Breast Cancer and Pregnancy

Typically, breast cancer affects menopausal women. However, one in four women diagnosed with breast cancer will be in her childbearing years. Additionally, between 1 in 1,000 and 3 in 1,000 pregnant women will be diagnosed with breast cancer. In fact, breast cancer is more frequently diagnosed in pregnant women compared to non-pregnant women of the same age. Although diagnosing breast cancer in pregnant women may be more difficult, early detection can improve your prognosis.

Lumps, Bumps and Other Changes
One of the first signs of pregnancy is changes in the breast. In addition to swelling, your breasts likely feel more tender and sore. These changes are due to the increase in estrogen and progesterone in your system. While extra estrogen helps to promote the growth of your breast ducts, the increase in progesterone stimulates your glandular tissue, causing it to expand.

It is also very normal to notice some new lumps and bumps emerge in the breast area. The vast majority of the time, these lumps are due to cysts or other non-cancerous tumors that have grown due to the increase in estrogen in your system. Furthermore, many pregnant women experience some type of discharge from their nipples. This is commonly attributed to your breast ducts being irritated. Although these changes are normal and often nothing to worry about, they can also mask the signs of breast cancers.

If you experience any type of nipple discharge or notice a new lump during pregnancy, bring it to your health care providers attention. There�s never any harm in being cautious.

Breast Cancer Checks
An important part of breast cancer prevention is breast cancer screening, which involves both clinical and self breast exams. While you may be tempted to skip the self-exam now that you�re pregnant, it is important to remember the imperative role breast exams play in early breast cancer detection.

In addition to self-exams, your prenatal health care provider should also make a point of checking your breasts every month. Ideally, you should have a clinical breast exam at your first prenatal appointment, before your breasts have gone through any major changes. These clinical breast cancer checks should continue throughout your pregnancy.

As your pregnancy progresses, and your breasts become larger and more swollen, it can get harder to detect breast cancer. As a result, delayed diagnosis becomes a concern. This means that a breast cancer diagnosis may not occur until the cancer is considered to be advanced. Performing regular self and clinical exams can help to avoid this as you and your practitioner become more familiar with what is normal for your breasts. Any suspicious changes that may occur are likely to be noticed sooner and investigated quicker.

I�ve Found Something � Now What?
If you haven noticed a lump or some other unusual change in your breast, notify your doctor right away to have it examined. While mammograms and ultrasounds are commonly used for detecting the presence of tumors, during pregnancy these methods are not as helpful due to the fact that your breasts are denser. Additionally, mammograms and ultrasounds can miss as much as 10% to 15% of malignant tumors, even those that are palpable. Instead, it is likely that you will receive a non-surgical biopsy.

A non-surgical biopsy is typically done through a fine needles aspiration (FNA). This is the least invasive method of performing a biopsy and can be done quickly with relatively little pain. To carry out an FNA, your doctor will insert a fine needle into the suspicious lump. The needle will then draw out cells from the lump, which will be studied under a microscope. If the cells reveal that you have cancer, treatment will be recommended. However, it is important to remember that as much as 80% of lumps found in the breast are benign, or non-cancerous.

Should I Receive Treatment?
If you have been diagnosed with breast cancer, it is important to seek treatment right away. Generally, the only time that treatment is put-off is when a woman�s due date is just two to three weeks away.

Once you have received a breast cancer diagnosis, further testing will be done to determine the stage of your breast cancer. Just how far advanced your breast cancer is will indicate which type of treatment is best. Stage 3 breast cancer or stage 4 breast cancer, because of their advanced progression, will require thorough discussion with your health care provider as to what form of treatment you should pursue.

Typically, treatment for early stage breast cancer in pregnant women will involve surgery, most likely a mastectomy although a lumpectomy may be done instead. Having a mastectomy, though, generally eliminates the need for radiation treatment for breast cancer later. Once the baby is born, chemotherapy may be started, so long as you are not breastfeeding.

Many women who have undergone surgery for breast cancer desire to have reconstructive breast surgery done. If you desire to have breast reconstruction done but are breastfeeding, you will likely be advised to wait until you have finished breastfeeding and your breasts have returned to the pre-pregnancy size.

What About My Baby
One of the first questions that comes to a woman�s mind when she is diagnosed with breast cancer during pregnancy is whether she should terminate the pregnancy. Currently, there is no evidence to support the fact that a termination is necessary; the cancer will not affect the child. However, the type of treatment you require may be dangerous to your developing baby.

Typical cancer treatments, like chemotherapy and radiation treatment, can increase your child�s risk of being born with birth defects as well as increase your risk of a miscarriage. Yet, recent studies have found that women undergoing chemotherapy during their second or third trimester are not necessarily at any more risk of experiencing complications. All of the women involved in the studies had live birth while only a few delivered a child with a low birth weight or went into premature labor. This suggests that pregnant women diagnosed with breast cancer after the 14th week of pregnancy may be able to receive effective treatment right away. However, you will need to discuss the issue thoroughly with your doctor first.

While it is safe to breastfeed a child if you have cancer, chemotherapy shouldn�t be pursued during this time as the drugs can pass through the milk.


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