By Dr Suhasini Inamdar
It may sound strange, but it is possible to get breast cancer during pregnancy. The occurrence is of course quite rare and it is estimated to happen to one in five thousand pregnancies. Getting pregnant is not a risk for getting breast cancer, but it is possible that the hormonal changes during pregnancy could aggravate the condition of a person who already has cancer cells in the breast.
Breast cancer could occur during pregnancy or even in the first year of postpartum. This is usually seen more in geriatric pregnancies or those who delay their pregnancy. Therefore, it is thought that the number of pregnancy associated breast cancer rates will continue to rise. A study says that only 6.5 per cent of women under the age of 40 are affected by breast cancer during pregnancy.
Diagnosis and treatment
Often, diagnosis is delayed because breast masses are thought to be related to pregnancy. While a normal woman’s breast would show up the mass and be diagnosed earlier, it would be difficult to discover in a pregnant woman because of the increased density of breasts. Once a mass is identified a breast ultrasound is usually done to confirm the diagnosis. Once this is done, a fine needle aspiration is performed to draw fluid and tissue which is sent for tests. More than 80 per cent of breast masses during pregnancy are benign.
Doctors don’t insist on ending the pregnancy because there is no benefit to that. Breast cancer also does not harm the baby, but the kind of treatment you receive will depend on various factors including the general health of the woman, how advanced the cancer is and how far she is in her pregnancy.
Surgery is usually safe during any trimester of pregnancy. Doctors usually advise surgery to remove the lump or perform a mastectomy, if the patient is in the first or second trimester. Chemotherapy and radiation is however not recommended for the woman during pregnancy because it could harm the baby. It could result in preterm birth, low birth weight if the baby is exposed to certain drugs or chemotherapy.
At times if radiation treatment is required urgently and the pregnancy is still in the first trimester, the mother could be advised to abort the pregnancy. Hormone therapies are also not considered safe to use during pregnancy. Inducing of early labour is only considered if the kind of treatment that is required is harmful to the baby. The good news, however, is that delivery of the baby is usually safe when precautions are followed.
Breastfeeding during treatment
It is possible to breastfeed if only a part of the breast is removed, but there could be scar tissue and decreased production of milk. Feeding is possible in the breast that is not affected. Women who are having chemotherapy and hormone treatments are advised not to breastfeed the baby because the drugs could be passed on to the baby in the milk.
If surgery is scheduled after the birth of the baby, doctors usually advise the mother not to breastfeed the baby. This will ensure less flow of blood to the breasts and could help with the operation. Risk of infection is also reduced by this.
Making sure the patient is monitored at all times, with regular scans for the foetus is important during pregnancy. The patient should be advised to join a support group and be counselled to understand her options. A team of multidisciplinary specialists would be able to help address her needs and that of the baby.
It is therefore mandatory to get the breast examination done prenatally and while visiting the obstetrician for the first-time during pregnancy.
(The writer is Consultant Obstetrician & Gynecologist, Motherhood Hospitals, Indiranagar, Bangalore.)