Most breast cancers are found in women who are beyond 50 years of age. Breast cancer during pregnancy is a rare but challenging condition that occurs when a woman is diagnosed with breast cancer while expecting a child. It presents unique complexities due to the need to balance the health and safety of both the mother and the developing foetus.

According to the National Cancer Institute, women who are older than 30 when they give birth to their first child have a higher risk of breast cancer than women who have never given birth. Let us tell you about the key aspects of breast cancer during pregnancy and its treatment.

Health Shots got in touch with Dr Pritesh Munot, Consultant Medical Oncologist and Hemato Oncologist, Bombay Hospital, to understand more about breast cancer during pregnancy, this breast cancer awareness month.

Risk of breast cancer during pregnancy

The prevalence of pregnancy-associated breast cancer has increased rapidly over the last 30 years, owing to delayed pregnancy or an older childbearing age. As per the Johansson et al study, there is a 7 percent chance of pregnancy-associated breast cancer (PABC) being diagnosed during pregnancy or the postpartum period. Dr Munot says, “PABC is a highly aggressive form of cancer, usually diagnosed at an advanced stage with an increased risk of localized relapse.” Here are some risk factors for breast cancer during pregnancy:

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• Hormonal changes can accelerate tumor growth, making it harder to detect.
• Delayed diagnosis is common due to misconstruing symptoms as pregnancy-related.
• Women with high breast density are more likely to get breast cancer.
• Women with a family history of breast cancer may face an elevated risk.
• Furthermore, exposure to radiation, such as for medical purposes, can contribute.
• Having a pregnancy after the age of 30 also raises the risk of breast cancer.
• Excessive alcohol consumption is also a risk factor for breast cancer.
• Following a sedentary lifestyle and being overweight or obese after menopause also increase breast cancer risk.

Symptoms of breast cancer during pregnancy

Breast cancer during pregnancy can present with symptoms like a painless lump or thickening in the breast, nipple changes, such as inversion or discharge, skin changes like redness or dimpling, and persistent pain. Detecting these signs is crucial, as hormonal changes during pregnancy might confuse you with the typical warning signs of breast cancer. If you notice any change in your breast, consult with a doctor.

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Diagnosis of breast cancer during pregnancy

Since the breast changes quite drastically during pregnancy, clinical examinations and sonographic imaging may not give accurate results. While these remain the first steps to evaluation and diagnosis, mammography can be performed with minimal risk to both mother and child; however, the role of mammography is limited in diagnosis.

In certain conditions, an ultrasonography investigation can diagnose breast cancer, says Dr Munot. A core needle biopsy and chest radiography with adequate shielding are also considered safe during pregnancy. At the same time, magnetic resonance imaging can identify metastasis but carries risks due to heating and cavitation.”

Treatment of breast cancer during pregnancy

When PABC is diagnosed, the treatment must be carefully considered to ensure the best results for both mother and child. The treatment approach depends on factors such as the stage of the cancer, the pregnancy trimester, and the mother’s overall health.

Dr Munot says, “While early-stage PABC (Stages I and II) is treated in the same way as regular breast cancer, with changes to protect the foetus, there is no set treatment for late-stage PABC (Stages III and IV). In some instances, surgery could be performed during pregnancy to remove the tumor, while chemotherapy and radiation therapy could be considered after the first trimester. The care team will need to work closely with the patient to develop an individualized treatment plan that balances the mother’s needs and the unborn child’s safety.”

Can you breastfeed during PABC?

While breastfeeding is the best way to bond with a newborn child, breastfeeding is considered unsafe during or immediately after breast cancer treatment. When breast cancer treatment includes chemotherapy and radiotherapy, some medications can pass into breast milk and may harm the baby. After the completion of breast cancer treatment, breastfeeding is possible. However, it should be discussed with the healthcare team for individual circumstances.

Takeaway

A PABC diagnosis can be challenging and overwhelming, but it is essential to ask questions about the diagnosis, treatment, and recovery care throughout every stage of the journey. It is important to have an open and honest discussion with your healthcare professional to ensure the best possible outcome for both you and your baby.