8 Important facts about Pregnancy associated Breast Cancer
Pregnancy-associated breast cancer is diagnosed when a woman gets cancer while been pregnant, up to 1 year after delivery. Though many could be familiar with facts on breast cancer, may be unaware of how it reflects when associated with pregnancy. This article enlightens the most important facts about pregnancy-associated breast cancer, which are of concern.
It has been estimated that approximately 1 in 3000 cases of breast cancer could occur during pregnancy. As many women get pregnant when they are young, the average age of pregnancy-associated breast cancer has been reported as 32 – 38 years. This reflects adversely not only on the woman but on the development of the infant as well as on the entire family unit.
Breast cancer among women in their 20s and 30s could be due to family history genes up to 33% and 22% respectively. As pregnancy-associated breast cancer also affects the young, it is best to do genetic testing once the familial incidence is demonstrated within their family tree.
Pregnancy-associated breast cancer raises many concerns and worries. The 8 important facts about Pregnancy associated Breast Cancer are:
- Did the hormonal change that occurs during pregnancy cause this cancer?
- Can the pregnancy delay and obscure in detecting cancer?
- Can cancer cells spread to the womb affecting the baby?
- Is mammography during lactation harmful?
- Does my survival rates different to other women with breast cancer?
- Can I avoid total removal of the breast as a surgical option?
- How safe is chemotherapy during pregnancy?
- How safe is radiotherapy during pregnancy?
- Did the hormonal change that occurs during pregnancy cause this cancer?
Also read: Beat breast cancer be victorious…
Therefore, the pregnancy itself does not initiate cancer formation, but the hormonal change and influx of hormones during pregnancy might enhance the growth or the progress of the tumour faster than normal.
2. Can the pregnancy delay and obscure in detecting cancer?
The breasts will start to grow bigger around 6 to 8 weeks of pregnancy. Further, it will commence milk production in 16 weeks. During this period, the breasts can be tender, sore with sensitive nipples to touch. Sometimes there could be hard or firm lumpy areas within the breast that could be normal. But unusual firm lumps that persist and grow need to be attended to. Most women tend to ignore unusual lumps considering them to be harmless cysts filled with milk (galactocele) or benign fibroadenomas. This misconception and with engorged breasts do mislead many pregnant ladies to seek medical advice early. Apart from these misleading facts which can be avoided, routine investigations like an ultrasound scan of the breast are sensitive and specific in detecting cancers even during pregnancy.
Mammography uses a comparatively smaller dose of radiation and is focused more on the breast. But still, for all, it can be done with shielding of the pregnant uterus if there are concerns of irradiating the growing fetus. A mammogram could be more sensitive than an ultrasound scan on an engorged breast and can be done if the woman is older than 40 years.
Be aware that breast cancer could occur during pregnancy, and therefore it is important to seek medical advice and investigate as engorged breasts could conceal the growth and mislead.
3. Can cancer cells spread to the womb affecting the baby?
No. Although advanced cancer can spread via the bloodstream, it has never been reported to cross the placenta and affect the baby.
But if there are genetic predisposition genes as in familial breast cancer (family history of breast cancer), the mutated gene can affect some members in the next generation, during their early adulthood.
4. Is mammography during lactation harmful?
No. Mammography does not affect your milk or milk production. She can continue to feed the baby soon after the investigation is done.
Also read: Can Mammography Harm You
5. Does my survival rates different to other women with breast cancer?
Considering the cancer cell behaviour per se, the prognosis (the forecast of the likely outcome) of pregnancy-associated breast cancer do not differ from breast cancer that occurs in the non-pregnant. But if the cancer is detected late due to the facts mentioned above, or delay your treatment, may affect your prognosis and survival.
It is important to note that the usual treatment modalities recommended in the non-pregnant breast cancer patient could not be given appropriately in pregnancy-associated breast cancer, as some of them could harm the fetus. Therefore certain delays in treating when pregnant might harm the overall prognosis.
6. Can I avoid total removal of the breast as a surgical option?
Once pregnancy-associated breast cancer is diagnosed, should not delay treatment any longer. If the pregnancy is closer to term, it is wise to commence treatment after delivering the baby as soon as possible. But in case if the pregnancy has not reached the time for delivery, the treatment needs to be commenced. There is no evidence to recommend termination of the pregnancy during the first or the second trimester for the sake of starting treatment.
Surgery is the best choice as the first-line treatment. Total removal of the breast (mastectomy) with the management of the axillary (armpit) nodes is the gold standard. It should be noted that there is a risk of spontaneous abortion in the first trimester due to the effects of general anaesthesia.
Lumpectomy or breast conservation surgery (wide removal of the tumour) has relative contraindications in the offer during pregnancy, as radiation therapy which needs to follow soon cannot be given with a live fetus.
7. How safe is chemotherapy during pregnancy?
Chemotherapy has also shown beneficial effects in treating pregnancy-associated breast cancer. Although the usual chemotherapeutic agents used in treating breast cancer can be used in this instance, it is not recommended during the first trimester as these drugs have a teratogenic effect (affecting the normal development of organs in the fetus).
Tamoxifen is a hormonal drug (tablet form) that is used to treat breast cancer once all adjuvant treatment regimes (chemotherapy and radiotherapy) are completed. It is given usually for 5 years as a daily dose. As tamoxifen can cause spontaneous abortions, preterm labour, growth restrictions etcetera, is delayed until the pregnancy is over.
8. How safe is radiotherapy during pregnancy?
Radiation therapy is contraindicated during pregnancy due to the high risk of fetal damage. The hazardous effects of radiation are the main reason why breast conservation or lumpectomy cannot be offered during pregnancy, as radiation to the rest of the breast should always follow after partial removal of the breast. Many studies have shown that if the follow-up radiation is given within 6 weeks after surgery, is safe and have no impact on the prognosis. Hence if pregnancy is closer to term, breast conservation can be offered when radiation is given within 6 weeks, after the delivery of the baby.
My wife is having large cyst in her breast. Will it turn to he a cancer? If so is it necessary to carryout FNAC test?
Dr. Naomal Perera MBBS, MS, FRCS(Edin), FSSO(USA)says:
Thank you for visiting Cancer in Sri Lanka site.
Cyst is a bubble filled with water, in the breast. They are non cancerous and will not change later into a cancer.
FNAC will only aspirate the fluid out and the report will be inconclusive, unless there is a solid component within the cyst. Therefore no need of FNAC for simple cysts.
But follow up ultra sound scan is useful.
Dr Naomal Perera