Introduction Pregnancy-associated cancers (PACs), defined as malignancies diagnosed during pregnancy or within the first postpartum year, represent a growing and highly complex clinical challenge. Management requires balancing timely maternal cancer treatment with fetal safety, often forcing difficult decisions regarding surgery, chemotherapy and radiation during pregnancy.
Introduction
Pregnancy-associated cancers (PACs), defined as malignancies diagnosed during pregnancy or within the first postpartum year, represent a growing and highly complex clinical challenge. Management requires balancing timely maternal cancer treatment with fetal safety, often forcing difficult decisions regarding surgery, chemotherapy and radiation during pregnancy.
Problem Statement
Despite increasing recognition of PACs, limited large-scale data exist regarding how pregnancy affects timing of cancer treatment and the downstream impact on maternal and neonatal outcomes. Understanding these treatment patterns is essential because delays in oncologic care may compromise cancer control, while treatment modifications can influence obstetric and neonatal health.
Summary
This large multicenter analysis demonstrates that pregnancy-associated cancer significantly alters cancer treatment timelines and is associated with increased maternal and neonatal morbidity. Patients diagnosed with cancer during pregnancy experienced meaningful delays in locoregional therapies, including surgery and radiotherapy, likely reflecting concerns regarding fetal exposure and procedural risk. In contrast, chemotherapy initiation occurred earlier, suggesting greater clinical acceptance of selected systemic therapies during pregnancy when maternal disease control is prioritized. Importantly, gestational PAC was also associated with substantially higher risks of cesarean delivery, preterm birth, low birth weight and adverse neonatal condition at delivery, emphasizing the broader maternal-fetal consequences of cancer during pregnancy. Postpartum cancer diagnoses demonstrated shorter treatment initiation times, highlighting how pregnancy itself directly influences therapeutic decision making and care pathways. These findings underscore that PACs require highly coordinated multidisciplinary management involving oncology, maternal-fetal medicine, surgery and neonatology to balance oncologic urgency with fetal safety. The study also highlights the need for standardized care pathways and prospective research aimed at minimizing treatment delays while improving maternal and neonatal outcomes in this vulnerable population.
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