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Breast Cancer During Pregnancy

Can You Develop Breast Cancer During Pregnancy?

Any woman can develop breast cancer during pregnancy although it is a rare finding.

Can Breast Cancer in Pregnancy Affect my Baby?

Cancer does not usually spread to the baby in the womb, but treatments for breast cancer can put your baby at risk and must be administered cautiously.

Is it Possible to Safely Treat Breast Cancer during Pregnancy?

Although breast cancer can be safely treated during pregnancy, the type and timing of treatment will vary according to your pregnancy as well as other factors. A team of specialists coordinates to plan your care. Treating breast cancer in pregnancy is complicated as your doctor must ensure that your baby is unharmed while providing you with the most effective treatment.

What are the Factors That could Influence the Treatment of Breast Cancer during Pregnancy?

While you’re planning treatment for breast cancer, your doctors will consider:

  • The size and location of the tumour
  • Whether cancer has spread and the extent of spread
  • Your stage of pregnancy
  • Your general health
  • Your preference

Sometimes, certain treatments that are ideal for you may be harmful to your baby. You could choose to delay treatment for the safety of your baby, but you may be putting yourself at risk. In rare cases, your doctor may recommend that the pregnancy be terminated. These choices can be difficult and may require emotional support and counselling.

What are the Breast Cancer Treatments that are Safe during Pregnancy?

Surgery is the safest form of treatment for breast cancer during pregnancy. Chemotherapy may be administered after the first trimester (first 3 months of pregnancy). Other forms of treatment, such as radiation, targeted therapy, and hormone therapy, could harm your baby and are best administered after delivery.

What are the Surgical Treatment Options for Breast Cancer during Pregnancy?

There are two types of surgery to remove breast tissue:

  • Mastectomy: Removal of the entire affected breast
  • Lumpectomy: Removal of a part of the breast containing the tumour

Mastectomy is usually recommended if breast cancer is discovered early during your pregnancy while lumpectomy may be recommended for breast cancers detected in late pregnancy.

This is because lumpectomy is usually followed by radiation therapy to eliminate cancer cells and prevent a recurrence, and radiation can only be safely administered after delivery. If a lumpectomy is performed early during your pregnancy and there is a long wait for radiation therapy, the chances of cancer recurring are higher. Therefore, a mastectomy is preferred for breast cancer in early pregnancy as it minimizes the chances of recurrence.

Removal of lymph nodes: Your surgeon may also remove lymph nodes from your armpit or under your arm to check for cancer spread. Two types of procedures are performed:

Axillary Lymph Node Dissection (ALND): Most of the lymph nodes in your breast and under your arm are removed.

Sentinel Lymph Node Dissection (SLND): Radioactive tracers and a blue dye are used to track lymph nodes that are likely to contain cancer cells, and only those are removed. This type of surgery is mostly preferred for breast cancers that develop late in pregnancy.

Is the use of Anaesthesia for Breast Cancer Surgery Safe during Pregnancy?

There are certain times during pregnancy when the administration of anaesthesia may not be safe for your baby. Your anesthesiologist and doctors will determine the best timing that anaesthetic drugs and techniques can be used to safeguard your pregnancy.

How is Chemotherapy Administered for Breast Cancer during Pregnancy?

Chemotherapy may be administered following surgery or without surgery for advanced cases of breast cancer. It is not safe during the first trimester of pregnancy (first 3 months) when your baby’s internal organs are forming, and the chances of a miscarriage are higher. Certain types of chemotherapy may be administered during the second and third trimesters.

For breast cancers in early pregnancy, chemotherapy is administered during the second trimester. For breast cancers that develop as late as the third trimester, chemotherapy is usually administered after delivery. In these cases, your doctor may sometimes choose to induce birth earlier.

Chemotherapy is not administered 3 weeks before the due date or after 35 weeks of pregnancy as it can lower your blood count, increasing the risk of bleeding and infection.

What are the Treatments used for Breast Cancer after Pregnancy?

If you have been diagnosed with breast cancer during pregnancy, surgery and chemotherapy may be performed to treat cancer in a safe and effective manner. Other treatments for breast cancer include:

  • Radiation Therapy: This treatment uses ionizing radiation to destroy cancer cells and is usually performed after a lumpectomy. A lumpectomy may be performed in the third trimester and radiation are given soon after delivery.
  • Hormone Therapy: Some cancers have hormone receptors that bind to hormones such as estrogen, which promote the growth of cancer. This therapy reduces the availability of such hormones to the cancer cells.
  • Targeted Therapy: Some cancers produce a protein called HER2 that promotes cancer growth. This therapy prevents the production of HER2.

These treatments cannot be administered during pregnancy as they may affect your baby’s growth and health. They are usually administered after delivery as adjuvant therapy, depending on the stage of your cancer.

How is Breastfeeding affected by the Treatments given for Breast Cancer?

If you have just had a baby and are going to start chemotherapy, it is not advisable to breastfeed. Stopping feeding reduces the blood flow to the breast, thereby reducing the breast size. This makes surgery easier to perform and reduces the chances of infection. Additionally, drugs used in chemotherapy, targeted therapy, and hormone therapy can enter breast milk, so feeding is not recommended. Talk to your doctor if you wish to start breastfeeding again after therapy.

Can Pregnancy Affect the Outcome of Cancer Treatment?

Although diagnosis and treatment are more difficult for those who have breast cancer during pregnancy, studies reveal similar outcomes for those who are pregnant and those who aren’t. Nowadays, terminating a pregnancy is rarely recommended, except for more aggressive types of breast cancer. Sometimes ending the pregnancy can help slow the growth of advanced cancers, but this has not been shown to improve survival rates. There are also no studies to show that delaying cancer treatment for your baby’s sake has led to poor outcomes