Breast Cancer and Pregnancy: What You Need to Know Before, During and After
Receiving a breast cancer diagnosis can be a jolting life moment for anyone. It can be difficult to navigate the flood of emotions. Whether you have a family history of breast cancer, are currently receiving treatment, or are in remission, this article will outline some helpful points for consideration.
What changes in the body?
Breast cancer is a disease where cancer cells form in the tissues of the breast.1 The most common type of breast cancer is ductal carcinoma, which starts in the lining of the milk ducts7. Lobular carcinoma, another type of breast cancer, begins in the milk glands.8 Invasive breast cancer is an advanced stage of the disease where the cancer has spread to surrounding normal tissue.9
There are 3 stages of cancer progression.
Stage 1 – Clinical Prognostic Stage
Stage 2 – Pathological Prognostic Stage
Stage 3 – Anatomic Stage
The stage of the cancer is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and the presence of certain biomarkers.1
The presence of cancer cells or tumors can cause visible changes in the breast. You should check with your doctor if you have any of the following signs or symptoms below:
A lump or thickening in or near the breast or in the underarm area.
A change in the size or shape of the breast.
A dimple or puckering in the skin of the breast.
A nipple turned inward into the breast.
Fluid other than breast milk leaking from the nipple, especially if it’s bloody.
Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple).
Dimples in the breast that look like the skin of an orange, called peau d’orange.1
Treatment Options
Breast cancer can be treated by surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, immunotherapy, or any combination.
Surgery: an operation to remove the cancer and some normal tissue around it, but not the breast itself.1
Mastectomy: the surgical removal of a whole breast that contains cancerous tissue.1
Radiation Therapy: the use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors.1
Chemotherapy: treatment that uses drugs to stop the growth of cancer cells, either by killing them or by stopping them from dividing.1
Hormone Therapy: treatment that adds, blocks, or removes hormones to slow or stop the growth of cancer.1
Target Therapy: uses drugs or other substances to target specific molecules that cancer cells need to survive and spread.1
Immunotherapy: uses drugs to help a patient’s immune system fight their cancer.
There are several factors that determine which method of treatment can be used including: the stage and type of the cancer, how fast the tumor is growing, whether the patient has had cancer before, and their age, overall health, and menopausal status.1
How does breast cancer impact fertility?
It is possible to get pregnant after breast cancer treatment. A breast cancer diagnosis may mean you have to think about your fertility options sooner than expected.6 Men treated for breast cancer may also need to consult with their medical team to preserve fertility.
Most cancer patients receive a combination of treatments, and each treatment can affect fertility in different ways. Some do not affect fertility at all while others may cause temporary fertility or irreversible menopause. Hormonal therapy can make it difficult to conceive, however, pre-menopausal women may resume their periods .5 Chemotherapy can also impact fertility. The outcome is heavily on your age, the medication used, and the dosage received.
There’s a medium to high risk that the following chemotherapy medicines may cause infertility:
Cytoxan (chemical name: cyclophosphamide)5
Platinol (chemical name: cisplatin)5
Adriamycin (chemical name: doxorubicin)5
The following chemotherapy medicines are less likely to cause infertility:
Methotrexate5
Fluorouracil5
Vincristine5
Targeted therapies are generally less likely than chemotherapy to harm healthy cells, so they may have fewer side effects.5 Radiation has no effect on fertility. It is very unlikely that the amount of radiation that might scatter from the breast area will impact reproductive organs. However, doctors recommend fertility treatments before cancer treatments.
There are ways to preserve your fertility during breast cancer treatment.
Extracting your eggs4
In Vitro Fertilization (IVF)4
Freezing eggs or embryos4
Freezing and transplanting ovarian tissue4
Using donor eggs4
How does breast cancer impact pregnancy?
Breast cancer can occur during pregnancy and shortly after birth. The signs are similar to those mentioned earlier but breast cancer can be hard to detect early during pregnancy or while nursing, making these diagnoses more common in later stages.2
If breast cancer is detected during pregnancy, how far along you are will be a determining factor to which type of treatment is used. Because breast cancer does not seem to harm the fetus, it is possible to safely receive breast cancer treatment while pregnant. However, this comes with many difficult choices as the health of mother and baby must be taken into consideration.3 It is important to work closely with your medical team to determine the best course of action and timing of treatment.
If breast cancer treatments take place during and/or after delivery, lactation and breastfeeding should be stopped if surgery or chemotherapy is planned. While chemotherapy has been delivered with no effect on the fetus in the second and third trimesters, many of the drugs used in chemotherapy appear in high levels in breast milk and can be harmful to the baby.2 Surgery as a form of treatment can also be used without harm to the baby; however, anesthesia is potentially harmful to the fetus at certain points in pregnancy. It’s best if your doctor and anesthesiologist work together to decide which drugs and techniques will be best.3 Radiation therapy, hormone therapy, and targeted therapy are generally not used during pregnancy as they are not deemed safe for the fetus.
Hormonal birth control may increase the risk of breast cancer. Doctors often recommend that pre-menopausal women with a history of breast cancer use non hormonal methods instead.5Emergency contraceptives can be used and is unlikely to affect your breast cancer.6
Regardless of the circumstances in which one is diagnosed, the objective remains the same – to cure the cancer whenever possible, or at least control it and keep it from spreading. It is recommended to wait at least 2 years after treatment to begin trying to conceive so that early return of cancer cells can be detected. The most important thing to do is speak with your doctor to review options and create a treatment plan that works for you.
Writer: Candace Page
Content Expertly reviewed by: Dr. Krista Mincey
References
NIH National Cancer Institute. (2022). Definition of breast cancer – NCI Dictionary of Cancer Terms – NCI
NIH National Center Institute. (2022). Breast Cancer During Pregnancy – NCI
American Cancer Society. (2021). Treating Breast Cancer During Pregnancy | American Cancer Society
Breast Cancer Org. (2022). Fertility Treatments (breastcancer.org)
Breast Cancer Org. (2023). Fertility and Pregnancy After Breast Cancer
Breast Cancer Now. (2019). Fertility and breast cancer treatment | Breast Cancer Now
NIH National Cancer Institute. (n.d.) Definition of ductal carcinoma – NCI Dictionary of Cancer Terms – NCI
NIH National Cancer Institute. (n.d.) Definition of lobular carcinoma – NCI Dictionary of Cancer Terms – NCI
NIH National Cancer Institute. (n.d.) Definition of invasive breast cancer – NCI Dictionary of Cancer Terms – NCI