Breast Cancer During Preganancy
Breast cancer during pregnancy is becoming more common as women put off child bearing until they older and thus more and more older women are having children. We are also seeing an increase in breast cancer in younger women. For these reasons, there is a growing body of literature on how to successfully treat pregnant women with breast cancer. Many women have gone on to have healthy babies and live healthy lives after a diagnosis of breast cancer. Even more reassuring, the research shows that pregnant women who have breast cancer can do as well as non-pregnant women who have breast cancer.
Diagnosis During Pregnancy
Breast cancer can be harder to diagnosis during pregnancy and breast feeding due to the changes that occur to the breast. For this reason, the cancers that are diagnosed in pregnant or nursing mothers tend to be larger than those in non-pregnant women. It is appropriate to seek a consultation with a breast surgeon if you have a lump or other finding in your breast that concerns you or otherwise catches your attention. The issue may be more difficult to sort out and answer definitively as some tests are either not safe or less accurate during pregnancy but many diagnostic procedures and treatments are safe for pregnant women and their babies.
Treatment for a breast cancer that is found during pregnancy will depend upon the characteristics or your tumor, the stage and how far along you are in your pregnancy. The treatments usually end up being fairly similar to non-pregnant patients. What your treatment team will pay a lot of attention to is the order and timing of the therapies relative to the different trimesters of your pregnancies.
In terms of surgical options, both mastectomy and partial mastectomy (also called lumpectomy) can be options. There can be more factors than just tumor size when deciding between mastectomy and lumpectomy when you are pregnant. Radiation is not recommended during pregnancy. When it is necessary, radiation treatments are given after delivery. The need for, and the potential for a delay, in radiation may move a patient towards mastectomy. A young age at diagnosis may be the result of a gene mutation which could alter surgical choice and a lactating breast poses another set of surgical challenges.
Your medical oncologist will give you systemic therapy to help make sure the cancer does not come back not spread to other parts of your body. Systemic therapy includes chemotherapy. Chemotherapy is not given during the first trimester as it can cause birth defects and even the loss of the pregnancy. Every mother wants only the best for her baby, so it can be hard to fathom but there are some chemotherapy agents that can be safely given to a pregnant mother after the start of the second trimester. Endocrine therapy is considered an important treatment for women who have estrogen or progesterone receptor positive breast cancer. However, endocrine therapy essentially blocks hormones that are important for a heathy pregnancy and therefore endocrine therapy is not recommended during pregnancy. If such treatments are indicated, they will be started after delivery. There may be some chemotherapy agents that could not be given safely while you were pregnant. Those may also be given after delivery. In some cases, consideration is given to delivering the baby early in order to minimize the delay for treatment.
The medications that you will be taking after delivery may cross into your breast milk. They may not be safe for the baby. For this reason, it may be recommended that you not breast feed while on certain treatments. Lactation specialists are available to help with questions and concerns. You will also have a maternal-fetal medicine specialist on your team to help guide the team and monitor the health of your baby. You can be reassured that the team at Alaska Breast Care and Surgery along with the other providers at the Providence Cancer Center have experience successfully treating women who had breast cancer while they were pregnant.
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