It was last thing Rebecca O'Donnell expected at 30 weeks' pregnant. One morning, while putting on her bra, she felt a pea-sized lump in her right breast.
At first the cancer drug rep thought it might be something related to milk production. A blocked duct perhaps?
Her obstetrician seemed more alarmed. As soon as the doctor saw the lump a few days later, she referred Ms O'Donnell to a surgeon immediately.
Within two days, the then 35-year-old was diagnosed with breast cancer found in two separate tumours. One was the lump she felt, the other was growing stealthily inside.
"I was pretty shell-shocked ... and my husband nearly passed out," she said. "I talked about cancer all day long in my job and now it was happening to me. It was quite surreal."
Ms O'Donnell is one of about 80 Australian women diagnosed with breast cancer while pregnant each year. But experts say that as more women are having babies later in life, more will suffer the same fate that creates two complex patients in one.
After consulting various specialists, Ms O'Donnell had a caesarean at 33 weeks so she could begin treatment as soon as possible. A decision was made in favour of surgery to remove the cancer and radiation after her baby was born.
William in a special care nursery after birth. Source: supplied.
However, before that, she was advised that if she wanted more children, she should create embryos through IVF to be frozen for future use.
The decision to give birth early meant her son, William, was born in a precarious state. With underdeveloped lungs, he struggled through his first few days of life at the Royal Women's Hospital. It was a frightening time.
"I'd be in the hospital day and night with him until the nurses would kick me out," Ms O'Donnell said.
Two years on, Ms O'Donnell and her son William are well. While she continues to have monthly chemotherapy injections, her son is a healthy toddler.
"I feel so grateful," the 37-year-old said.
On Wednesday, experts at a Clinical Oncology Society of Australia conference said a study of 47 women like Ms O'Donnell found that their babies had excellent survival rates, but were often born premature, at a low birth weight and needed special care immediately after birth.
One of the authors of the study, Professor Christobel Saunders, said although radiation was not usually given to pregnant women, studies showed chemotherapy was safe after the first trimester. The most recent study on this published in the New England Journal of Medicine found the drugs had no adverse effects on babies when they were tracked to a median age of 22 months.
However, Professor Saunders said this message was not always reaching women and their obstetricians, who often opt for early delivery of their babies rather than undergoing important cancer treatment.
"Our message is do not delay the cancer treatment because of a pregnancy ... And there is rarely an indication for termination of pregnancy," she said.
One woman who feels she received the best of care is Pamela Cinquini. After trying for eight years to get pregnant and suffering through six miscarriages, Ms Cinquini finally received the news she had longed for in December. At 45, she had a viable pregnancy.
Pamela Cinquini having chemotherapy while pregnant with her son Leonardo. Photo: supplied
However, at four months' gestation her happiness was tempered by the discovery of a lump in her breast. Like Ms O'Donnell, she hoped it was a blocked milk duct, but tests soon revealed aggressive cancer.
"We had just announced to our family before Christmas that we were expecting a baby and then two weeks later I had to tell them I had breast cancer. We went from extreme joy to utter fear," she said.
Shortly after the diagnosis, Ms Cinquini had surgery to remove the cancer, followed by chemotherapy.
"I did chemo for about four months before I had the baby," she said. "It was pretty intense. My baby had more hair than I did when he was born."
After her son Leonardo was born healthy via caesarean at 38 weeks in June, Ms Cinquini received more chemotherapy two weeks after the birth. She has since had radiotherapy for six weeks and will soon start hormone-inhibiting treatment which will last for five years.
"We're just thrilled to be parents ... My mother calls him a miracle baby. He was there with me going through the chemo. I think he's pretty brave without having the decision to be brave. It was always comforting to have him with me," she said.
Pamela Cinquini and her son Leonardo. Photo: supplied
Professor Saunders said with more women giving birth at an older age, it was important for all women and their carers during pregnancy not to dismiss any signs of breast cancer.
"It should not be ignored, it should not be put down to thickened tissue because of lactation," she said. "Unfortunately you do hear stories … of women being reassured that it's all normal and part of the pregnant breast but it's not."
In good news though, she said research suggested women diagnosed with breast cancer during pregnancy had similar outcomes to other women with the disease.
"If you compare them to women with the same stage of cancer who are not pregnant the outcomes are the same. The only exception to that is for women who present in the lactational period, so the first few months after pregnancy. Unfortunately it does seem that they have more aggressive cancers ... we don't know what that is due to," she said.