Breast Cancer & Pregnancy
Breast Cancer Diagnosed During Pregnancy
Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy or within one year postpartum. It is a relatively rare condition. The possibility even through thin but is possible as more and more younger women are developing breast cancer due to change in the natural history of the disease. Challenges would be balancing effective cancer treatment while minimizing risks to the foetus.
Diagnosis During Pregnancy
- Symptoms: Breast changes are common in pregnancy with breasts becoming enlarged, engorged and heavy and dense. This potentially delays the diagnosis as the cancer related changes could be mistaken for pregnancy induced changes.
Common tests done during pregnancy when there is a suspicion of cancer would be imaging methods like Ultrasound and MRI as they do not involve any radiation. Rarely Mammogram could be done with shielding but generally avoided.
Treatment During Pregnancy
Treatment depends on the stage of breast cancer, trimester of pregnancy, and tumor biology. The primary goals are to maximize maternal survival while minimizing harm to the fetus. An option of termination of pregnancy is offered if the lady is in the first trimester.
Surgical Treatment
Mastectomy or Breast-Conserving Surgery can be done Safely during pregnancy. Further Axillary lymph node evaluation can also be performed if indicated. Surgery if necessary is usually done in the 2nd trimester ( After 3rd month of pregnancy)
Chemotherapy:
Chemotherapy is not allowed in first trimester of pregnancy. It can be considered following appropriate surgery or in Neo adjuvant format also as indicated. Selective molecules are given during pregnancy ( Doxorubicin or cyclophosphamide)
Radiation Therapy
Radiation therapy is not allowed in any trimester of pregnancy and it needs to be planned after completion of pregnancy.
Delivery Planning
- Decisions regarding delivery timing depend on cancer progression and treatment needs. Early delivery may be considered in advanced cases, balancing fetal maturity and maternal health.
Safety of Pregnancy
- Pregnancy does not increase the risk of breast cancer recurrence, including in hormone receptor-positive cancers.
Timing Pregnancy
Patients should wait until completing active treatment to consider pregnancy:
- Hormone Receptor-Negative Breast Cancer: Pregnancy may be considered 1–2 years after treatment.
- Hormone Receptor-Positive Breast Cancer: Pregnancy may be delayed until after completing hormonal therapy (usually 5–10 years).
- Temporary interruption of hormonal therapy to allow for pregnancy is being studied in a trail setting.
Risks and Complications
Pregnant women with a history of breast cancer require close monitoring by a multidisciplinary team, including oncologists, obstetricians, and fertility specialists.
Breastfeeding After Breast Cancer
Feasibility:
- Breastfeeding from the unaffected breast is possible after surgery or radiation.
- Breastfeeding is safe and does not increase the risk of recurrence.
Challenges
- Reduced milk production in the treated breast due to surgery or radiation.
- Ongoing hormonal therapy is a contraindication to breastfeeding.
