Pregnancy-Associated Breast Cancer: Balancing Maternal and Fetal Health

Learn about the risks, symptoms, diagnosis, and treatment of breast cancer during pregnancy and the possibility of breastfeeding post-treatment.

Highlights:

Pregnancy-associated breast cancer (PABC) is a rare but aggressive form of breast cancer often diagnosed at an advanced stage
Hormonal changes during pregnancy can obscure breast cancer symptoms, making early detection crucial
Treatment decisions for PABC depend on cancer stage, pregnancy trimester, and overall health to ensure both mother and baby's well-being

The majority of breast cancers are diagnosed in women over the age of 50. Breast cancer during pregnancy is an uncommon but difficult condition in which a woman is diagnosed with breast cancer while pregnant (). Because of the need to balance the health and safety of both the mother and the developing baby, it offers unique challenges. Women over the age of 30 who have their first child have a higher risk of breast cancer than women who have never given birth, according to the National Cancer Institute.

Breast Cancer during Pregnancy
Management of breast cancer during pregnancy or pregnancy associated breast cancer requires special consideration to avoid harm to the fetus.

‘Breast cancer during pregnancy requires special care. Prioritize open communication with your healthcare team for the best outcome for both you and your baby. #breastcancer #pregnancy’

Breast Cancer Risk During Pregnancy

Due to delayed conception or older childbearing age, the prevalence of pregnancy-associated breast cancer has increased substantially during the last 30 years. According to the Johansson et al study, there is a 7% possibility of developing pregnancy-associated breast cancer (PABC) during pregnancy or the postpartum period (). PABC is a highly aggressive form of cancer, usually diagnosed at an advanced stage with an increased risk of localized relapse ().

Some risk factors for breast cancer during pregnancy include ():

Hormonal changes can hasten tumor growth, making it more difficult to detect.
Delayed diagnosis is common as a result of misinterpreting symptoms as pregnancy-related.
Women with dense breasts are more prone to develop breast cancer.
Women who have a family history of breast cancer may be at a higher risk.
Radiation exposure, such as for medical purposes, can also play a role.
Pregnancy after the age of 30 increases the chance of breast cancer.
Excessive alcohol consumption is also linked to breast cancer risk.
Sedentism and being overweight or obese after menopause both raise the risk of breast cancer.

First-Time-Moms Diagnose Breast Cancer During Pregnancy
Up to age 29, women have a one in 1,950 chance of developing breast cancer, rising to one in 210 by age 39 and one in 48 by age 49.

Breast Cancer Symptoms During Pregnancy

Symptoms of breast cancer during pregnancy include a painless lump in the breast, nipple changes such as inversion or discharge, skin changes such as redness or dimpling, and chronic pain (). Detecting these indicators is critical since hormonal changes during pregnancy might be confused with the standard breast cancer warning signs. Consult a doctor if you notice any changes in your breast.

Can Women with Breast Cancer Embrace Motherhood?
Motherhood after breast cancer doesn’t lower survival chances. The findings reassure breast cancer women who want to become mothers.

Breast Cancer Diagnosis During Pregnancy

Clinical tests and sonographic imaging may not provide appropriate results since the breast changes dramatically during pregnancy. While these are the initial steps in examination and diagnosis, mammography can be conducted with low risk to both mother and child; nonetheless, mammography's function in diagnosis is restricted. In certain cases, an ultrasonography examination can detect breast cancer. Core needle biopsy and chest radiography with sufficient shielding are also considered safe during pregnancy. At the same time, magnetic resonance imaging can detect metastases but is dangerous due to heating and cavitation ().

Breast Cancer
Breast cancer is a cancer that affects the breasts or mammary glands. Early detection and lifestyle changes help in controlling breast cancer.

Breast Cancer Treatment During Pregnancy

When PABC is diagnosed, the therapy must be carefully considered to give the best possible outcomes for both the mother and the child. The treatment strategy is determined by elements such as the cancer stage, the pregnancy trimester, and the mother's overall health.

While early-stage PABC (Stages I and II) is treated similarly to ordinary breast cancer, with modifications to protect the fetus, there is no standard treatment for late-stage PABC (Stages III and IV). In some cases, surgery to remove the tumor could be undertaken during pregnancy, while chemotherapy and radiation therapy could be explored after the first trimester. The care team will need to collaborate closely with the patient to design a specific treatment plan that balances the requirements of the mother with the safety of the unborn child ().

Can you Breastfeed While Having Pregnancy-Associated Breast Cancer?

Breastfeeding is the best method to bond with a newborn. Lactation from the treated breast is not contraindicated (). However, you might want to reconsider the decision to breastfeed during or immediately following breast cancer treatment. Some drugs can transfer into breast milk and harm the baby if breast cancer treatment includes chemotherapy and radiotherapy. Breastfeeding is possible once breast cancer therapy is completed. Individual circumstances, however, should be explored with the healthcare team.

A PABC diagnosis can be difficult and overwhelming, but it is critical to ask questions about the diagnosis, treatment, and recovery care at each point of the journey. To secure the greatest possible outcome for both you and your baby, it is critical to have an open and honest discussion with your healthcare practitioner.

References:

Breast Cancer During Pregnancy - (https://pubmed.ncbi.nlm.nih.gov/30202672/)
Family history and risk of pregnancy-associated breast cancer (PABC) - (https://pubmed.ncbi.nlm.nih.gov/25893584/)
Pregnancy Associated Breast Cancer: Awareness is the Key to Diagnosis -A Case Report - (https://pubmed.ncbi.nlm.nih.gov/26675315/)
Pregnancy-associated breast cancer: the risky status quo and new concepts of predictive medicine - (https://pubmed.ncbi.nlm.nih.gov/29515683/)
Cancer during pregnancy - (https://cancer.ca/en/cancer-information/cancer-types/cancer-during-pregnancy)
Breast cancer diagnosis during pregnancy - (https://pubmed.ncbi.nlm.nih.gov/19392610/)
Breast cancer during pregnancy and lactation - (https://pubmed.ncbi.nlm.nih.gov/2218825/)
Pregnancy-associated breast cancer - (https://pubmed.ncbi.nlm.nih.gov/22866188/)

Source-Medindia