A new study finds that pregnant women or new moms who get melanoma skin cancer have worse outcomes from the disease. Here's how to protect yourself.
You've heard about the dangers of tanning and know to load up on SPF, but did you know this is even more important in pregnancy? A new study published in the Journal of American Academy of Dermatology has found that women who are diagnosed with melanoma, the most dangerous type of skin cancer, during pregnancy or in the year after giving birth have a greater risk of recurrence, spread of cancer and even death.
Could pregnancy make skin cancer worse?
Researchers at the Cleveland Clinic's Dermatology and Plastic Surgery Institute in Ohio looked at data on 462 women under the age of 50 who were diagnosed with melanoma over a period of almost 25 years. They compared the prognosis and outcomes of the women who were pregnant or who'd had a baby in the year before being diagnosed with women who weren't pregnant or hadn't recently given birth. "Although the overall numbers reflect a still rare incidence of pregnancy-related melanoma, our findings indicate up to a five times rate of death from melanoma in those women versus those who did not have a pregnancy-related melanoma," the study's principal investigator, Dr. Brian Gastman, M.D., a plastic surgeon and director of melanoma surgery at Cleveland Clinic, tells Fit Pregnancy. Pregnant or recently pregnant women were also seven times more likely to have a recurrence of the cancer, and nine times as likely to have the cancer metastasize, or spread to other areas of the body.
What is it about pregnancy that makes skin cancer so much worse? "There are many possibilities including hormonal, immune-related—pregnancy is a state of immune suppression, psychosocial and others that can explain our findings," Dr. Gastman says. One theory is that the extra estrogen the body produces when pregnant somehow helps cancer growth. Another is that the weakened immune system of pregnant women makes them more susceptible. Or it may even be that pregnant women don't get diagnosed as quickly. "Lack of previous evidence of this phenomenon has curtailed the study of the problem," Dr. Gastman says.
In fact, whether or not skin cancer is worse in pregnant women has been debated among doctors for years. "There has been decades of controversy on whether pregnancy has a role in the aggressiveness and incidence of melanoma," Dr. Gastman says. "Many large studies conclude that there is no role." But this study was unique because it used a large database of electronic records to piece together women's medical histories. "Ultimately we concluded that at least in a large metropolitan academic center in the U.S. and studying women in the modern era, there is a significant impact of pregnancy, up to one year postpartum, and an increased rate of recurrence, metastases and death," Dr. Gastman says.
Looking at cases in recent decades is important because of the rise in the number of instances of melanoma, which doubled from 1982 to 2011. It's the fifth most common cause of cancer in the United States, and increasingly is diagnosed in women of childbearing age. Why is it increasing so dramatically? "It's hard to know for sure, some have proposed our atmosphere is not as protective as it had been, and there is clearly a concern on tanning booths," Dr. Gastman says. "It may also be the type of clothing we wear. We are also seeing more people working near windows or driving for long periods of time. These indoors situation can also lead to increased UV exposure and skin cancer risk."
Whatever the underlying cause for the increase, if you're pregnant you should be vigilant about protecting against skin cancer. Guard yourself against harmful UV rays by wearing sunscreen with an SPF of 30 or higher. Cover up in long sleeve and pants, and wear a hat and sunglasses. It goes without saying to avoid tanning beds when you're pregnant, but you should probably also do so if you've recently given birth. And although some of these recommendations might seem unnecessary in the winter, remember that the snow reflects light and can cause sunburns, too. "Although there is less intense sun in the winter, UV radiation and protecting against it should always be something a person with risk factors for melanoma should consider," Dr. Gastman says. The same goes if you're planning a winter getaway to a warmer locale. "When us northerners have a chance to go out in the sun we are probably much more careless about it, like on vacation," he says.
Although it makes sense to take extra care while pregnant, your chance of getting skin cancer is still very low. "Being pregnant alone should not be a risk factor," Dr. Gastman says. It's just that if you do get it while pregnant, it can be more serious. So if you have other risk factors, followup with your doctor regularly. "A personal or family history of skin cancer, especially melanoma, or other major risk factors such as major burning as a child, more than 50 moles or use of tanning beds should prompt a woman who is pregnant to at least discuss precautions with her doctor," he says.