As any woman who's ever found a lump in her breast knows, it's impossible to feel one without also feeling a lump in your throat. Fear, confusion and worry are common emotions, and if you're pregnant when you find that lump, your worries are likely magnified. But take solace: There is good news for pregnant women.
Most breast lumps don't turn out to be anything to be concerned about — especially during pregnancy, when changes to the breasts are common. When you're expecting, your breasts naturally feel lumpier, firmer and heavier because they're gearing up to nourish your baby-to-be.
In fact, most breast lumps that appear during pregnancy turn out to be clogged milk ducts, which can develop as your breasts get a head start on the task ahead (feeding your baby).
Still — and if only for reassurance — it's important to get any new breast lump you notice checked out by your practitioner. While breast cancer during pregnancy is very rare, it does happen (statistics show that it occurs in about 1 in every 3,000 pregnancies — most often in women between the ages of 32 and 38). Early detection can make all the difference.
What is the relationship between pregnancy and breast cancer risk?
It's known that a woman's risk of developing breast cancer is related to her exposure to estrogen and progesterone — two hormones produced by the ovaries. The more exposure to these hormones, research shows, the greater the risk of breast cancer.
Women who have had more menstrual cycles because they started their periods earlier (before age 12) and/or went through menopause later (after age 55) and those who have never been pregnant have a slightly higher risk of getting breast cancer.
Research suggests that pregnancy and breastfeeding lower a woman's risk of breast cancer, and suggests the changes that occur in a woman's breasts during pregnancy and through breastfeeding make the breast cells less likely to transform into cancer cells down the road. Having a child before age 20 and breastfeeding for longer than a year are also linked to a lower risk of certain types of breast cancer.
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On the other hand, women older than 30 who give birth to their first child have a slightly higher risk of breast cancer compared to women who are that age and have never given birth.
How is breast cancer detected during pregnancy?
Because it's difficult to detect breast cancer in moms-to-be (due to the normal tenderness and swelling that comes with being pregnant),[1] it's important to watch for other signs of breast cancer (in addition to any lump you might notice), such as dimpling or puckering of the skin, bloody fluid from the nipple, scaly skin on the breast and any unusual thickening in one area of the breast.
If you have any of these signs, it's important to talk to your doctor. Delayed diagnosis remains one of the biggest problems with breast cancer in pregnancy, precisely because it's so difficult to differentiate normal pregnancy breast changes from changes in the breasts that might be due to cancer.
If your doctor notices any concerning lumps or abnormalities, further testing will likely be recommended. This may include:
- Blood tests
- A mammogram, which can be used safely during pregnancy since the amount of radiation required is small and focused on the breasts (though a lead shield will be placed over your belly to stop radiation from reaching the womb)[2]
- An ultrasound of the breasts
- A biopsy where cells from the lump are removed via a long needle and then checked under a microscope for signs of cancer
- If cancer is found, your doctor and oncologist will use these test results as well as others (such as those from tests that measure the amount of hormones, growth factors and genes in the cancer tissues) to determine how quickly the cancer may grow or spread.
If you're diagnosed with breast cancer during pregnancy, you'll likely be shocked and overwhelmed when you hear the news, worried about your health and that of your baby-to-be, and concerned about what lies ahead.
Try to take some comfort knowing that the cancer cells will not spread to your baby or harm her. And terminating a pregnancy isn't tied to survival rates and it's not usually a treatment option, though it may be necessary in those rare cases when a cancer is aggressive and treatments aren't compatible with an ongoing pregnancy.
What are the stages of breast cancer?
How will you know how aggressive your cancer is? Your doctors will determine what stage breast cancer you have.
Stage describes how big the tumor is, if it has spread and where it has spread. Staging is very important for pregnant women with breast cancer, because their cancers tend to be found at a more advanced stage, when the tumor is likely to be bigger and to have spread beyond the breast.
Unfortunately, the best way to determine a cancer stage is through imaging studies (CT, bone, PET), which are usually off-limits when you're pregnant. Luckily, standard methods for giving imaging scans can be adjusted so the fetus is exposed to less radiation.
For instance, an MRI is safe during pregnancy as long as contrast dye isn't used. Chest x-rays use only a small amount of radiation and are thought to be safe for pregnant women when the belly is adequately shielded.
The stages start with 0 and progress to IV:
- Stage 0: These are noninvasive conditions called ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS), in which abnormal cells are found only in the lining of a breast duct or in lobules of the breast.
- Stage I and II: Cancer tissue is invading normal, surrounding breast tissue. This is diagnosed based on the size of the tumor found in the breast and/or lymph nodes nearest the breast.
- Stage III: Cancer cells have extended to beyond the immediate region of the tumor and may have invaded nearby lymph nodes and muscles. This stage is considered advanced, but there are effective treatment options available.
- Stage IV: Breast cancer has spread to other parts of the body, such as the brain, bones, lung or liver.
How is breast cancer treated during pregnancy?
Treating cancer at any time presents challenges, and during pregnancy it's even more complex, because there's not only you but your baby-to-be to think about.
However, the goal of treatment is the same whether you're pregnant or not: to control the cancer and keep it from spreading. Your treatment options[3] will depend on the stage of the cancer and the age of your fetus. Self-advocate to fully understand the risks and benefits of all your treatment options. Talk to your doctors — your OB/GYN, your oncologist — and get as much information as you can through reading, possibly joining a support group and asking for the support of friends and family before making a decision about how to proceed.
Most expectant moms with breast cancer are able to have surgery — either a lumpectomy or a mastectomy. These are procedures where the lump or the breast (or a portion of it) is removed, along with any involved lymph nodes. But even if doctors remove all the cancer during surgery, further treatment is often needed to kill any cancer cells that might be left, depending on the stage of cancer.
In some cases, this treatment can be put off until after delivery. But if you'll need treatment during pregnancy, several of the typical treatments are an option for you.
In fact, one study of 129 children found that babies whose mothers are treated for cancer while pregnant have no development problems as a result. Treatments looked at included radiotherapy, chemotherapy, surgery and medication, and babies exposed to these in utero were no different from those whose mothers had cancer but received no treatment.
Breast cancer treatments might include:
- Radiation. Radiation therapy uses high-energy X-rays to kill cancer cells. Moms-to-be typically aren't given radiation until after the baby is born.
- Chemotherapy. Chemotherapy (“chemo”) uses drugs that kill cancer cells or stop them from dividing. Studies have shown that chemo doesn't usually harm the fetus but may cause preterm labor and low birth weight. Doctors sometimes won't give chemotherapy during the first three months of pregnancy.
- Hormone therapy. This breast cancer treatment uses drugs such as tamoxifen to block certain hormones and stop cancer cells from growing. Pregnant women aren't candidates for hormone treatments, however, because these drugs have been linked to a high rate of birth defects. Other targeted drugs are also not used on pregnant women because of the risk to the fetus.
If you've been advised to start treatment after your baby is delivered, it's likely that you won't be able to breastfeed. Chemo and other drugs pass through the breast milk to the baby, making it an unsafe feeding practice.
Whichever treatment you end up needing, the good news is that survival rates of pregnant women with breast cancer are comparable to those of non-pregnant women at the same stage of breast cancer, resesarch has found.
Can you get pregnant again after breast cancer?
What about after your treatment? Wondering when you can try for another baby? Some treatments for breast cancer, such as certain chemo drugs, may affect a woman's fertility, so it's important to let your oncologist know if you're hoping to have another baby after you've completed treatment.
If fertility isn't an issue, most doctors recommend that a woman wait two years after treatment before trying to have a baby — so that any early return of the cancer can be detected without exposing the fetus to testing.
Happily, a new pregnancy does not increase the risk of the cancer coming back.
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