OCT 30, 2014 12:00 PM PDT

What is best practice for testing for unexpected pregnancy in pediatric and adult patients prior to cancer diagnostics, imaging and therapy?

  • Chief, Pathology at Lucile Packard Children's Hospital at Stanford, Associate Professor in the Department of Pathology, Stanford University
      Dr. Geaghan is Chief, Pathology at Lucile Packard Children's Hospital at Stanford, and Co-Director of Clinical Laboratories at Stanford Hospital and Clinics. She also directs the Bass Pediatric Cancer Center Laboratory at the Lucile Packard Hospital; is Director of the Point of Care Testing Program for the women and children's hospital and is Director of Stanford Clinical Laboratory at Mary L. Johnson Pediatric Ambulatory Care CenterShe is an Associate Professor in the Department of Pathology and in Pediatrics at Stanford University School of Medicine, teaching medical students, residents, fellows and post-graduate continuing medical education programs. Dr. Geaghan received her undergraduate degree at Dartmouth College and MD at Boston University School of Medicine. She received her training, including two residencies in Anatomic and Surgical Pathology and in Laboratory Medicine, at the University of California, San Francisco, where she also served as Chief Resident and was the first Hematopathology Fellow. Dr. Geaghan holds four board certifications: in Anatomic Pathology; Hematopathology; Clinical Pathology and Pediatric Pathology. Dr. Geaghan is Chair-elect of the American Association of Clinical Chemistry Division of Pediatric Maternal Fetal Division, the largest organization of laboratory medicine professionals (2012-2014). Dr. Geaghan was recently named to the International Federation of Clinical Chemistry's Task Force on Pediatric Laboratory Medicine, and the College of American Pathologists Point of Care Testing Committee. Dr. Geaghan serves on numerous Executive Boards, including the Medical Executive Board at Lucile Salter Packard Children's Hospital at Stanford and also serves on Advisory Boards as an avid advocate for children's health, in various national Pediatric Clinical and Laboratory Medicine Associations. She has recently been named in Top Doctors of the Year by San Jose Magazine, and in the American Registry of Outstanding Professionals.  


    Female cancer patients in the reproductive years face a variety of diagnostic and therapeutic procedures which pose teratogenic hazards to an unexpected pregnancy. Ionizing radiation, diagnostic biopsy and surgical resection procedures, anesthesia, chemotherapeutic agents and nuclear medicine scans are commonplace interventions which are contraindicated in the presence of a pregnancy, yet may be required for cancer diagnosis and treatment. Woman facing such procedures are tested for pregnancy so that decision-making regarding pregnancy and the need for cancer treatment can be made prospectively, and to avoid potential iatrogenic harm, emotional distress for the patient, and liability for the physician. There are substantial knowledge gaps amongst physicians regarding the limitations of the different tests. It is critically important that the physician understand the types of available human chorionic gonadotropin (HCG) tests; the differences in sample types (urine or serum); and the locations where the tests can be performed. Analytical sensitivities differ between urine and blood HCG tests, which yield differences of several days in pregnancy detection. Reasons for erroneous urine HCG results will be examined. Variability between measurements, test interferences and HCG variants will be discussed. The clinical impact of using the right test on the right sample at the right time on sexually active female cancer patients in their reproductive years will be highlighted.

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