Breast Cancer during Pregnancy
During pregnancy, a woman's body goes through many changes. Unfortunately, the same hormonal and tissue changes that nurture the baby and prepare the mother for birth can also speed the progression of breast cancer and make it more difficult to detect. Breast cancer is the most common cancer in pregnant women.
It is extremely important to see your obstetrician regularly during pregnancy. Not only will your doctor make sure your baby is doing well, he or she will also monitor your whole body carefully, including your breasts.
In addition to these breast examinations performed by your doctor, you should be doing self-exams at home regularly. (Your doctor can show you how to do this correctly.)
Breast cancer diagnosis during pregnancy
Hormonal changes during pregnancy cause the breasts to enlarge, and can make them feel tender and even lumpy. This can make it more difficult to locate and identify suspicious lumps. If you are pregnant and feel any sort of lump in your breast, you should see your doctor as soon as possible for an examination.
If a suspicious lump is found, there are a few different diagnostic tests that may be used, the most common of which is a mammogram. It is believed to be fairly safe to have a mammogram during pregnancy, as the radiation is concentrated on the breast, and a lead shield is placed over your belly to protect the baby during the procedure. However, if you are uncomfortable with this risk, there may be alternatives. Ask your doctor about other options, such as a breast ultrasound.
Depending on the results of the initial tests, a biopsy may be required as well.
Pregnancy and breast cancer treatment
Once breast cancer has been detected, the treatment of a pregnant woman proceeds much like it would for a non-pregnant one. If the cancer is detected early (Stage I or II), the first course of action is usually surgical removal of the tumor (lumpectomy) or the entire breast (mastectomy). Nearby lymph nodes may be removed during surgery as well, in case the cancer had begun to spread.
This kind of surgery is considered fairly safe during pregnancy, however anesthesia may be risky for the baby during certain stages of pregnancy, so timing can be important. Mastectomy is sometimes a better choice for pregnant women, as it makes it less likely that radiation will be needed afterwards. Your doctor, surgeon, and anesthesiologist can help you decide which options are best for you and your baby.
If chemotherapy is needed after surgery, it is usually postponed until after the 1st trimester. In the first trimester most of the baby's internal organs are developing, and chemo is believed to be a lot more risky during this time. Some studies have shown that certain chemo drugs given during the 2nd and 3rd trimester do not raise the risk of birth defects or stillbirths, however the long term effects of these drugs on the child are not known. In addition, chemo is generally not given in the last 3-4 weeks of pregnancy, as it can decrease the mother's blood cell count, raising the risk of certain complications during birth. In some cases, when the woman is in her third trimester, it may be possible to delay chemo until after the baby is born, and the birth may be induced so that treatment can begin as soon as possible.
If the cancer is already in an advanced stage (III or IV) when detected, treatment options are more limited, and the mother may have to consider aborting the pregnancy to increase the chances of her own survival. Radiation therapy is usually needed for advanced cancer, and the high doses used can harm the fetus during any stage of pregnancy. Hormone therapy is another treatment that may be used, and is also considered risky for the baby.
Breastfeeding during breast cancer
There is no evidence that breastfeeding will harm your baby if you have breast cancer. It is also believed that breastfeeding does not affect the progression of the cancer. However, if you are undergoing breast cancer treatment, it is likely that you will be asked to not breastfeed during this time.
If you stop breastfeeding (or don't start), this will reduce blood flow to your breasts, making them smaller, which can be advantageous during surgery. Stopping will also reduce your chances of infection, and will make it less likely that breast milk will be a problem during surgery or biopsy.
If you are receiving chemotherapy or hormone therapy, it is essential that you not breastfeed. These chemicals can pass into the breast milk and harm the baby.
Pregnancy and breast cancer survivors
Many women are able to become pregnant after breast cancer, though some cancer treatments, such as chemo, can affect a woman's fertility. You should not try to become pregnant while you are on hormone therapy, as there is some evidence that this treatment can cause birth defects.
Some studies have shown that pregnancy does not increase the likelihood that the cancer will recur, however, there is clear evidence that estrogen levels affect the growth of breast cancer cells. For this reason, many doctors still advise women to wait at least two years before becoming pregnant. This allows time for an early relapse to be detected and treated.
A woman's history of breast cancer is not believed to cause any problems for her future babies.
