Breast Cancer During Pregnancy

Breast cancer found during pregnancy is a challenge, but one that a multidisciplinary team can help you manage. About 7% of breast cancers are diagnosed during pregnancy.

I've found a lump. How will they diagnosis it?

A physician will feel the lump, looking for certain characteristics. An ultrasound is a helpful tool in determining if the lump has characteristics of cancer. Mammography is usually not performed on a pregnant woman because of the density of the breast during pregnancy and the contraindications of radiation to the fetus. If the lump has suspicious characteristics, a needle biopsy, using only local anesthesia, can be performed for a study of the cells. This type of biopsy is safe anytime during pregnancy.

Is breast cancer during pregnancy a more aggressive disease?

It was long thought that breast cancer during pregnancy carried a less favorable prognosis. It is now known through clinical studies that the course of the disease is no different. The differences are in decisions of how to manage the disease and maintain pregnancy.

Do I have to have an abortion if I do have breast cancer?

The high levels of estrogen and prolactin during pregnancy may stimulate a cancer to grow, but studies have shown that abortion does not change the course of your cancer and does not improve chances of survival. Abortion is an option only when aggressive chemotherapy is required early in the pregnancy.

What about surgery for breast cancer?

Surgical choices for breast cancer during pregnancy are limited. Breast conservation (lumpectomy) can only be done if delivery is within 6 to 8 weeks. Radiation therapy is needed after a lumpectomy. Radiation therapy is contraindicated with pregnancy because of potential side effects to the baby. Mastectomy, unlike lumpectomy, can be performed anytime during pregnancy.

Can I have general anesthesia during pregnancy?

After the first trimester (3 months) during pregnancy, women can have general anesthesia for a mastectomy. If you are in your first few months of pregnancy, your physician will discuss surgical options with you. When you have your surgery, the baby will be monitored carefully and the smallest possible amount of anesthesia is given.

Can I have chemotherapy during pregnancy?

During the first trimester (3 months) of pregnancy, chemotherapy is not recommended. Your physician will discuss the possibility of delaying treatment. There is a risk anytime during pregnancy for abnormalities in fetal development if chemotherapy is given. However, the risks are greatly reduced after the first three months. Your physician will discuss with you these risks. Chemotherapy drugs are usually administered differently and some drugs are avoided during pregnancy.

Can I breast feed after breast cancer?

You can breast feed from the remaining breast. It has never been documented that breast milk increases the risk of an offspring having breast cancer in the future. If you have a lumpectomy and radiation therapy, the treated breast will usually not produce milk, but the other breast will continue to be functional.

Can I breast feed if I'm taking chemotherapy?

Breastfeeding during chemotherapy is not recommended. Systemic chemotherapy reaches high levels in breast milk.

If I take chemotherapy during pregnancy, what special care should I take?

• You will need to monitor carefully your diet to ensure adequate calories and nutrition.
  
• If you take drugs which cause nausea and vomiting, you will need to carefully monitor your intake to maintain your fluids. Your doctor will probably order antinausea medication. Report any persistent nausea and vomiting immediately.
  
• Constipation is a major problem during pregnancy and, often, chemotherapy drugs can compound this difficulty. Monitor your bowels, avoid constipation and report any problems to your physician.
  
• Fatigue is a problem for pregnant women and will be compounded with chemotherapy. You will need to plan your activities to get as much rest as possible. Avoid strenuous activities that tire you unnecessarily.
  
• Report any spotting or bleeding immediately. Chemotherapy drugs lower your clotting factors and you are at a higher risk for bleeding.

Your delivery will be planned to occur when your blood counts are at a safe level to prevent bleeding and infections.

For more information, please call The Connie Dwyer Breast Center at (973) 877-5189.

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