lois anti-avortement santé femmes cancer

Anti-abortion laws endanger the lives of pregnant women with cancer

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On June 24, the US Supreme Court flatly nullified nationwide protections of the constitutional right to abortion, which had existed since 1973. Being diagnosed with pregnancy-associated cancer is one of the reasons that might encourage abortion. But the restrictions associated with abortion could put hundreds of women who will be affected by the disease at risk: they could be forced to refuse oncological treatment that is contraindicated for the fetus – and thereby give it a chance of surviving theirs.

Since June 24, every American state has been free to introduce the abortion law that suits it. More than twenty of them have already banned (or are planning to ban) this act or restricted the right to abortion – in particular by shortening the period for claiming the procedure. Many of these states do not tolerate exceptions, including cases of rape, incest, or for health reasons. This last point is the subject of a new study published in the journal JAMA oncology.

It turns out that about one in 1000 pregnancies is affected by a simultaneous diagnosis of cancer. The nursing staff must therefore do everything possible to ensure the safety of the mother and the fetus. Abortion occurs in 9 to 28% of cases, mostly during the first trimester. In some cancers, pregnancy hormones can accelerate the progression of the disease, even though the mother is curable; in this case, there is an urgent need to act and terminate the pregnancy, even if the fetus is not viable. What happens to women in this situation who can no longer take advantage of this opportunity?

More and more cancers

The study’s authors point out that 41% of births in the United States in 2020 occurred in the 26 states that ban or are likely to ban abortion. They estimate that nearly 1,500 women will be diagnosed with pregnancy-related cancer in the same states over the next year. Breast cancer, cervical cancer, lymphoma, ovarian cancer, leukemia, colon cancer and melanoma are the most common. Its incidence is expected to increase as the age at which women decide to have a child continues to rise.

Restrictions on termination of pregnancy will mainly affect cases where oncological treatment is urgently needed but contraindicated during pregnancy when the fetus is not yet viable Sums up Katherine Van Loon, associate professor of clinical medicine at the University of California, San Francisco, director of the UCSF cancer program and lead author of the study.

There are four main factors involved in this difficult decision-making process: the mother’s diagnosis, stage and prognosis; the gestational age of the embryo or fetus; the recommended treatment plan; mother’s values ​​and beliefs.

A fetus is considered “medically viable” from a gestational age of at least 24 weeks and “extremely premature” up to 28 weeks – in both cases the risk of death is high. Therefore, in the event that cancer treatment cannot be safely administered to the unborn child, the medical team must assess the risk-benefit balance of the treatment: in other words, compare the risks of delivering the fetus prematurely with the risks of delaying cancer treatment for the mother.

Hundreds of women’s lives are at stake

The reflection is all the more difficult given the limited safety data on the effects of cancer therapies on the fetus. Chemotherapy should be avoided during the first trimester, but multiple products can usually be safely administered during the second and third trimesters. The operation should be performed by pregnancy specialists. Radiation therapy can be done if the target does not involve the pelvis and additional shielding is applied.

In any case, the Supreme Court’s recent ruling will have a significant impact on oncologists’ ability to provide optimal care in these complex cases. Based on the incidence of pregnancy-related cancer and estimated abortion rates, between 135 and 420 women will find themselves in a life-threatening situation in the coming year, according to the two study authors.

Similarly, oncologists working in states that restrict access to abortion find themselves in delicate situations caught between their duty to save their patients’ lives and the strict legal requirements for abortion defined by those states , are trapped. ” When a woman needs cancer therapy to save her own life, doctors should not be criminalized for choosing to provide her with the best possible care. said van Loon.

One of the Supreme Court Justices, Brett Kavanaugh — a staunch opponent of abortion — cited the constitutional right to travel between states as a way to access abortion in another state, but Van Loon and his co-author fear that provision will be debated Length. At best, only the wealthiest women will be able to afford the trip, further exacerbating social divisions.

Source: J. Silverstein et al., JAMA Oncology

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