Breast Cancer in Pregnancy

Motherhood is an exciting new chapter for many women. The anticipation of giving birth to an entire human being that belongs to you is a feeling that may be hard to put down in words. However, for some women, pregnancy may not always be picture-perfect. Although uncommon, breast cancer is one such disease that can effect a new mother and is often difficult to diagnose during the prenatal period.

This Breast Cancer Awareness Month, we believe it’s important to understand the signs and symptoms of recognizing a breast tumor that could be suspicious for malignancy. It’s also equally important to learn about your possible treatment options and how you should proceed once the diagnosis has been made.

The Challenges of Managing Breast Cancer During Pregnancy

Science has evolved rapidly in recent times with current treatment modalities for breast cancer resulting in a high remission rate. In fact, breast cancer is now one of the most curable malignancies in the developed world because of increased awareness, timely screening and effective treatment options.

However, the same statistics may not hold true for the pregnant woman. Diagnosing a breast malignancy is often challenging during pregnancy because many women overlook their symptoms as a part of the normal pregnancy process. However, it’s important to understand that lumps around the breast area or in the axillary region are always pathological and need to be investigated by your doctor.

Treatment for breast cancer during pregnancy is also made complicated because many chemotherapeutic agents and radiotherapy have known side effects for fetal health and development. In fact, most of these drugs have a high teratogenic potential and can cause serious birth defects in the baby. Similarly, surgical removal of a breast lump may also put the pregnant woman and her baby at risk because of the risk of bleeding and anesthetic side effect.

Because of these reasons, many health care professionals and patients often struggle with prompt breast cancer treatment during pregnancy. Some will prefer to initiate treatment only once the baby has been delivered. However, if treatment needs to be done as soon as possible, the goal will be to carry the baby as close to full term as possible in case a complication during the pregnancy arises.

How is Breast Cancer Diagnosed in Pregnancy?

The signs and symptoms of a breast tumor in pregnancy are identical to the signs in a non-pregnant individual. However, pregnancy symptoms may sometimes mask them.

Women should be encouraged to perform a self-exam by palpating and feeling around the breast for possible lumps or growths. The axillary region should also be checked during this examination. Some types of breast cancers will present with only a hard, fixed lump; others may be associated with prominent skin and nipple changes that will be hard to miss.

You should contact your physician as soon as you can if you experience the following symptoms:

Only a doctor will be able to make the confirmatory diagnosis of a breast malignancy after performing certain tests. One of the first tests is a mammography that looks for calcifications in the breast which can be a sign of an underlying cancer. The confirmation of the type and grade of the cancer is made only once a biopsy is performed.

Mammography and biopsy are relatively safe diagnostic procedures that can be done even in the pregnant state.

Treatment Options for Breast Cancer in Pregnancy

The treatment options for a breast tumor varies woman to woman. Depending on the grade and stage of the cancer, your doctor will suggest the best treatment options for you. Generally speaking, a cancer that is localized to the breast and has not metastasized is surgically removed along with the lymph nodes that drain the area.

If the cancer has metastasized to distant areas of the body, surgery is no longer a viable option. In that case, your doctor will suggest chemotherapy or radiotherapy.

Surgical lumpectomy is the procedure of choice if the cancer is in its preliminary stages, however because of a high recurrence rate, a mastectomy procedure is preferred. This is when the entire breast tissue and the draining lymph nodes are removed. Some women will prefer a breast reconstruction surgery along with the procedure for better cosmesis.

In pregnancy, surgery is only advisable if the cancer is in its very early stages. Surgery is also preferably done in the very last weeks of the pregnancy to improve the survival rate of the fetus should an emergency delivery need to be performed.

Chemotherapy is the option that will be given to patients with metastasized cancer. Because chemotherapeutic drugs exert teratogenic effects, this treatment is not given in the early weeks of pregnancy. The first trimester is when fetal development and organogenesis is happening at its maximum capacity. Teratogenic drugs taken during this time can pose a significant birth defect risk on the baby.

Once the critical organogenesis period has passed, some women may opt to undergo a course of chemotherapy; however, it is still preferable to wait until the baby has been delivered before chemotherapy can be initiated.

Radiotherapy is used as a treatment option for a small subset of breast cancers. This type of therapy involves giving high levels of ionizing radiation to the body which can have potentially harmful effects on not just the baby but also the mother. For this reason, radiotherapy is almost never the option of treatment for pregnant woman with a breast tumor.

What About Breastfeeding?

Women with a breast cancer should not attempt to breastfeed their baby. If the breast cancer has been surgically removed from one breast, lactation may still be possible through the other breast. However, it is still preferable to choose other methods of feeding the baby.

Chemotherapeutic drugs have the potential to pass down from the milk to baby. Therefore, if a woman is undergoing chemotherapy, breastfeeding should be strictly avoided.

The Bottom Line

Getting a diagnosis of a breast cancer when you’re pregnant can be devastating. As hard as it is, there is light at the end of the tunnel. With the latest advances in breast cancer treatment and an increased awareness of the signs and symptoms, the prognosis of breast cancer in pregnancy is improving.

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