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    Adoption: Challenges and Solutions After Breast Cancer
    By Ann Hosage Moss

    This article is reprinted with permission from Living Beyond Breast Cancer. Originally, it appeared in the Summer 2004 issue of the LBBC newsletter and on

Some women affected by breast cancer elect to adopt as an alternative means to parenthood. If you and your family decide to do so, you face many decisions. Do you adopt domestically or internationally, through a public agency or a private source? Do you want a newborn, an older child, a child of a different race or ethnic background? How do you balance issues around length of survival and the best interests of the child?

Adoption can be conducted in a variety of ways, and the laws that regulate adoption differ in each state and country involved. An important first step is learning about your options.

Children can be adopted through the public or private adoption systems. In public adoptions, children typically come from foster homes and are under the care and protection of the state. Children enter the system at different ages and for different reasons. Foster children who are eligible for adoption cross a wide range of ages. Adoptive parents are especially needed for children over age six and children with special needs.

Private adoptions can be done domestically or internationally; they offer the best opportunity for those seeking a newborn or child under 18 months old. Domestic adoptions must comply with state law. Depending on your particular state's requirements, you may use private agencies, attorneys or facilitators to identify a child and conduct the process required to complete an adoption. Other resources include physicians, counselors, pastors and organizations specializing in finding newborns, older children or special-needs children.

In domestic adoptions, some sensationalized stories in the news media have resulted in some prospective parents having fears about birth parents who may return to reclaim children after the adoption. Generally, these fears are unfounded. Each state has different laws regarding the voluntary surrender or termination of birth parents' rights. Using competent professional services and following appropriate procedures ensure that the legal rights of birth parents will be addressed in a clear and secure manner. In addition, more recent practices of openness in adoption have reinforced that the voluntary placement of a child for adoption is a fundamentally cooperative process between the birth and adoptive parents. Typically, in domestic infant adoption, babies come home to the adoptive parents upon release from the hospital or shortly thereafter.

International adoptions are regulated by the child's country of origin, and most are legally finalized in those countries. They are growing in popularity because more people want infants and young children than are available domestically. Some international adoptions are done privately by individuals, but most are conducted by agencies and professional services. The federal government will soon begin regulating international adoptions.

Price is another factor. Typically, there are no fees associated with adopting children from the public system. Private domestic adoption costs range from $15,000 to $35,000 and may include agency services, legal fees and travel costs. You also may encounter advertising fees in states that allow families to run ads in print or online to connect with a pregnant woman interested in making an adoption placement for her child. International adoptions range from $10,000 to $30,000. Costs may include legal fees, translations, agency services, document processing fees, the services of foreign facilitators, travel and incidentals and sometimes a donation to an orphanage or other facility that cares for children.

Whichever route you choose, you are entitled to a “statement of fees” that lays out the costs associated with the adoption process. Most likely you will be eligible for an Adoption Tax Credit of up to $10,160.

Knowing the facts is just the beginning. Allison Rosen, PhD, a psychologist and breast cancer survivor, says women affected by breast cancer share common concerns, including fear of discrimination and uncertainty about sharing their cancer history. She wrote about these issues in “Third Party Reproduction and Adoption in Cancer Patients,” a study she recently presented at the Parenthood After Cancer Conference, held at the MD Anderson Cancer Center.

“Most regulatory structures in adoption are very broad,” says Peter Gibbs, MA, LMFT, director of the Center for Adoption Research at the University of Massachusetts. “The statutes are general regarding the prospective parents, including evaluations of their fitness and ability to provide care and a stable, nurturing environment for the child. The determination of who can adopt is based on the decision of the professionals who conduct the home study process.”

In the home study, a social worker meets with the prospective adoptive parents and makes a home visit over a period of time to ensure you have the basic capabilities to meet the needs of a child. Home study workers also explain the adoption process, answer your questions, discuss the realities of the experience and review your personal and health history. Home studies are required in all adoptions.

Many people do not realize they can choose their home study worker, Rosen says. Because home studies have no set rules, she advises families to pre-interview workers and gage their attitudes toward cancer before moving forward. “Once you start the process, it's harder to shift agencies and social workers,” she says.

To prepare for these interviews, Gibbs suggests your family discuss some of the difficult issues you may face as a parent and cancer survivor. Among them are:

* Your motivation for adopting

* How you would handle parenting and communication with your child should you be rediagnosed

* How your partner would handle raising your child alone

Make specific plans for various contingencies. Once you make them, think them through again and explore their effect on a child. If you became very ill, how would you manage?

“People who have had cancer are in a position to consider those things, whereas those who haven't can't even imagine it,” Gibbs says. “But all parents have an obligation to think about these possibilities. On the positive side, someone who has considered all of these significant, powerful possibilities may be very well prepared to parent.”

Another area of concern is the requirement that prospective parents submit health information, usually in the form of a doctor's letter. This letter is a critical piece of the information-gathering process, and its language should be carefully articulated. No set standards exist, but the letter may describe your diagnosis and treatment, current medical status, and issues of future medical risk and length of survival. It can aid in an open discussion of the implications of a possible loss and the challenges in attachment for the child.

The letter also provides an opportunity to educate your home study worker, who will explore your current health status, prognosis and issues related to your experience with cancer, Gibbs says. You may need to get information from medical specialists to help them understand the implications of your history with cancer.

“Breast cancer is a complicated illness—it's not one illness—and not all adoption professionals will understand this,” Gibbs says. “They will need the help of qualified medical professionals to understand the issues.”

In a domestic or private adoption the doctor's letter may impact the decision of the birth parents regarding a prospective parent with cancer. And legally, no single diagnosis is exclusionary. Says Gibbs: “There isn't a one-size-fits-all here. People's circumstances should be evaluated on an individual basis.”

However, foreign authorities or agencies that conduct international adoptions may have more rigid and exclusionary standards regarding the health status of prospective adoptive parents. International children usually have been living in orphanages where attachments to caregivers and other children may make them more vulnerable to loss than other children. This phenomenon, known as “attachment disorder,” is more common in children adopted internationally, Rosen says.

In Rosen's study of six adoption agencies, she found agencies differed in their openness toward cancer survivors. Between .5 and 10 percent of the agencies' clients were cancer survivors. “No agency wanted to discriminate, but they view their primary client as the adopted child and are protective of the countries they work with,” she says.

Perseverance is important, says Gibbs. For the three women profiled in this article, perseverance helped them adopt after breast cancer.

For Janet*, 40, one of the biggest challenges of the adoption process was finding a reliable resource for information. “Selecting the right agency for a foreign adoption and obtaining word-of-mouth recommendations from other adoptive parents—from someone else with breast cancer—helped us find the solution,” Janet says. “You have to place your complete trust in the agency and all the people you work with along the way. It's blind faith.”

Diagnosed with breast cancer at age 33, Janet had a two-year-old daughter and plans for another child. Her treatment comprised a lumpectomy, chemotherapy and radiation therapy. Because her tumor was estrogen-receptor positive, she went on tamoxifen.

“I began to feel cautious about getting pregnant again and began to consider adoption,” says Janet. So at age 36 she consulted an adoption counselor recommended by her radiation oncologist. “I was afraid of misinformation and aware that adoption is time consuming. Our counselor described the process, walked us through domestic and foreign situations, and explained that relinquishment of parental rights was different in different states.”

Janet and her husband had no initial preference for domestic versus foreign adoption. “The focus of our concern was our daughter, who was four at the time, and how her life was about to change,” Janet says. “If an adoption did not come to fruition and we had to start over again, what would be the impact on our daughter? She was an integral part of the process. Foreign adoption seemed to alleviate some of the uncertainty, and that's how we decided.”

Leela, 33, recently adopted two children from Russia. Diagnosed two years ago with stage II breast cancer with lymph node involvement, she underwent a bilateral mastectomy, chemotherapy and radiation therapy. “I did a tremendous amount of research into the adoption process throughout the nine months of my treatment,” says Leela. “I wrote to and interviewed different social workers and located an agency I felt comfortable with. It helped me focus on the future.”

At the time, Leela and her husband had a 12-year-old daughter and wanted a larger family. “Knowing we didn't want a newborn made the option of foreign adoption our first choice,” says Leela. “The hardest thing about adopting from Russia is finding an agency that isn't closed off from considering a woman with breast cancer. The social worker's personal opinions about cancer do come into play. It's her interpretation of the home study results that reflect your current and future health to the agency. The agency we finally settled on barely mentioned my medical condition in the home study.”

Maria, 36, adopted her first son domestically six years ago. Through a facilitator, she is finalizing the private adoption of her youngest son, now one year old, who has lived with her family since birth. Initially diagnosed at age 24, Maria had a lumpectomy, chemotherapy and radiation therapy. Four years later her cancer recurred, and she received a bone marrow transplant.

“My husband and I chose to adopt domestically for three reasons,” says Maria. “We thought it would be easier to understand the adoption process here rather than abroad, where we'd have to deal with language and other barriers. We wanted to adopt a Caucasian infant. And I had a friend who'd successfully adopted domestically and could guide me through the process.”

The family had adopted their oldest son privately through an attorney. “A birth mother would contact the attorney, informing him she had decided to put her child up for adoption, and he would present her with four or five sets of prospective parents,” Maria explains. “After much work and time a match was finally made between a birth mother and us. The second time around we chose to use an adoption facilitator through a website. The site lists information about various birth mothers, such as due date, health status and medical and agency fees. Prospective parents e-mail the site when they locate a birth mother that interests them, requesting the birth mother's profile. Either way, the whole process is time consuming and requires a lot of paperwork, follow-up and patience.”

Although the process took two years, Maria says the experience was wonderful and she would do it again. “We were prepared for the home visit and felt nothing was unanswerable or undoable. The social worker delved through our backgrounds and asked questions about our own childhoods, our discipline styles and our likes and dislikes. She wanted to know who we were and that we'd have a safe place to keep a baby. My husband and I each had to present doctor's letters stating we were in good health.”

“Both cancer and the adoption process are intrude on our most intimate space,” says Gibbs. “We have to tell our personal stories and give information we don't typically have to share. There's also a certain element of fear of exposure to the judgment of others.”

“We were completely up front about my health history,” says Janet. “Both of us felt my breast cancer diagnosis is just one part of who I am and don't view it as a detriment. I believe all the information and facts from both sides should be on the table, for everyone involved to be able to make an informed decision—and a decision in the best interests of the child.

“Now that we have Miranda [from China], we can't imagine our lives without her. It's a privilege to bring another culture into our family. My message to someone else with breast cancer is [that] if you want to adopt, there is no reason why it can't happen.”

Leela was direct in asking the various social workers she interviewed how to address questions of medical risk and life expectancy. She got letters from her oncologist, primary care physician, radiation oncologist and cancer counselor. Each letter described her treatments and did not directly provide a prognosis.

For the home study Maria and her husband had to provide proof of financial stability, present life insurance policies and undergo child abuse and criminal history record checks. “We also had to have physicals and demonstrate normal life expectancy,” Maria says. “My medical history disclosed my 1991 diagnosis and follow-up treatment.”

  “My philosophy during the process was, ‘if asked, tell the whole truth,'” says Leela. “I didn't want to distort the facts and end up with heartache and lost time and effort. I recommend presenting all the facts. However, after five years [of disease-free survival], I might never bring it up. For the home study I was ultra prepared to overcome the social worker's misconceptions around breast cancer.”

  “To other women with breast cancer who decide to adopt, I say don't give up,” Leela says. “If you get a ‘no' at one door, go to the next. Open the phone book and get on the Internet. Someone will work with you. Interview the social workers, be selective and don't be frightened by rejection. Ask them how they conduct the home study and how they feel about your prognosis. Ask about the agency's policies and whether you have to mention your cancer history if you are adopting within the first five years of diagnosis and treatment. Focus on your current health.”

Maria advises: “Both cancer and adoption are like riding a rollercoaster. Each is an emotional ride, and the hardest part is the waiting. Neither is easy, but I am a witness that success can happen.”


* Not her real name. LBBC withheld the women's names upon their request.


Select Resources


* A listserve and resource for people interested in adopting after cancer:


* About state adoption laws:

National Adoption Information Clearinghouse:

Center for Adoption Research:


* Nonprofit groups


Living Beyond Breast Cancer:


Young Survival Coalition:


* About the adoption tax credit:

Internal Revenue Service: