Giving new life

When breast cancer & pregnancy collide: New study shows that cancer's childrencan thrive

Dr. Jennifer Litton
Photo by John Everett

A cancer diagnosis is confusing and scary under the best circumstances. But when pregnancy enters the mix, everything changes — well, sort of.

According to Dr. Jennifer Litton, associate professor at the Department of Breast Medical Oncology at The University of Texas M.D. Anderson Cancer Center, negotiating pregnancy and cancer just wasn't done when she started in the field 20 years ago.

"I was a medical student in my third year in obstetrics and we had to do a project. I was interested in breast cancer, so I asked the medical school director what we do when a pregnant woman gets cancer. And the answer was that we terminated the pregnancy," Litton says. "I came to Houston to M.D. Anderson and studied under Dr. Richard Theriault, who has championed changing that for over 20 years."

According to Litton, as recently as five years ago it was recommended that pregnant women who were diagnosed with breast cancer terminate their pregnancy, but recent research has given women more options to save their life without sacrificing their child.

"Those who are pregnant are often young and because of pregnancy-related changes in breasts they are generally diagnosed later. They also thought the hormones from the pregnancy were feeding cancer and making it worse," Litton says. "But now we have data from M.D. Anderson, from clinical trials, that chemotherapy is safe for them and works just as well if you're pregnant.

"Those who begin treatment in their second or third trimester do as well or better than other patients. They actually do better with the chemo, with less nausea."

Litton presented the first-ever long-ranging study chronicling the health of children born while their mothers received chemotherapy at the American Society of Clinical Oncology annual meeting in Chicago earlier this month.

The study followed 81 children born over a 21-year period and found "no significant trend in increased medical problems" from birth to puberty.

Still, Litton says women are understandably concerned when doctors bring up chemo.

"Imagine all the stuff you're told — not to eat soft cheese, not to eat some different deli meats, all these different things — and now we tell them they're about to get chemo. Imagine getting past that shock." she says.

Litton says that though some chemotherapies are safe, pregnancy does alter the course of treatment.

"We always wait until after the first trimester because the risk of birth defects is very high," she says. "With other cancers like leukemia you have to start immediately because if you wait the woman might not live long enough to give birth. In that situation there's about a 15-20 percent chance of birth defects.

"For breast cancer, you work up to the second trimester and start chemo. For some types of chemotherapies we wait until after delivery, and some other therapies — trastuzumab and lapatinib — have to wait until after delivery."

The biggest factor that inspires Litton is just how quickly her field is changing.

"For breast cancer in general, things are changing rapidly," she says. "The technology we have in identifying individual tumors has changed drastically in the past five years. There's a shift in the old way of thinking — instead of trying chemo and seeing what happens, big cancer centers are focusing on therapies, using biopsies to find molecular weaknesses to treat cancer without only using chemo.

"I'm excited about M.D. Anderson's capability — we have a whole institute of personalized cancer therapies, an umbrella of all of different tumor types and we can take advantage of things certain tumors have in common."

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A Bange-up good job

Pink Ribbon Program uses pilates to speed recovery from breast cancer surgery

Mary Bange demonstrates an exercise.
Photo by Karen Davin
Mary Bange leads her class in the "inner peace" exercise of pilates.
Photo by Karen Davin
Bange corrects the movements of a class member during warm-up exercises.
Photo by Karen Davin
Bange leads her class in mat exercises designed to strengthen core muscles.
Photo by Karen Davin
Mary Bange

With a Ph.D. in finance and as a professor at Michigan State University, the University of Oregon and the University of South Carolina, Mary Bange had lived a life immersed in academia. After her husband was transferred to Houston five years ago, however, she decided it was time for a career change.

After joining him here, Bange shifted her focus towards her first love — fitness — and began working towards her certification as a personal trainer and pilates instructor.

At the same time, a new movement was gaining speed in the pilates world: The Pink Ribbon Program.

It was created by Doreen Puglisi, a New Jersey pilates instructor and exercise physiologist, who hoped to build a successful rehabilitation program for women who had recently undergone breast cancer surgery by using pilates methods. The program was put to the ultimate test when Puglisi was diagnosed with breast cancer and used the program to aid in her own rehabilitation. Through this, Puglisi was able to tweak the program based on her own experiences to make it more effective.

After losing her mother to a breast cancer, witnessing first-hand her struggles to regain movement, Bange felt a strong personal connection to the program. Like Puglisi, Bange was disheartened by the fact that most women are discharged from hospitals with barely even a mention of physical rehabilitation. With no guidance, they often find themselves in discouraging situations, feeling overwhelmed and losing confidence when attempting to navigate the post-operative exercise world.

Bange began working with individuals after receiving her pilates certification in 2006, but was only recently approached about the possibility of teaching Pink Ribbon methods in a class setting. After a chain of events led her to Memorial Hermann Memorial City's Bobetta Lindig Breast Center during its May opening, Bange reached an agreement with the hospital to offer the six-week class to patients for the first time.

The hospital has provided every necessary material for the program, from exercise mats to the illustrated Pink Ribbon Program manual, so that women may participate free of charge.

Teaching the class is deeply rewarding for Bange. The program is split into four phases of increasing physical difficulty, and when Bange works with individuals, she is able to begin the program at the appropriate phase for their strength. However, in the class setting, all participants must start at phase one. The unlevel playing field may be frustrating for some, but Bange ensures that each participant is given a high level of individual attention. The women are encouraged to adjust the exercises to their own abilities and range of motion.

The once-weekly class begins with simple, standing warmup exercises. The women then move to exercises seated in chairs, focusing on the core muscles of the body. It is clear from early on that some of the five women in the class have significantly more arm and torso movement than others. If you pay enough attention, you can even identify which sides of their bodies have been affected by treatment. Despite their differences, though, there is no competition among the women, as each clearly focuses on her own progress and ability.

Bange plays the role of coach and cheerleader throughout the session, correcting movements when necessary and offering encouragement. At one point, Bange even references the 1984 film, The Karate Kid, to illustrate a point she is trying to make. "Eyes, always eyes," she says, correcting those who accidentally twist their heads to the side when only the eyes should move.

The exercises get increasingly strenuous as the session goes on, and Bange explains to her class how they build on one another. She demonstrates how one exercise, done while standing with the back to a wall, is really just the standing version of an exercise done laying on the mat for extra arm support. While flashes of frustration occasionally come across the women's faces, they seem at ease with the fact that, at this point in time, their bodies can only do so much.

At the end of a calm and quiet 45 minutes, the women scurry on their own way, eager to cook dinner for their families and return to everyday life. The class clearly gives them time, for once, to think only of themselves and their own needs. The camaraderie is evident as participants use each other as a support group. The only thing more daunting than entering the overwhelming world of post-operation exercise is going at it alone.

The physical benefits of the program are its main selling point, but not the only one. The program not only helps women regain muscular strength lost in the weeks following their operation but also provides an emotional boost. Bange believes the program gives women a feeling of control over their bodies and situations, which has been fleeting throughout treatment. The women also gain the confidence to hit the gym and begin normal exercise — something that seemed nearly impossible immediately following surgery.

The program has a wide network of trainers, including several in Houston, but Bange's program is currently believed to be the only organized class in the area. One of her primary goals for the future is to make the program more accessible to breast cancer survivors; she is exploring other partnerships as a means to bring the Pink Ribbon classes to the community.

The patients are not the only ones who benefit from the program. "It's very rewarding to use pilates to help people recover from surgery," Bange said. "I make a difference when I work with them."