Breast cancer during pregnancy

This wear it pink day we want to highlight the importance of checking your breasts, even in pregnancy.

Yes, breast cancer can occur during pregnancy and just after giving birth, but it’s rare, affecting about 1 in 3,000 pregnant women. It most often occurs in women aged between 32 and 38 years old and is the most common type of cancer found in pregnancy, so now’s not the time to stop checking yourself. 

It’s important to know that if you're diagnosed with breast cancer while pregnant, treatment can usually start immediately and the ultrasounds, medications and surgeries used to treat breast cancer during pregnancy are safe for the baby. 

Check yourself regularly

Checking yourself can be a bit trickier in pregnancy as your breasts change shape, become lumpier and grow. This happens because of hormone changes in your body and is perfectly natural. But it’s important to look out for irregular changes or lumps. These won’t necessarily be a sign of cancer but it’s always best to check with your doctor if you find any of the signs 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, 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.

Tests to diagnose pregnancy breast cancer

If you do find anything unusual go to your doctor straight away. They will arrange for you to have tests and procedures. We know this can be a little scary, especially when you are thinking about the baby you are growing, but all of these tests are safe and remember only 1 in 3,000 women will find they have breast cancer in pregnancy.

The following tests and procedures may be used:

Physical exam and review of yourhealth history:

• You may have a general check for signs of good health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of your health habits and any past illnesses and treatments will also be reviewed.

Clinical breast exam (CBE):

• Your doctor or other health professional will examine your breasts, carefully feeling your breasts and under your arms for lumps or anything else that seems unusual.

Ultrasound exam:

• You may have an ultrasound exam – which is a procedure where high-energy sound waves (ultrasound) are bounced off your internal tissues or organs to make echoes. The echoes will form a picture of your body tissues called a sonogram This picture will be printed out and examined by medical professionals.

Mammogram:

• A mammogram is an x-ray of your breasts, showing breast tissue. It can be done with little risk to your baby and your doctor will discuss this with you first. Mammograms in pregnant women may appear negative even though cancer is present, which is why you may have a biopsy too.

Biopsy:

• During your biopsy your cells or tissues will be removed so they can be viewed under a microscope by a pathologist, who will check for signs of cancer. There are three types of breast biopsies:

• Excisional biopsy: The removal of an entire lump of tissue.
• Core biopsy: The removal of tissue using a wide needle.
• Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid, using a thin needle.

What happens if breast cancer is found when you’re pregnant

Your oncologist will make decisions on the best treatment for you, based on the results of these tests and the trimester of your pregnancy. From the range of tests we’ve mentioned they will know:

• How quickly the cancer may grow.
• How likely it is that the cancer will spread to other parts of the body.
• How well certain treatments might work.
• How likely the cancer is to come back.

Treatment for breast cancer in pregnancy

If breast cancer is found during these tests, a personalised course of treatment will be planned out.

This will depend on the stage of cancer and the trimester you are in.

Here are some of the treatments you may receive:

• Surgery: The most common surgery is a lumpectomy, which removes the lump. A mastectomy removes the entire breast. Lymph nodes under the arm may also be removed for examination. 
• Chemotherapy: Usually safe for the baby in the second or third trimester, but not in the first. 
• Radiation therapy: May be given after surgery to kill any remaining cancer cells. 
• Hormone therapy: Given after the baby is born for early-stage breast cancer. 
• Endocrine therapy: Given after delivery. 

Immunotherapy is not recommended during pregnancy because it could potentially cause an immune response against your baby. 

Ending your pregnancy is rarely suggested, unless it will improve your chance of survival. However, it may be discussed as an option for aggressive cancers or metastatic cancers that require immediate treatment. 

After giving birth, you may need to continue treatment, which could make caring for your baby more difficult. If this is the case, it’s important to ask for help from family, friends, medical professionals and counsellors.

So this Wear It Pink Day let’s show our support for all women, pregnant or not, with breast cancer. And remind ourselves to check breasts regularly, as early detection could make all the difference to baby and you.