Expert contributor: Dr Shani Paluch-Shimon
Breast cancer is the most common cancer amongst women in middle-high income countries. Breast cancer is mostly a disease affecting women who are well into menopause, with the average age at diagnosis being 60 years old. Only 6-7% of newly diagnosed breast cancers are diagnosed in women under the age of 40. A breast cancer diagnosis is challenging at any age but can be particularly devastating when a woman is young and in the peak of her reproductive years. Breast cancer in young women may be diagnosed late, especially if it presents during pregnancy and lactation as any lumps and breast changes may be assumed to be normal. This blog aims to provide practical guidance for moms facing a breast cancer diagnosis during pregnancy or while breastfeeding.
How common is breast cancer during pregnancy?
Around 1 in 3,000 women will be diagnosed with breast cancer while pregnant. The average age of diagnosis for this group is between 32-38 years. Often breast cancer is detected later, because changes were thought to be pregnancy related. In and amongst all the changes happening during and after pregnancy, it is important to stay vigilant about one’s body and look out for any unexpected changes.
It is not uncommon for lumps to appear while breastfeeding - these may be painful and impact on feeding your baby successfully. Mastitis and clogged milk ducts are familiar issues for many breastfeeding women, but there are a host of other lumps that can develop. In most cases, these lumps are not serious and will resolve with continued breastfeeding and prompt lactation support. If a lump persists for more than a week, contact your health provider.
Signs and symptoms of concern include a new lump or swelling in the breast or underarm; asymmetry of the breasts (where one breast appears firmer or larger); and changes to the nipples and the appearance of redness and swelling. It can be hard to detect these changes when pregnant or breastfeeding, but it is worth following up with your doctor if you are unsure or if symptoms do not resolve quickly. Redness or inflammation, or an orange peel-like appearance can be signs of a less common type of breast cancer.
Who is at higher risk of breast cancer while pregnant or breastfeeding? Can I lower my risk?
Breast cancer mostly affects older women. However young women with a strong family history of breast cancer or those who carry a hereditary mutation in genes such as BRCA1 & BRCA2, are at a higher risk of being diagnosed during their reproductive years than their peers. As with all health conditions, we can not change our genetic makeup but we can make choices about some of the evidence-based risk factors such as physical fitness, maintaining a healthy weight and minimizing our alcohol consumption.
Diagnosis & treatment of breast cancer during and after pregnancy
Being diagnosed with breast cancer while pregnant is very confronting, but it is important not to delay treatment. Your doctor can help you work through your options, as this will depend on the diagnosis and your stage of pregnancy. Many treatments can be administered during pregnancy, and nowadays, most medical teams will support the continuation of the pregnancy till as close to term as possible. In fact, unless diagnosed in the first weeks of pregnancy, most women will be able to safely continue their pregnancy while being treated if they wish to do so. Many breast cancer treatments (including most chemotherapies!), other than radiotherapy, are considered safe for pregnant women in the second and third trimesters. This of course needs to be tailored to the individual. Expert multidisciplinary care is a must and when possible it is important to be managed in a large tertiary centre with experience in treating women in this group.
Side effects of surgery, chemotherapy and hormonal therapy are challenging to manage together with the everyday load of being pregnant, or having a newborn, so it is important to think about the family and community support that can help you through this time. Getting emotional support is also important – you may find solidarity with other women or through individual counselling. The treatment type will impact on whether one can breastfeed – your medical team will be able to answer all your questions.
Can I breastfeed if I have breast cancer?
For women diagnosed with breast cancer while nursing, most physicians will recommend that they stop breastfeeding. Chemotherapy and hormonal drugs can be passed through breast milk.
Women who have had breast cancer in the past and are currently well, or have been given a green-light (from their oncologist) to take a temporary break from treatment for the purpose of conceiving, pregnancy and a short period of breastfeeding, can safely feed from the unaffected breast. Feeding from the affected side is usually not possible if a woman has had a lumpectomy followed by radiation or undergone a mastectomy.
Mothers who are unable to breastfeed may be disappointed that this choice has been paused or taken from them. At Emulait we have designed a bottle that mimics the benefits and experience of breastfeeding. The bottle has been engineered to support smoother transitions between breast and bottle, as well as optimal oral development. It also allows mom - or any caregiver - to recreate the intimacy of breastfeeding. Moms can choose a bottle that truly represents them in color and shape, and the Anatomy bottle is designed to facilitate responsive feeding and bonding by supporting a more natural breastfeeding position and facilitating eye contact.
If you have been diagnosed with breast cancer, remember:
- Most women will have a great outcome - timely care is critical.
- Multidisciplinary care is paramount.
- Emotional support is so important - ask your health provider about support groups or therapist recommendations.
- Most women can continue their pregnancy and receive treatment while pregnant in a way that is safe for mum and baby! Therefore don’t delay seeking medical care.
- Most women who have been diagnosed with breast cancer will be able to move on and have further pregnancies and even breastfeed in the future.
Pregnancy and post-partum are accompanied by so many changes - hormonal, physical and emotional. It makes sense that women will be suspicious of breast-related lumps, but it is important to be reassured that most lumps are not a cause for concern. However, for peace of mind, or if the lump persists for more than a week, speak to your doctor. Timely medical attention is of utmost importance and will enable prompt treatment and support for those diagnosed with breast cancer.
The information contained in this article is for educational and informational purposes only, and does not substitute for professional medical or health advice. Always consult a medical professional or healthcare provided for any medical advice, diagnoses, treatment, or health objectives.