Breast cancer is the most common cancer in pregnant women. It tends to affect women in their mid-thirties. Only about 1 in every 1,000 pregnant women is diagnosed with breast cancer. However, the disease can be devastating to both the mother and her child. Therefore, it is essential that pregnant women and their doctors continue to do routine breast exams and thoroughly investigate any suspicious lumps.
A major problem is that a lot of changes take place in a woman's breasts during pregnancy. This makes it harder to identify suspicious lumps. In addition, breast cancer tumors in pregnant women are often larger and more advanced by the time they are detected than lumps in women of the same age who are not pregnant.
How is breast cancer diagnosed in pregnant women?
The best thing you can do while pregnant is to see your obstetrician regularly. These doctor visits, called prenatal (or “before birth”) visits, are very important in keeping both you and your baby in the best possible health. During these visits, your obstetrician will perform a breast examination to check for suspicious breast changes.
It is also important to regularly perform breast exams on yourself. Your doctor or nurse can teach you how to do this properly.
If a suspicious lump is found, your doctor will likely ask you to get a mammogram or an ultrasound. The technicians will take extra care to shield your baby from radiation during the mammogram.
If the lump is still suspicious after these tests, the doctor will usually perform a biopsy. In fact, your doctor will often recommend that you get a biopsy even if the initial tests come back negative. During the biopsy, a small sample of the suspicious tissue will be removed with a needle or by making a small cut. This sample is then thoroughly examined using a microscope and other methods to detect any cancer cells.
What if I do have cancer? Will I have to lose my baby?
First of all, terminating the pregnancy does not improve the mother's chances of surviving the cancer.
Second, there is no evidence that breast cancer can harm the baby. What can harm the baby are some of the treatments for breast cancer. These depend on how far advanced the cancer is. This is another reason why it is so important to detect these and other cancers early.
If the cancer is still in the early stages (Stage 1 or 2), the doctor will most likely recommend that you have surgery to remove either the suspicious lump (lumpectomy) or the affected breast (mastectomy). During the operation, the surgeon will examine the lymph nodes to see whether any are affected and will (usually) remove the lymph nodes where the cancer is most likely to have spread. If is it necessary to give chemotherapy, your doctor will usually wait until after the first trimester to reduce the chances that it will harm the baby.
If the cancer is more advanced (Stage 3 or 4), the situation can become more complicated and treatment would need to be individualized for each woman.
If radiation is needed to treat the cancer, every attempt is made to do this portion of the treatment after the birth of the baby. Whether or not to undergo treatment can be a difficult decision for both the woman and her family. A full discussion of benefits, risks and alternatives should be fully discussed with the health care team. Most of the time, pregnant women can be treated safely for their breast cancer and go on to have healthy babies.
Can I breastfeed my baby if I have breast cancer?
Breastfeeding while you have breast cancer will not harm your baby. Moreover, there is no evidence that stopping your flow of breast milk will improve your cancer.
However, breastfeeding after having a breast cancer surgery can sometimes be difficult secondary to the disruption of the milk ducts that occurs after surgery.
A clear contraindication to breastfeeding would be if you are receiving chemotherapy, as chemotherapy drugs can travel through your breast milk and be harmful to the baby.
I had breast cancer, but have been successfully treated for it. Is it OK for me to get pregnant? Will this harm either me or my baby?
Pregnancy does not change the overall length of time a woman who has had breast cancer can expect to live. At this point, it appears that babies born to women who have had breast cancer in the past are normal and healthy.
A decision to become pregnant after breast cancer treatment should be discussed with your oncology team. Some doctors feel that postponing pregnancy for a minimum of 2 years or so after being treated for breast cancer is advisable. However, this depends on various factors and a full benefit/risk discussion is appropriate.
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