BREAST CANCER DURING PREGNANCY
Breast cancer can be diagnosed during pregnancy or in the 12 months postpartum, known as gestational breast cancer or pregnancy associated breast cancer.
How is breast cancer during pregnancy diagnosed?
The triple test is used to investigate any breast abnormality in a pregnant or lactating woman. The triple test refers to 3 diagnostic components: medical history and clinical breast examination, imaging with mammogram and ultrasound and biopsy.
| TEST | IS IT SAFE DURING PREGNANCY AND LACTATION? |
|---|---|
| Ultrasound | Yes. |
| Mammogram | Yes. Shielding can be used to protect your baby from the radiation used. |
| Fine needle aspiration biopsy | Yes. |
| Core biopsy | Yes. There is a small risk of a milk fistula. |
Can breast cancer affect my baby?
There is no evidence that having breast cancer during pregnancy affects your baby’s development in the womb. You cannot "pass" cancer on to your baby and there is no evidence that your child will develop cancer in later life as a result of you having breast cancer during pregnancy. However, some breast cancer treatments can be harmful to your unborn baby, so they are not given during pregnancy.
What is the treatment for breast cancer during pregnancy?
Most pregnant women can safely have treatment for breast cancer, although the types of treatment and the timing of treatment might be affected by the pregnancy.
| TREATMENT | IS IT SAFE DURING TRIMESTER 1? | IS IT SAFE DURING TRIMESTER 2 & 3? |
|---|---|---|
| Surgery | Yes | Yes |
| Chemotherapy | No | Yes |
| Radiotherapy | No | No |
| Targeted Therapy | No | No |
| Endocrine Therapy | No | No |
Surgery
Surgery
to remove the cancer in the breast and nearby lymph nodes is generally safe in pregnancy. Mastectomy
is often recommended for pregnant women with breast cancer, as women who have breast conserving surgery
need radiotherapy afterwards. Radiotherapy is not safe to give during pregnancy, and delaying radiotherapy too long can increase the risk of the cancer coming back. If the cancer is found in the third trimester, breast conserving surgery can be an option because there might be little or no delay in starting radiotherapy.
The lymph nodes in the armpit are usually sampled at the time of breast surgery. A sentinel lymph node biopsy can be performed using a lower dose of the radioactive tracer, but the blue dye used for non-pregnant women is not recommended during pregnancy.
Breast reconstruction at time of mastectomy (immediate reconstruction) is not normally offered during pregnancy due to changes in the breast and to avoid a long time under anaesthetic. However, breast reconstruction can be performed at a later date (delayed reconstruction).
Chemotherapy
Chemotherapy can be given during pregnancy. It is not given during the first trimester as it can harm your unborn baby. It is generally safe to be given during the second and third trimesters. Studies have shown certain chemotherapy drugs used during the second and third trimesters do not raise the risk of birth defects, stillbirths or health problems shortly after birth, though they may increase the risk of early delivery. Researchers still do not know if these children will have any long-term effects.
Chemotherapy is generally not recommended after 35 weeks of pregnancy or within 3 weeks of delivery to avoid complications at birth. Chemotherapy can lower the mother’s blood cell counts, which can cause bleeding and infection during birth.
Radiotherapy
Radiotherapy is not recommended at any time during pregnancy as it can harm your unborn baby. It may cause miscarriage, birth defect, slow fetal growth or a higher risk of childhood cancer.
Endocrine and Targeted Therapies
Endocrine and targeted therapies are not safe to use during pregnancy, but can be given after birth if appropriate for your type of cancer.
Can I breastfeed during breast cancer treatment?
Most doctors recommend that women who have just had babies and are about to be treated for breast cancer should stop (or not start) breastfeeding.
If breast surgery is planned, stopping breastfeeding will help reduce blood flow to the breasts and make them smaller. This can help with the operation. It also helps reduce the risk of infection in the breast and can help avoid breast milk collecting in the surgical area.
Many drugs used in chemotherapy, endocrine therapy and targeted therapy can enter breast milk and be passed on to the baby. Breastfeeding is not recommended if you are having chemotherapy, endocrine therapy or targeted therapy.
How does pregnancy affect survival rates for breast cancer?
Pregnancy associated breast cancers are more advanced at diagnosis (larger tumours and lymph node positive). This is likely due to delays in diagnosis, with literature showing there is a delay of 2 to 15 months between first symptoms and diagnosis in pregnancy associated breast cancer compared with their non-pregnant counterparts.
The prognosis for pregnant women with breast cancer is similar to that for non-pregnant women at the same age and stage of cancer.
