Pregnancy and Breast Cancer

Pregnant women can, and do, develop breast cancer. Prompt diagnosis and therapy are just as important in this population as in the population at large.

Very few pregnant women are diagnosed with breast cancer. But because more women are choosing to have children later in life, and because the risk of breast cancer increases as women age, there may be more cases in the future. Today about 1 out of 3,000 pregnant women is diagnosed with breast cancer.

Pregnancy brings about many hormone changes in the body. It interrupts the normal menstrual cycle hormone levels for some time. Because of this, women who go through pregnancy while they are young may have a slightly lower risk of breast cancer. Women who have had no children or who had their first pregnancy after age 30 have a slightly higher breast cancer risk.

It is helpful to conceptually divide the management of Breast Cancer during pregnancy into 2 steps:

• Making the correct diagnosis, and

• Managing the pathology in an appropriate and definitive manner that is as gentle as possible to the developing pregnancy and to the process of lactation.

 Breast cancer detection during pregnancy

When a pregnant woman develops breast cancer, it is often diagnosed at a later stage than it is in women who are not pregnant. This is because during pregnancy, hormone changes cause a woman's breasts to enlarge and become more tender and lumpy. This can make it harder for you or your doctor to find a lump in your breasts. Mammograms are also harder for doctors to read during pregnancy because the breasts become denser. The early changes caused by cancer could also be mistaken for or hidden by the normal changes that happen with pregnancy.

It is relatively safe to have a mammogram during pregnancy. The amount of radiation needed for a mammogram is small. And the radiation is focused on the breast. For extra protection, a lead shield is placed over the abdomen to stop radiation from reaching the womb. Still, scientists can't be certain about the effects of even a small dose of radiation on an unborn baby. If your doctor does not believe you need to have your mammogram right away, it may be best to wait. Other imaging tests that do not use radiation, such as breast ultrasound, may be used instead. These are thought to be safe alternatives to mammograms during pregnancy.

Even during pregnancy, early detection is an important part of breast health. Talk to your doctor or nurse about breast exams and the best time for your next mammogram -- especially if you are age 40 or older, or if you or your doctor notices a change in how your breasts look or feel. As always, if you find any lump or change in your breasts, tell your doctor or nurse right away.

Breast cancer diagnosis and staging during pregnancy

Biopsy

Although a new lump or abnormal imaging test result may cause concern, breast cancer can only be diagnosed by biopsy. During a biopsy a piece of tissue is taken from the area of concern. This is usually done either using a long, hollow needle or through a small surgical incision. A breast biopsy during pregnancy can usually be done on an outpatient basis. Local anesthesia is used to numb just the involved breast area. This causes little risk to the fetus. The biopsy can also be done under general anesthesia (where drugs are used to put the patient into a deep sleep) if needed, with only a very small risk to fetal well-being.