Oncologists worry restrictions on abortions in Republican-led states after Roe v. Wade's reversal could force pregnant cancer patients to delay critical treatments, like various chemotherapies.
"This ruling is going to impact many different aspects of women's health and women's health care -- but specifically for cancer patients, this could be a death sentence for some of them," Dr. Shikha Jain, an oncologist at the University of Illinois Cancer Center, told ABC News.
Many common cancer treatments run the risk of severely damaging a growing fetus or being harmful to a woman's reproductive system, especially in the first trimester of pregnancy. Because of this, pregnancy tests are commonly administered to patients with cancers and many doctors have conversations about fertility with patients right after a cancer diagnosis when discussing treatment options.
"Some women opt to have an abortion if they need to start chemotherapy urgently," Jain said. "My biggest concern is that the patients are either going to not be able to make that decision for themselves -- and [be able to] have that abortion to start their chemotherapy urgently -- or the decision is going to be put into the hands of the court."
Many state abortion bans include exceptions for when the life of the mother is at risk. However, multiple oncologists told ABC News that cancer patients may not qualify for those exceptions as the new laws are currently written, or patients may have to go to court to secure abortion access -- potentially delaying treatments.
Dr. Banu Symington, an oncologist in southwest Wyoming, said cancer patients who are pregnant can be faced with stark choices about their futures.
While "we generally discourage treatment with chemotherapy in the first trimester of a pregnancy because chemotherapy can be a mutagen, it can cause birth defects," she said, there are other risks: "If they don't start chemotherapy, their curable cancer, for example, may be incurable by the time their pregnancy comes to term. Their child may have to grow up without a mother."
Symington said in her work she has these sorts of conversations with pregnant patients about whether to postpone chemotherapy or end their pregnancy "not frequently, but not rarely either."
She recalled one pregnant patient diagnosed with Hodgkin lymphoma, a curable cancer of the immune system. By waiting until after she delivered her child to start treatment, the patient went from having stage 1 cancer to having stage 3 cancer and required more chemotherapy, which brought greater risk, and she faced lower cure rates.
"Some of my patients have elected, have chosen, to postpone chemo so they can give birth to the child. But that choice may soon be taken away from women," Symington said.
Dr. Julie Gralow, chief medical officer for the American Society of Clinical Oncology, wrote in a column earlier this month: "For people who are diagnosed with cancer during pregnancy, already a devastating life circumstance, decisions about what treatments to pursue ... are urgent and best made with an informed physician who can consider all evidence-based, scientific options, including termination."
"Patients must be able to trust their doctors and we are therefore concerned about the potential impact of the decision that inserts the government and even lay-people into the most private and personal decisions patients face," Gralow wrote. "The Dobbs ruling [overturning Roe] creates uncertainty and confusion that can undermine the sacred doctor-patient relationship."
Wyoming, where Symington lives and practices, has a "trigger law" enacted in anticipation of the end of Roe -- set to ban all abortion except in the case of rape, incest or when the life of the mother is at stake. The law is still being evaluated but will likely go into effect this summer.
"What is defined as a 'medical emergency'? This is what physicians are having to grapple with across the country, especially in states that are outlawing abortion," said Jain, the Illinois oncologist. "Because if, for example, a woman comes in and she has a new lymphoma diagnosis and she needs to start chemotherapy, it's not a medical emergency in the sense that she's not going to die in the next hour or five hours or a day, if you don't start chemotherapy. But if you don't start chemotherapy within a certain number of days, yes, it is indeed a medical emergency."
The oncologists and medical experts who spoke to ABC News for this story said they also worried that the abortion restrictions and bans could intimidate doctors, leading many to censor themselves. For example, a doctor who believes a patient's odds of surviving her cancer would be significantly improved should she terminate her pregnancy and start treatment immediately may instead chose not to give such advice -- fearing prosecution -- if they are in states where the abortion laws are vague and changing
Symington said she already tells her cancer patients to use contraception and avoid getting pregnant because of the heightened risks of pregnancy with cancer.
But now, she said, "I'm going to have to change that conversation to say, 'Don't get pregnant because in addition to the stress of having cancer and undergoing chemotherapy, you will have to live with the stress of a pregnancy whose outcome is unknown to you.'"
One cancer survivor in Houston who spoke with ABC News, and who asked to go by her first name, Allie, due to work sensitivities, said that while pregnant with her second child she did not feel well and her doctors began to realize it was something more than the expected morning sickness or fatigue.
After a CT scan and a biopsy, Allie's doctors confirmed a terrifying complication to her pregnancy: She had cancer, and the prognosis was serious enough that they advised she start treatment right away.
But because cancer treatments like chemotherapy can damage a fetus, especially in the first trimester, Allie considered her options, including whether to have an abortion to move ahead with treatment.
"It's that power to choose for what's right for my family, for my husband, for my daughter that I already have, for my unborn child, for myself -- that ability to have those options rather than it just be, 'This is the only choice you have,'" Allie told ABC News.
Ultimately, she was able to work with a team of specialists in the Houston area and developed a course of treatment she could pursue while pregnant.
She gave birth to a healthy son, who is now 4, and she's been in remission for four and a half years.
ABC News' Conor Finnegan contributed to this report.