
“Every day is a blessing,” Flynn says.
Kevin Flynn said he never questioned his wife’s desire to have children, and he believes the girls helped her beat the odds against recovery.
“There’s no real medical reason she made it,” he said. “I really think that she willed herself to live, but she would not have willed herself to live without those two kids. I think that’s what happened. A second miracle had to occur to allow the first miracle to continue.”
They say that when cancer treatment is over, worries about recurrence intensify. I was no different, but I felt safer knowing that my doctors and I were more vigilant. As the years passed, checkups dwindled down to every six months, then finally, each year. As my five-year mark approached, I began to ask about pregnancy and the risk of it causing my cancer to return.
No one could give me guarantees, and waiting for permission was pointless. “We can’t promise you,” they said, “but we expect that you will continue to do well.” If I waited any longer than my late 30s, the door to having a child might be closed.
I found out that I was pregnant on Christmas morning, 1998.
My medical checkups now included my new Chicago obstetrician, Julie Barton, who would stay in touch with my other doctors if problems cropped up. But the pregnancy, my oncology checkups and Scott’s birth were smooth.
As he held our newborn, my husband’s smile was unwavering. We were a new family now.
It is bedtime for my two boys, and I put my toddler, Scott, on my lap while his brother and I read Matt’s old favorite, the illustrated alphabet book.
“W” is for walrus wearing a wig, I read.
“We used to say Mommy’s wig,” Matt informs Scott, who is already groping for his favorite book, “Toy Story.”
I look at my sons, and I know that I will never take for granted that “M” stands for miracles.
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For more information about having a child after cancer, or to find a physician specializing in preserving fertility during cancer treatment, here is a partial list of resources.
– Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60156; CAN-HELP, Loyola’s cancer information service, 708-226-4357; www.luhs.org.
– Northwestern Memorial Hospital, 251 E. Huron St., Chicago, IL 60611; Lynn Sage Comprehensive Breast Center, 312-926-5522; www.nmh.org. The center can refer callers with any type of cancer.
– Rush-Presbyterian-St. Luke’s Medical Center, Cancer Institute, 1725 W. Harrison St., Chicago, IL 60612; physician referral, 312-942-5555; general information, 312-653-2190; www.rush.edu.
– University of Chicago Hospitals, Department of Reproductive Endocrinology, 5841 S. Maryland Ave., Chicago, IL 60637; 773-834-3849; Women’s Breast Center, 773-834-7032; Department of Hematology/Oncology, 773-702-4400; www.uchospitals.edu.
– Y-Me National Breast Cancer Organization, provides peer counseling, support and information, 203 N. Wabash Ave., Suite 500, Chicago, IL 60601; 800-221-2141; www.y-me.org.
– The Boston Children’s Hospital pamphlet for teens is available online at www.youngwomenshealth.org.
