Breast cancer is a daunting diagnosis for any woman at any time in her life, but facing it during pregnancy or while nursing adds complexity and emotional weight. While rare, breast cancer can develop during these critical times. This amplifies the importance of making early detection, awareness, and appropriate care essential for both the mother and the baby.
Understanding the Risks
Breast cancer during pregnancy, known as pregnancy-associated breast cancer (PABC), is diagnosed in about 1 in 3,000 pregnancies. While the overall risk of breast cancer increases with age, there is not evidence that pregnancy itself raises the likelihood of developing breast cancer. However, pregnancy-related breast changes can mask symptoms and delay diagnosis.
Breast Changes During Pregnancy and Nursing
During pregnancy and nursing, hormonal changes cause the breasts to become denser, which can make it more difficult to detect lumps or abnormalities through physical examination or mammography. Dense breast tissue is comprised of less fat and more connective tissue which appears white on a mammogram. Cancer also appears white on a mammogram, thus making it more difficult to detect. This can lead to delayed diagnosis, often when the cancer is at a more advanced stage.Â
Although mammograms are the gold standard for early breast cancer detection, typically, it is not recommended for women who are pregnant to have a screening mammogram because of the radiation. If women know they have dense breast tissue, or choose to be extra cautious or diligent during this time, having a 3D dense breast ultrasound screen can be a good option. This ultrasound uses sound waves and a wand called a transducer to create an image of the breast without using radiation.Â
In addition, screening mammograms are not recommended for nursing mothers. However, if a woman has just fed her baby or has pumped, a 3D dense breast ultrasound is a good option.Â
Signs and Symptoms to Watch For
The signs of breast cancer during pregnancy and nursing are similar to those at any other time, but they may be harder to detect due to the natural changes in breast tissue. Key symptoms include:
A persistent lump that doesn’t go away after a few weeks
Changes in the shape or size of the breast
Dimpling or puckering of the skin
Unexplained redness, rash, or swelling
Inverted nipple or nipple discharge (outside of normal milk production)
If you notice any of these symptoms, it’s essential to consult your healthcare provider as soon as possible.Â
Diagnosis and Treatment During Pregnancy
If breast cancer is suspected during pregnancy, your doctor will likely recommend diagnostic imaging tests such as an ultrasound or mammogram. To minimize risks to the baby, mammograms can be done with abdominal shielding. In some cases, a biopsy may be performed to confirm the diagnosis.
Treatment for breast cancer during pregnancy depends on the stage of the pregnancy and the cancer’s characteristics. Options may include:
Surgery: Surgery, either a lumpectomy or mastectomy, is considered safe during pregnancy. The timing of surgery will depend on your specific circumstances, but it can usually be performed in any trimester.
Chemotherapy: Chemotherapy is generally avoided during the first trimester due to the risk of birth defects, but it may be administered during the second and third trimesters if necessary. Certain chemotherapy drugs are considered safe during these stages.
Radiation Therapy and Hormonal Treatments: These are typically postponed until after delivery, as they can pose risks to the developing fetus.
Your healthcare team will work closely with you to develop a treatment plan that balances the health of both you and your baby. In some cases, early delivery may be considered to allow for more aggressive treatment postpartum.
Breast Cancer and Nursing
Research shows that there are numerous benefits of breastfeeding for both mother and child. Studies show that mothers who breastfeed can have a reduced long-term risk of breast and ovarian cancer, among other diseases. However, if you are diagnosed with breast cancer while nursing, there are options to continue breastfeeding during treatment that should be discussed with your doctor.Â
In some cases, breastfeeding can continue on the unaffected breast, while in others, it may be necessary to wean. Breastfeeding while having chemotherapy, radiotherapy, hormone, and targeted therapy is not recommended. Lactation consultants can be invaluable in providing support and guidance during this time.
Breast cancer during pregnancy or nursing is a complex and challenging situation, but it is one that can be navigated with the right care and support. Early detection and prompt treatment are key, so it’s important to stay informed about your breast health during these critical times.
Remember, you’re not alone in this journey. With the support of your healthcare team, family, and community, you can face breast cancer with strength and resilience while prioritizing both your health and the well-being of your baby.
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