Being diagnosed with breast cancer while pregnant is not a regular event. It is estimated that it occurs in 1 in 1,000 to 1 in 10,000 pregnancies.
Breast cancer identified during pregnancy or in the first year after birth is referred to as pregnancy-associated breast cancer.
The chances of breast cancer in pregnancy may increase as a result of more women having children later in life. Further, the risk of having breast cancer increases as a woman’s age increases. Although pregnancy does not cause breast cancer, however if you already have some, the hormonal changes of pregnancy may cause them to expand.
Screening during pregnancy
Breast cancer is the most frequent cancer in India, accounting for 2.5–32 percent of all female malignancies, and has surpassed carcinoma cervix as the primary cause of cancer. It is becoming more frequent in younger age groups, and it is one of the most common malignancies during pregnancy, along with melanoma and cervical cancer. Pregnancy-associated breast cancer (PABC), defined as breast cancer that occurs during pregnancy or during the first year after birth, is quite uncommon, with an incidence of one in 3000. Because of prenatal physiological changes in the breast and incidence at a younger age, the diagnosis is nearly always delayed. A one-month delay in diagnosis results in a 0.9 percent increase in the likelihood of lymph node metastases. When breast cancer is discovered in the first trimester, the option of terminating the pregnancy should be explored. The National Comprehensive Cancer Network guideline, on the other hand, does not suggest medical abortion for pregnancy-associated breast cancer, particularly in women with early breast cancer. The Society of Medical Oncology likewise believes that, since evidence of a difference in prognosis between pregnant and non-pregnant women with breast cancer is absent, pregnancy termination in that context is not recommended, regardless of the tumor’s ER status. Breast cancer is treated throughout the second and third trimesters with mastectomy followed by chemotherapy. Anthracyclines and cyclophosphamides are safe to administer; however, evidence on the usage of taxanes is sparse. Another option is to use neoadjuvant chemotherapy before surgery to enable tumour downstaging and to make surgery easier. Mastectomy is sufficient for low-risk cancers since chemotherapy is not indicated; radiotherapy, targeted therapies, and endocrine treatments are postponed until after delivery.
Mammograms may be explored during pregnancy for women who have indications or symptoms of probable breast tissue.
According to the Cancer Society, having a mammogram while pregnant is mostly safe. A mammography requires just a little amount of radiation, and the radiation is concentrated on the breast, so the majority of it does not reach other regions of the body. A lead shield is put over the belly for further protection, preventing any harmful radiation dispersion.
During pregnancy, regular screening mammography is not performed on women who have no symptoms.
Ultrasound is often done prior to mammography to assess a palpable mass (a lump you can feel).
Ultrasound can properly determine whether a lump is a harmless cyst filled with fluid or a solid tumour that might be malignant in both pregnant and non-pregnant women. It is, however, much less accurate in discriminating between a solid lump that is breast cancer and a solid lump that is not.
The safety of magnetic resonance imaging (MRI) during pregnancy has not been proved, according to the Food and Drug Administration. Nonetheless, the majority of modest studies on MRI during pregnancy demonstrate no adverse effects. MRI is occasionally used to examine breast tumours in pregnant women that seem to be malignant on a mammogram. Consult your doctor to determine if this sort of test is safe for you and your baby.
Doctors must remove a tiny bit of the suspicious breast lump in pregnant women in order to diagnose breast cancer with confidence. This is referred to as a biopsy. Such tissue may be extracted with a needle (needle or core biopsy) or surgically by removing the whole lump (excisional biopsy).
Breast biopsies may normally be performed as an outpatient treatment during pregnancy. The doctor numbs just the region of the breast that will be biopsied using medication. The infant is not in any danger. A biopsy may also be performed under general anaesthesia if necessary, with only a minor risk to the foetus.
Breast cancer and pregnancy: Treatment that considers the baby’s health
Pregnancy complicates the diagnosis and treatment of breast cancer. The goal is to either cure the cancer or stop it from spreading while simultaneously protecting your baby’s health. In order to offer the greatest care for you and your baby, your cancer care team and your obstetrician will need to work together.
There are no known incidences of breast cancer spreading to a foetus, though it has been identified in the placenta in a few situations.
According to one study that tracked infants who were exposed to chemotherapy in utero for more than 18 years, no cancer or other significant abnormalities were discovered.
Still some therapies may need to be postponed until the baby is born. The goal is to carry the kid to full term as much as feasible.
Another important point is that the chances of survival are unlikely to improve if the pregnancy is terminated. When compared to non-pregnant women with similar forms of breast cancer, both groups have the same overall prognosis.
What are the alternatives for treating breast cancer during pregnancy?
Much will rely on the degree of the malignancy when developing a treatment plan. Your doctors will consider the following:
● The quantity and size of tumours
● The tumour grade reflects how quickly the cancer is predicted to grow and spread.
● The particular form of breast cancer
● How far along in your pregnancy you are
● Your overall health
● Individual preferences
Even if you are pregnant, surgery is the first-line treatment for breast cancer. This could include breast-conserving surgery (lumpectomy) or a mastectomy with lymph node removal.
Although general anaesthesia may provide some risk to the baby, breast surgery for early stage breast cancer is considered safe during pregnancy.
Chemotherapy is often not administered during the first trimester of pregnancy, when the baby’s internal organs are growing. Some chemo medicines are safer to use during the second and third trimesters, according to research. Although they are rarely used in the final three weeks of pregnancy.
Chemotherapy may be used depending on the type of breast cancer you have and how aggressive it is. Waiting till after you deliver is a possibility in some instances.
High doses of radiation provided at any moment during pregnancy can raise the baby’s chance of injury. These dangers include:
● Slowing of foetal growth
● Birth defects
● Cancer in children
● As a result, radiation therapy is frequently postponed until after the baby is born.
Mastectomy during pregnancy
Regardless of whether you are pregnant or not, surgery is the primary treatment for breast cancer.
Lumpectomy is often combined with radiation therapy, however the radiation must be administered after the baby is born. This is an option if you are nearing the end of your pregnancy and radiotherapy will not be delayed for too long.
In most cases, mastectomy is the better option. During a mastectomy, the surgeon will also examine the lymph nodes beneath your arm to see whether the cancer has spread. This occasionally necessitates the use of radioactive tracers and dye. Your doctor may advise against it depending on how far along you are in your pregnancy.
General anaesthesia may endanger the infant. Your obstetrician, anesthesiologist, and surgeon will collaborate to determine the most safe time and manner for the surgery.
Breastfeeding and cancer therapy
Breast feeding is possible after a lumpectomy, however scar tissue and decreased milk volume can make it difficult in that breast. The opposite breast is unaffected.
You will be able to breastfeed from the unaffected breast if you have a single-sided mastectomy.
Chemotherapy, hormone therapy, and targeted therapy medications can be passed on to your baby through breast milk.