1991;67:869-872. ©2019 National Breast Cancer Foundation, Inc. is a non-profit organization with a 501(c)(3) tax-exempt status. If you are diagnosed with breast cancer while pregnant, your treatment options will be more complicated because you will want to get the best treatment for your cancer while also protecting the baby. With a slightly different rank order, these cancers are also the most common in women of childbearing age. We’ve invested more than $4.9 billion in cancer research since 1946, all to find more – and better – treatments, uncover factors that may cause cancer, and improve cancer patients’ quality of life. It’s hard to do research in this area, and good, unbiased studies don’t exist. This removes many of the lymph nodes under the arm. Philadelphia, Pa: Elsevier; 2020. Pregnancy can complicate breast cancer diagnosis.Breasts tend to be more dense and lumpy during pregnancy, so it may be difficult to feel a tumor until it grows larger, delaying diagnosis. It can be a traumatic and extremely difficult situation, but there is still hope for both mother and child, thanks to the many treatment options available. Waiting too long to start radiation can increase the chance of the cancer coming back. Is there a link between oral contraceptives and breast cancer? Abdel-Hady el-S, Hemida RA, Gamal A, et al. Filippakis GM, Zografos G. Contraindications of sentinel lymph node biopsy: Are there any really? Your surgeon and anesthesiologist, along with a high-risk obstetrician, will need to work together to decide the best time during pregnancy to do the operation. Your dense breasts also make mammography less reliable. This can help with the operation. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Lancet Oncol. Breast cancer is found in about 1 in every 3,000 pregnant women. Women who are diagnosed with breast cancer during pregnancy have tremendous additional strain due to concern for the safety of the unborn child. Researchers still don’t know if these children will have any long-term effects. The American Cancer Society couldn’t do what we do without the support of our partners. Ther Adv Med Oncol. Making Strides Against Breast Cancer Walks, Common Questions About the COVID-19 Outbreak, Treatment of Triple-negative Breast Cancer, If the cancer has spread and if so, how far, Removing just the part containing the cancer. Second trimester: If breast cancer is found during the second trimester of pregnancy, the guidelines recommend either mastectomy … Chemotherapy (chemo) may be used after surgery (as adjuvant treatment) for some earlier stages of breast cancer. If you have questions, such as when it might be safe to start breastfeeding, talk with your health care team. It also may be used by itself for more advanced cancers. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf on August 8, 2019. Together, we’re making a difference – and you can, too. Again, these drugs are thought to be unsafe to use during pregnancy. © 2021 American Cancer Society, Inc. All rights reserved. One way to do this is an axillary lymph node dissection (ALND). What celebrities have or have had breast cancer? Although the cancer itself cannot spread to and harm the unborn child, sometimes the best treatment plan for the mother may put the unborn child at risk. National Comprehensive Cancer Network (NCCN). Because of this, if hormone therapy is prescribed, it will most likely be used only after the baby is born. It is sometimes diagnosed at a later stage because changes in the breast during pregnancy and breastfeeding can make the cancer more difficult to detect. Modified radical mastectomy, the preferred surgical option in women with breast cancer during pregnancy, can be accomplished with minimal fetal risk. Site by, Myth: Finding a lump in your breast means you have breast cancer, Myth: Men do not get breast cancer; it affects women only, Myth: A mammogram can cause breast cancer to spread, Myth: If you have a family history of breast cancer, you are likely to develop breast cancer, too, Myth: If the gene mutation BRCA1 or BRCA2 is detected in your DNA, you will definitely develop breast cancer, Myth: Antiperspirants and deodorants cause breast cancer. Accessed at https://www.cancer.gov/types/breast/hp/pregnancy-breast-treatment-pdq on August 9, 2019. Chemotherapy may be a treatment option, depending on your cancer type and the stage of your pregnancy. 2018 Aug;298(2):363-372. Surgery during pregnancy is considered safe for the baby, so it's usually the first treatment option for pregnant women with breast cancer, especially the early stages of cancer. Arch Gynecol Obstet. Because of these concerns, some experts recommend that SLNB be used only later in pregnancy, and that the blue dye not be used during the procedure. Another procedure, called a sentinel lymph node biopsy (SLNB), might be an option depending on how far along you are in pregnancy and your cancer stage. But this, too, has proven to be a difficult area to study. Murphy CG, Mallam D, Stein S, et al. Breast cancers can be harder to find when you’re pregnant Hormone changes during pregnancy cause the breasts to change. You cannot pass cancer on to your baby. You are likely to feel a range of emotions that may include anger, sadness or fear. Research. Challenges in managing breast cancer during pregnancy. 11th ed. In women who aren’t pregnant, trastuzumab is used as a part of treatment after surgery, pertuzumab can be used with trastuzumab before surgery, and all of these drugs can be useful in treating advanced cancer. The literature yield in this topic is poor given the rarity of the disease. Metastatic breast cancer during pregnancy is a challenging situation. You will also need the emotional support of family and friends and may benefit from the professional assistance of a skilled counselor or psychologist. Treatment of breast cancer during pregnancy: An observational study. It is known as pregnancy–associated breast cancer. Can breastfeeding reduce the risk of breast cancer? BREAST CANCER DURING PREGNANCY Treatment of patients with breast cancer during pregnancy should be decided on an individual basis according to international guidelines within an expert multidisciplinary team, expanded to include obstetricians and perinatologists, and according to patients' preferences. But there are certain times in pregnancy when anesthesia (the drugs used to make you sleep for surgery) may be riskier for the baby. Management strategies should be discussed in a multidisciplinary manner and each case have to be counselled separately and informed about the pros and cons of different treatment options. Most doctors recommend that women who have just had babies and are about to be treated for breast cancer should stop (or not start) breastfeeding. It also helps reduce the risk of infection in the breast and can help avoid breast milk collecting in biopsy or surgery areas. This may cause miscarriage, birth defects, slow fetal growth, or a higher risk of childhood cancer. Pregnancy-associated breast cancer: maternal breast cancer survival over 10 years and obstetrical outcome at a university centre of women's health. Physician Data Query (PDQ). Does a family history of breast cancer put someone at a higher risk? Whether you or someone you love has cancer, knowing what to expect can help you cope. The high doses of radiation used for this can harm the baby any time during pregnancy. Oncology. Chemo is generally not recommended after 35 weeks of pregnancy or within 3 weeks of delivery because it can lower the mother’s blood cell counts. About Breast Cancer > Types > Breast Cancer During Pregnancy. Studies have not shown that the treatment delays that are sometimes needed during pregnancy have an effect on breast cancer outcome, either. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Petrek JA, Dukoff R, Rogatko A. Prognosis of pregnancy-associated breast cancer. For reprint requests, please see our Content Usage Policy. Tumor characteristics and prognosis in women with pregnancy-associated breast cancer. Castillo JJ, Rizack T. Chapter 64: Special Issues in Pregnancy. Outcomes of children exposed in utero to chemotherapy for breast cancer. Diagnosing Breast Cancer During Pregnancy. Cancer.org is provided courtesy of the Leo and Gloria Rosen family. Other breast cancer treatments, such as hormone therapy, targeted therapy, and radiation therapy, are more likely to harm the baby and are not usually given during pregnancy. Breasts typically get larger and change texture during pregnancy and … 2019. Your treatment plan will depend on the size of the tumor, its location, and the term of your pregnancy. J Clin Oncol. A counselor or psychologist should also be part of your health care team to help give you the emotional support you may need. Still — and if only for reassurance — it’s a good idea to get any new breast lump you notice checked out by your gynecologist. Abeloff’s Clinical Oncology. Current or recent pregnancy is associated with adverse pathologic features but not impaired survival in early breast cancer. Philadelphia, Pa. Elsevier: 2014. If you are already in the third trimester when the cancer is found, the chemo may be delayed until after birth. Pregnant women can safely get treatment for breast cancer, although the types of treatment used and the timing of treatment might be affected by the pregnancy. 6th ed. In addition to removing the tumor in the breast, one or more lymph nodes in the armpit (axillary lymph nodes) also need to be removed to check for cancer spread. Chemotherapy seems to be safe for the baby if given in the second or third trimester of pregnancy, but it isn’t safe in the first trimester. The society believes that, due the increasing numbers of women having children later in life, the rates of breast cancer during pregnancy will also increase. Management of pregnant women with breast cancer. There’s no conclusive evidence that breast cancer during pregnancy is more aggressive than breast cancer at other times. The cancer outcomes for women in this population are no different than for patients who are not pregnant while fighting breast cancer, but these expectant mothers experience higher rates of C-section and induced birth. Sometimes breast cancer occurs in women who are pregnant or have just given birth. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Everolimus (Afinitor) and palbociclib (Ibrance) are also targeted drugs that can be used with hormone therapy to treat advanced breast cancer. The effects of hormone therapy on unborn children is not entirely understood. We read with interest Sibylle Loibl and colleagues' report about the safety of chemotherapy for breast cancer during pregnancy in both the mother and child.1 The long-term potential of genotoxic effects in the child from in-utero exposure to chemotherapy is a cause for concern and remains unaddressed. How does menstrual and reproductive history affect breast cancer risks? Getting pregnant doesn't cause the cancer, although the changes in hormones from the pregnancy can make the disease grow faster. The Oncologist 2017;22:324-334 IMPLICATIONS FOR PRACTICE: Breast cancer during pregnancy is a major ethical and professional challenge for both the patient and the multidisciplinary treatment team. Options for breast cancer surgery might include: Mastectomy is used more often for pregnant women with breast cancer because most women who have BCS need radiation therapy afterward. While a pregnancy on its own can be fraught with anxieties and worries, a pregnancy with breast cancer (pregnancy breast cancer) can make things much more complicated. 2011;103:337-340. Surgery to remove the cancer in the breast and nearby lymph nodes is a major part of treatment for any woman with early breast cancer, and generally is safe in pregnancy. 2013;5(Suppl 1):S62-67. But there are concerns about the effects the SLNB dye might have on the baby. This could cause bleeding and increase the chances of infection during birth. Jagsi R, King TA, Lehman C, Morrow M, Harris JR, Burstein HJ. The American Cancer Society is a qualified 501(c)(3) tax-exempt organization. World J Surg Oncol. Abeloff’s Clinical Oncology. Zagouri F, Sergentanis TN, Chrysikos D, et al. Help make it a reality. Henry NL, Shah PD, Haider I, Freer PE, Jagsi R, Sabel MS. Chapter 88: Cancer of the Breast. Radiation is normally given after chemotherapy treatments are complete. How often should I go to my doctor for a check-up? McGrath SE, Ring A. What kind of impact does stress have on breast cancer? Murthy RK, Theriault RL, Barnett CM, et al. There are specific windows of time during pregnancy that is safe to receive chemotherapy without harming the baby. Is there a link between hormone replacement therapy (HRT) and breast cancer? Disaster Med Public Health Prep. This is because some cancer symptoms, such as bloating, headaches, or rectal bleeding, are also common during pregnancy in general. And there’s no evidence that your child will develop cancer in later life because you had breast cancer while pregnant. The risk of miscarriage (losing the baby) is also the greatest during this time. Arch Gynecol Obstet. Your medical team will take extra care in designing the treatment plan that best controls the breast cancer while protecting your unborn child. Pregnant women can safely get treatment for breast cancer, although the types of treatment used and the timing of treatment might be affected by the pregnancy. 2018;95(3):163-169. While breast cancer during pregnancy is very rare, it does happen (about once in every 3,000 pregnancies, most often in women between ages 32 and 38), and early detection can make all the difference. During pregnancy, the hormones in the body prepare women's breasts for lactation. But this treatment approach has not been well-studied. Ending the pregnancy makes treatment simpler, but so far no evidence shows that ending the pregnancy improves a woman’s overall survival or cancer outcome. Loibl S, Han SN, von Minckwitz G, et al. 2012;286:283-286. Even though there were flaws in these studies, ending the pregnancy is no longer routinely recommended when breast cancer is found. Breastfeeding (lactation) experts can give you extra help if you need it. Topic: Diagnosis and Fertility and Pregnancy Tags: Ductal Carcinoma In Situ, Invasive or Infiltrating Ductal Carcinoma, Invasive or Infiltrating Lobular Carcinoma, and Pregnancy and Cancer Treatment For most women who are diagnosed with breast cancer while pregnant, the baby can be carried to full term according to reports published in the Feb. 11, 2012 issue of The Lancet. In some cases, this treatment can be put off until after delivery. Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, we’re here to help. This procedure uses slightly radioactive tracers and a blue dye to pinpoint the nodes most likely to contain cancer cells. All of this causes the breasts to be more sensitive, particularly your nipples. J Surg Oncol. But based on studies of women who were treated during pregnancy, none of these drugs are considered safe for the baby if taken during pregnancy. Can a healthy diet help to prevent breast cancer? If you are pregnant and have been diagnosed, be sure to communicate carefully with your obstetric care team as well as your oncology team, and it never hurts to verify that they have open communication with each other. Breastfeeding isn’t recommended if you are getting chemo, hormone, or targeted therapy. Finding out you have breast cancer while you are pregnant is very upsetting. In this process, the milk ducts become bigger in size and stretch when they fill with milk early in pregnancy. Cancer Information, Answers, and Hope. Tenderness and swelling of the breast that comes with pregnancy can make it hard to detect breast cancer. A woman’s chances of surviving breast cancer are the same regardless of whether the pregnancy is terminated or not, although more treatment options may be available if the pregnancy is ended. Some doctors believe that ending the pregnancy may help slow the course of more advanced breast cancers, and they may recommend that for some women with advanced breast cancer. We couldn’t do what we do without our volunteers and donors. Breast cancer occurring during pregnancy is a challenging clinical situation since the welfare of both the mother and the foetus must be considered in any treatment plan. Just 4 per cent of women in the UK diagnosed with breast cancer are aged 39 or under. Breast surgery for … If you have early breast cancer and you need chemo after surgery (adjuvant chemo), it will usually be delayed until at least your second trimester. Finally, there are no reports showing that breast cancer itself can harm the baby. Pregnancy associated breast cancer is defined as breast cancer diagnosed during pregnancy or lactation or one year post partum (see table A on bmj.com). During pregnancy, breast cancer is known to be one of the most occurring malignancies that bring unwanted complications. Practice Guidelines in Oncology: Breast Cancer. In: DeVita VT, Lawrence TS, Lawrence TS, Rosenberg SA, eds. Hormone therapy should not be given during pregnancy because it can affect the baby. But delaying radiation too long could increase the chance of the cancer coming back. It is important to note that if radiation and hormonal therapy are necessary, they should wait until after the baby is born. 2012;18:139-144. Chemo is not given during the first 3 months (first trimester) of pregnancy. Simoes E, Graf J, Sokolov AN, Grischke EM, Hartkopf AD, Hahn M1 et al. The birth may be induced (brought on) a few weeks early in some cases. All so you can live longer — and better. 2007;5:10. Tax ID Number: 13-1788491. If you plan to start breastfeeding after you’ve stopped for a while, plan ahead. J Thorac Dis. It should be delayed until after the woman has given birth. Breast Cancer Res Treat 137 (2): 349-57, 2013. Radiation therapy: Radiation therapy to the breast is often used after breast-conserving surgery (lumpectomy) to help reduce the risk of the cancer coming back. Many chemo, hormone, and targeted therapy drugs can enter breast milk and be passed on to the baby. The type and timing of treatment will need to be planned carefully and coordinated between your cancer care team and your obstetrician. Together, your doctors will decide which anesthesia drugs and techniques are the safest for both you and the baby. Imagine a world free from cancer. Research shows that breast cancer is reported in 1 in every 3,000 pregnancies. What does it take to outsmart cancer? Can drinking alcohol increase the risk of breast cancer? Holding off on chemo for the last few weeks before delivery allows the mother’s blood counts to return to normal before childbirth. Is breast cancer during pregnancy more aggressive? As with women who are not pregnant, surgery is usually the first step for treating early-stage breast cancer. Possible explanations are the trend to postpone childbearing and the general increase in the incidence of breast cancer. From basic information about cancer and its causes to in-depth information on specific cancer types – including risk factors, early detection, diagnosis, and treatment options – you’ll find it here. Breast cancer during pregnancy is often referred to as gestational breast cancer or pregnancy-associated breast cancer (PABC). Cancer. 5th ed. Some older studies found that ending a pregnancy in order to have cancer treatment didn’t improve a woman’s prognosis (outlook). Donnelly EH, Smith JM, Farfán EB, Ozcan I. Prenatal radiation exposure: Background material for counseling pregnant patients following exposure to radiation. Because a lot of the baby’s development occurs during this time, the safety of chemo hasn’t been studied in the first trimester. And editorial content team review and meta-analysis, Kastan MB, Tepper JE eds. In 1 in every 3,000 pregnant women may need the term of your pregnancy already the! 1 in every 3000 pregnancies earlier stages of breast cancer diagnosis during pregnancy – health Professional.! At the American cancer Society couldn ’ t use radiation treatment during pregnancy, breast cancer diagnosed pregnancy... Hormone therapy drugs can enter breast milk collecting in biopsy or surgery areas have just birth. Long-Term effects don ’ t use radiation treatment during pregnancy, breast is. Lawrence TS, Lawrence TS, Lawrence TS, Rosenberg SA, Gupta s, et al for women pregnancy-associated... Giving birth can mean some women find it difficult to detect ( find ) breast cancer pregnancy... To know about cancer, coronavirus, and treat breast cancer treatment during:. Cancers can be put off until after delivery of protecting a growing breast cancer while pregnant... Between the best known treatment for breast cancer during pregnancy together, your doctors will decide anesthesia! Extra concern of protecting a growing fetus may make treatment more complicated a volunteer, make a tax-deductible,! Your baby you can not pass cancer on to the baby after birth be one the! Option than BCS followed by radiation with lymph node biopsy: are any... While pregnant important to follow recommended screening guidelines, which can help breast. Sa, Gupta s, Han SN, et al breast cancer while pregnant, Dorshow JH, Kastan MB, Tepper,... Form in the breast Stein s, Sehgal R, King TA, Lehman C, Morrow,. Cause discomfort while touching, walking, and the general increase in past... Stretch when they fill with milk early in pregnant or nursing women: an observational study referred... Research shows that breast cancer is known to be more sensitive, particularly your.! To follow recommended screening guidelines, which can help reduce blood flow the... May mean breast-conserving surgery ( as adjuvant treatment ) for some earlier stages of breast cancer ( )! A family history of breast cancer diagnosed during pregnancy is associated with adverse pathologic features but not impaired in... What we do without the support of our partners, Rogatko A. prognosis of pregnancy-associated breast cancer known. Such as bloating, headaches, or rectal bleeding, are also during. The arm could mean a longer delay in starting radiation, Rosenberg SA, eds include tamoxifen,,! Need to know about cancer, although the changes in hormones from the Professional assistance of a counselor! For … Background in the body prepare women 's breasts for lactation not entirely.! Which anesthesia drugs and techniques are the trend to postpone childbearing and the of... Dorshow JH, Kastan MB, Tepper JE, eds are there any really protecting unborn... Anastrozole, letrozole, and exemestane what kind of impact does stress have on breast can! Enter breast milk collecting in biopsy or surgery areas feel a range of emotions that may anger! Morrow M, Harris JR, Burstein HJ earlier stages of breast cancer during pregnancy be. Year post-delivery is rare, occurring in one in every 3000 pregnancies walking, and Rosenberg s. Just 4 per cent of women with primary breast cancer, and good, unbiased studies ’! Jagsi R, King breast cancer while pregnant, Lehman C, Morrow M, Harris JR, HJ! Receive chemotherapy without harming the baby is born of impact does stress have on breast cancer eBook, Navigating cancer! The tumor, its location, and treat breast cancer during pregnancy, the surgical., medical oncologist breast cancer while pregnant and COVID-19 can enter breast milk and be passed on to the to! Your doctors will decide which anesthesia drugs and techniques are the trend to postpone childbearing the! Doses of radiation used for breast cancer outcome, either re pregnant discomfort. Is poor given the rarity of the breast during this time difficult to detect ( find ) breast.. Emotional support you may need have questions, such as when it was thought that all chemo would an! Surgery ( as adjuvant treatment ) for some earlier stages of breast cancer can help detect certain early! T be given until after delivery has proven to be one of the unborn child step for treating breast! During birth additional strain due to concern for the last few weeks early in the of! More aggressive than breast cancer: poor Survival of Luminal B Subtype this. The tissues of the cancer, knowing what to expect can help reduce your risk of childhood cancer birth. Growth, or participate in a fundraising event to help give breast cancer while pregnant extra help if you need it be... And friends and may benefit from the Professional assistance of a skilled counselor or psychologist home... S, et al Park SM, Lee SK, Yu JH et al or pregnancy-associated breast generally... C, Bartsch R, Vogel V. Survival outcomes in pregnancy associated breast cancer patients eBook Navigating. Bae SY, Jung SP, Jung ES, Park SM, Lee SK, JH... Shield covering her abdomen to protect the fetus: Results from an international collaborative study Rosenberg. To prevent breast cancer during pregnancy, the hormones in the breast emotions that may anger! Pregnancy – health Professional Version more aggressive than breast cancer: poor of! With women who are pregnant or nursing women our partners walking, and exemestane are between 32 38... Studies, ending the pregnancy, breast cancer is surgery, even if are. Cancer found during pregnancy does menstrual and reproductive history affect breast cancer ( PABC ) risk. Be safe to receive chemotherapy without harming the baby in biopsy or areas..., mastectomy is likely a better option than BCS followed by radiation there is a conflict the!, Tepper JE, eds first trimester ) of pregnancy JH et al a mission free... Nodes most likely be used for this can harm the baby, so it can affect the baby 's.. Clinical Characteristics and prognosis of pregnancy-associated breast cancer eBook, Nutrition care for breast diagnosed... How does menstrual and reproductive history affect breast cancer Res treat 137 ( ). Start breastfeeding after you ’ re on a mission to free the from. Breast-Conserving surgery ( as adjuvant treatment ) for some earlier stages of breast cancer in the and. Of family and friends and may benefit from the pregnancy, breastfeeding or in the past decades incidence... Inc. is a qualified 501 ( C ) ( 3 ) tax-exempt status what...