Breast Cancer During Pregnancy and Breastfeeding – Symptoms, Diagnosis and Treatment

Cancer during pregnancy is uncommon. However, breast cancer is the most common cancer type in women, affecting one in every 8 women, and can occur during pregnancy and breastfeeding, albeit rarely. Pregnancy itself does not cause cancer, but hormonal changes may accelerate the progression of a previously existing but unnoticed breast tumor. When pregnancy and cancer occur together, this can create a complex situation for both the expectant mother and healthcare professionals. However, cancer usually does not affect the baby or its development.

What Are the Symptoms of Breast Cancer During Pregnancy or Breastfeeding?

Enlargement of both breasts during pregnancy can make masses and lumps harder to detect. Breast tumors developing during pregnancy may therefore grow larger before being noticed. During breastfeeding, common breast infections called mastitis may be confused with tumor-related conditions. Any unusual swelling or lump should be examined by a doctor.

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How Is Breast Cancer Diagnosed During Pregnancy or Breastfeeding?

• Regular obstetric examinations throughout pregnancy are an important advantage for all pregnant women. You can freely share any questions or troubling signs and symptoms with your doctor. 
• Breast self-examination is no longer recommended for early breast cancer diagnosis because it is ineffective at detecting malignant masses early and causes unnecessary anxiety. Instead, 1 time each month, you can stand in front of a mirror and monitor your breasts for any changes (such as new asymmetry, breast retraction or nipple changes..). 
• Mammography is considered safe during pregnancy, but because breasts are denser before age 40, ultrasound (USG) is generally preferred to mammography. USG is completely safe for mother and baby.
• If a suspicious mass is felt, a breast biopsy should be performed to obtain a tissue sample. Today, experienced physicians perform breast biopsies under ultrasound guidance, using local anesthesia, with very little or no pain. The tissue sample obtained by biopsy is examined under a microscope in a pathology laboratory to determine whether cancer cells are present.
• Computed tomography scans are performed if necessary after consulting the medical team.
• Magnetic resonance imaging (MRI), ultrasonography and biopsy are generally safe during pregnancy. These tests do not use ionizing radiation.

Breast Cancer Treatment During Pregnancy and After Delivery

First, it should be stated that there is no evidence yet that cancer harms the baby. Terminating pregnancy does not eliminate the possible outcomes of breast cancer. Breast cancer during pregnancy requires careful management by specialist oncologists.

The most important determinants of breast cancer treatment during pregnancy remain the extent of cancer spread (stage) and the biological subtype of breast cancer (hormone-positive or negative, her2-positive or negative, and triple-negative).

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Can Breast Cancer Surgery Be Performed During Pregnancy?

Surgery is generally safe during the first 3 months of pregnancy. For early-stage breast cancer, your doctor may recommend surgical removal of the suspicious mass together with some surrounding normal tissue (lumpectomy) or removal of the entire breast (mastectomy).

Can Chemotherapy Be Given During Pregnancy?

If chemotherapy is necessary, your doctor will wait until the first 3 months have passed to reduce the chance of harming the baby.

Locally advanced breast cancer (involving the breast and axillary lymph nodes) generally requires surgery plus chemotherapy, and this treatment carries a higher risk for the baby. Treatment decisions may be difficult. Your doctor will explain to you and your family what treatment will involve and which chemotherapy medicines will be selected.

Can Radiotherapy Be Given During Pregnancy?

Radiotherapy can generally harm the baby during pregnancy, so treatment is postponed until after delivery.

Other Breast Cancer Treatments

Hormone therapy (tamoxifen and goserelin, for example) and targeted smart medicines (such as trastuzumab/Herceptin) are generally not given during pregnancy or breastfeeding.

Can You Breastfeed Your Baby During Breast Cancer Treatment?

There is no evidence yet that breastfeeding advances cancer. You can generally breastfeed while you have cancer, but you should consult your doctor for the most appropriate decision. If you are receiving chemotherapy, breastfeeding will most likely be considered unsuitable because these medicines pass into breast milk.

Breast cancer during pregnancy and breastfeeding also has various/negative psychological effects on the whole family. Therefore, it should not be forgotten to refer the mother and her family for psychological support .

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The moment time stands still: RECEIVING A CANCER DIAGNOSIS!