Breast cancer during pregnancy is relatively rare, affecting approximately one in 3,000 women. Although rare, breast cancer during pregnancy is generally treatable, although the timing of your treatments may be a bit different to protect your baby.
The specialists at the Janet Knowles Breast Cancer Center at MD Anderson Cancer Center at Cooper have expertise in caring for this rare condition. Our staff of medical, surgical, and radiation oncologists and maternal-fetal medicine physicians provide advanced treatments and compassionate care for patients with breast cancer during pregnancy. Cooper experts often serve as consultants to local oncologists and obstetricians, and they are on the forefront of cutting-edge research to better understand and treat breast cancer during pregnancy.
Pregnancy has been shown to be protective against most types of breast cancer, which is responsive to the female hormones, estrogen and progesterone. Pregnancy and breastfeeding can reduce the amount of exposure to these hormones, reducing the risk of breast cancer. In addition, there are other pregnancy-related factors that affect a woman’s risk for breast cancer, including her age when giving birth to her first child and the number of children she delivers.
In general, studies show that pregnant women who develop breast cancer do not have a worse survival rate compared to nonpregnant women. This similar survival rate depends upon the adequate and timely treatment for a pregnant woman’s cancer and may include treatment during the pregnancy.
Diagnosing Breast Cancer While Pregnant
Diagnosing breast cancer in women who are pregnant, recently gave birth, or are breastfeeding can present challenges because of the changes that naturally occur to the breasts during pregnancy and breastfeeding. These changes make it difficult to detect breast abnormalities by physical exam and imaging.
You may be able to detect breast cancer early by identifying symptoms such as a lump in the breast, an inverted nipple, or red and itchy skin on or around the breast. In most cases during pregnancy, breast cancer is diagnosed after a woman or her doctor finds a lump in her breast.
If you have a lump in your breast, imaging studies and a biopsy of the breast will be used to determine whether you have breast cancer. A pregnant woman may receive a mammogram while she wears a protective shield over her belly to protect her baby.
Cooper’s Breast Imaging Centers offer the highest level of clinical expertise and access to advanced diagnostic technologies. Once breast cancer is initially diagnosed, it is then confirmed through a biopsy of the concerning breast tissue. With a completed diagnosis, further tests will be administered to analyze any spread and determine the best treatment plan moving forward. We provide the latest in mammography, ultrasound, and MRI as well as biopsies, a minor procedure done with numbing medicine in which a needle takes a small piece of breast tissue for examination under a microscope. A biopsy is safe to have during pregnancy.
After a breast cancer diagnosis, your doctor will “stage” your cancer. The stage of your breast cancer depends on how much cancer there is, whether any lymph nodes are involved, and whether it has spread (metastasized) to other parts of the body. Determining the stage of your breast cancer may include several diagnostic tests, including:
- Physical exam
- Imaging studies
- Results from your biopsy or surgery
Not all tests are required for each woman diagnosed with breast cancer. Your doctor will determine what tests you may need to stage your breast cancer. Once the tests are completed and the stage of your cancer is known, your doctor will talk to you about the findings and the best treatment options for your type and stage of cancer.
Treating Breast Cancer While Pregnant
Cooper’s breast cancer and maternal-fetal medicine specialists and support staff will work with you to develop a personalized treatment plan to address the unique needs of your cancer while minimizing any possible risks to your baby. Your tailored treatment plan will depend on several factors, including your age, personal medical history, family history, type of breast cancer, and how far along you are in your pregnancy.
Surgery for breast cancer can be safely performed during pregnancy. Other treatments may be delayed until after the first trimester or after your baby is born. Some treatments, like radiation and anti-hormone therapy, are not used at any time during pregnancy because of the potential harm to your baby.
The First Trimester
During the first trimester, the risks for birth defects to your baby are the highest. To minimize these risks, mastectomy is often the best treatment option for a woman who wishes to continue with her pregnancy. A mastectomy involves removing all the breast tissue. Breast reconstruction at the time of the mastectomy or after delivery may be an option.
A lumpectomy, which only removes the breast tissue involved with the cancer, is not usually performed during the early first trimester because this surgery usually includes a course of radiation that couldn’t be given until after delivery. Pregnant women with breast cancer do not receive chemotherapy during the first trimester, when most of the baby’s organs are developing.
The Second Trimester
The surgical treatment options for breast cancer in the second trimester include mastectomy and lumpectomy. Any radiation needed to complement lumpectomy will be delayed until after your baby is born.
Unlike in the first trimester, chemotherapy during the second trimester is considered safe because your baby is more developed.
Regardless of your treatment plan, serial ultrasounds to assess fetal growth is suggested by specialists in maternal-fetal medicine.
The Third Trimester
The surgical treatment options for breast cancer for women in their third trimester of pregnancy are similar to those in the second trimester and include mastectomy or lumpectomy.
Unlike in the first trimester, chemotherapy during the third trimester is considered safe. However, chemotherapy is generally not given after you reach the 35th week of pregnancy so you have plenty of time to recover from the effects of chemotherapy before you deliver your baby.
Regardless of your treatment plan, serial ultrasounds to assess fetal growth is suggested by maternal fetal medicine. In the third trimester fetal monitoring with maternal-fetal medicine is suggested weekly.
Cancer and Breastfeeding
Breastfeeding while you have breast cancer can be safe for you and your baby, but it depends on your unique treatment plan.
Breastfeeding after surgery or a biopsy is considered safe. However, you should not breastfeed while you receive chemotherapy because it can be passed to your baby through your breast milk. Also, you may be more prone to breast infections if you breastfeed during chemotherapy or radiation.
If you breastfeed your baby, don’t be alarmed if your milk supply is low, especially compared to other children you may have had. After chemotherapy and radiation therapy, your milk supply may be diminished.
If you are only able to breastfeed from the healthy breast, your baby will still likely receive adequate nutrition.
It is important to talk to your doctor about your treatment plan if breastfeeding your baby is a priority for you.
Misconceptions Around Breastfeeding
Breastfeeding reduces the risk of breast cancer and has many health benefits for your baby. Still, there are several myths and misconceptions about breastfeeding while a woman is fighting breast cancer or even in remission. Some of the more common misconceptions include:
- Myth: Babies will refuse to feed from a cancerous breast. Babies tend to only refuse to nurse from a breast with cancer if the taste of the milk changes or the growth of the cancer decreases the mother’s milk supply.
- Myth: Anesthesia may transfer into the milk. The body metabolizes anesthesia medications quickly so it is safe for a mother to nurse her baby once the anesthesia medications wear off.
- Myth: Needle aspiration affects milk production. This procedure involves removing fluid only from cysts and other growths and has no impact on a mother’s production of milk.
- Myth: Diagnostic imaging techniques affect milk production. Diagnostic imaging is non-invasive and does not impact how much milk a mother produces. It is not dangerous to breastfeed your child after any of these procedures, but you should pump or feed your baby just before your imaging studies to empty the breast and make it easier to detect any abnormalities.
Please speak with your Cooper breast cancer or maternal-fetal medicine specialist if you have questions or concerns about breastfeeding during your treatment or while you have cancer.
Cancer and Pregnancy Registry
Most oncologists and obstetricians treat no more than two or three pregnant patients with cancer throughout their entire careers, so there are still a lot of questions to be answered for women who are facing cancer while they are pregnant.
Dr. Elyce Hope Cardonick, a maternal-fetal medicine specialist at Cooper, aims to change that by gathering information on cancer and pregnancy from various hospitals into the Cancer and Pregnancy Registry at Cooper.
The registry collects confidential information on the diagnosis and treatment of pregnant women with all types of cancer. The information gathered will help researchers around the world better understand the effects of a cancer and its treatment on pregnancy as well as shape the future of diagnosing and treating pregnant women who have cancer. Both mothers and children are followed closely even after the pregnancy is completed.
Learn more about the Cancer and Pregnancy Registry here.
A breast cancer diagnosis and treatment can be a stressful and scary time, and especially so if you are pregnant and concerned not only about your own health but also about the health and well-being of your baby. It is important to find emotional support through your family, friends, community, and support groups so you know you are never alone in your breast cancer journey.
Cooper is here to help you and your family every step of the way. As part of our Cancer Care Support Services, we will help connect you to our compassionate counselors, social workers, support groups, and other resources to ease whatever challenges you face during your treatment.
There are many other resources that provide valuable information and emotional support for women who are pregnant and diagnosed with breast cancer. Some of these resources include:
- Hope for Two: Pregnant with Cancer Network. This support network can match you to a support woman who was treated for breast cancer during pregnancy and has already delivered her child.
- Facts for Life: Breast Cancer During Pregnancy, from the Susan G. Komen Foundation
- Young Survival Coalition
- Social support resources, from the Susan G. Komen Foundation