When breast cancer occurs during pregnancy, it can be a complex and challenging situation. Balancing breast cancer early treatment while protecting the health of both the mother and the unborn child can be difficult.
However, with advances in medicine and an experienced team of doctors, it is possible to navigate breast cancer treatment and care during pregnancy. This article will explore the considerations that must be taken when treating breast cancer during pregnancy.
What is Pregnancy-Associated Breast Cancer?
Pregnancy-associated breast cancer (PABC), or gestational breast cancer, is diagnosed during the first trimester of pregnancy or within the first year after giving birth. There are two distinct types of PABC: breast cancer diagnosed during pregnancy and breast cancer diagnosed post-partum. This distinction is vital because emerging data suggest that outcomes for pregnancy-associated breast cancers may be worse for post-partum cases.
If you need breast cancer treatment during pregnancy, it is essential to seek professional advice from your doctor on how this distinction may affect you.
Read on to learn more about commonly asked questions and treatments for PABC.
Is Breast Cancer During Pregnancy Common?
Breast cancer occurs in approximately one in every 3000 pregnancies. In Singapore, where there are over 38,000 live births annually, which translates to around 12-15 pregnant women diagnosed with breast cancer annually. PABC is therefore considered a rare illness.
At Thomson Breast Centre, Dr Tan Yia Swam diagnoses about 50 patients with breast cancer each year. Among them, 5-6 cases are pregnancy-related breast cancer. This represents about 10% of her cases, however it is essential to note that the representation may be biased due to the sample size.
The incidence of PABC is low but may be increasing due to more women becoming pregnant at a later age. Therefore, while uncommon, breast cancer is the most prevalent malignancy encountered during pregnancy and postpartum.
Who is At Risk of Pregnancy-Associated Breast Cancer?
According to Dr Tan, PABC risk factors include obesity and a significant family history of breast cancer. If more than two women in your family were diagnosed with breast cancer before age 50, you might be at higher risk for PABC.
To reduce your risk, it is crucial to maintain a healthy weight and start performing regular breast self-exams from your teenage years. It is also essential to know your family history. Many patients are unsure about their family’s medical history because some feel it is taboo to ask about cancer diagnoses. By identifying whether you’re a high-risk patient, you can determine treatment options early.
How to Ensure Early Detection of Breast Cancer During Pregnancy?
Dr Tan states several steps can be taken to detect breast cancer during pregnancy. The first step is to start performing monthly breast self-examinations (BSE) to become familiar with the texture and shape of your normal breast tissue. Here’s what you can do if you find lumps.
It is also essential to understand how the body changes during pregnancy and what changes are expected. If you are unsure about any changes, you should see a doctor for a physical check. A radiation-free ultrasound scan, just like what is used to scan the unborn baby, may be recommended by your doctor.
Dr Tan also advises against relying on information from unverified sources on the internet about breast cancer outcomes. Instead, patients should see a doctor and search for reputable websites to learn more about managing breast cancer. For example, HealthHub, National Cancer Centre Singapore, and PubMed are reliable sources of information.
How is Breast Cancer Diagnosed During Pregnancy?
The initial breast cancer diagnosis during pregnancy is similar to that for non-pregnant women. It involves a needle biopsy to confirm the presence of breast cancer cells and determine the type of breast cancer.
However, it is important to note that some scans will not be performed during pregnancy. This is to avoid potential harmful exposure to radiation therapy. There may also be difficulty and delay in diagnosis due to pregnancy-related changes in the breast and various diagnostic challenges. Therefore, pregnant patients must avoid delaying a diagnosis to treat breast cancer if they suspect they require treatment.
Does Pregnancy Increase Breast Cancer Risk?
It is important to note that pregnancy does not trigger cancer.
However, Dr Tan explains that one possible link is due to estrogen exposure. That is why other factors, such as starting menstruation early, having late menopause or not having children, are classic risks. Additionally, women are starting families later, which may also increase the risk.
Furthermore, abnormal cell changes before pregnancy may already be present, and higher hormone levels during pregnancy can cause cancer to grow faster.
Ultimately, it has been reported that pregnant and non-pregnant patients with breast cancer have the same survival rates. Terminating pregnancy also does not improve the prognosis for pregnant patients who receive standard treatment for breast cancer.
Can a Pregnant Woman Receive Breast Cancer Treatment?
Yes, pregnant women can receive treatment even with an unborn baby. According to Dr Tan, breast cancer surgery and chemotherapy are reasonably safe during pregnancy, depending on the type of cancer, stage, and trimester. However, the treatment sequence for breast cancer in pregnancy may differ from what is typically done outside pregnancy. Discussions on fertility preservation, gene testing, breast-conserving surgery and reconstruction may also be necessary for young cancer patients.
The care of a pregnant cancer patient is complex and requires coordination between an experienced team of surgeons, oncologists, and gynaecologists. It is important to find a trustworthy team of doctors to guide the patient through this process rather than trying to navigate it alone. You can learn more about the different breast cancer treatment options during pregnancy here.
Can You Have a Healthy Pregnancy with Breast Cancer?
There is no evidence to suggest that a mother’s previous history of breast cancer negatively impacts her unborn baby. Infants exposed to chemotherapy while in the womb have been reported to have normal development and educational performance with no abnormalities in their neurological or psychological health.
Additionally, these infants did not show any cardiac abnormalities or dysfunction. It has been suggested that cognitive impairment may be due to prematurity rather than exposure to chemotherapy. Therefore avoiding preterm delivery when possible is recommended for young women with breast cancer. This indicates that a woman with breast cancer can have a healthy pregnancy.
Breast Cancer Treatment at Thomson Breast Centre
We recommend speaking with our specialists to receive a comprehensive assessment and consultation on breast cancer treatment and care during pregnancy.
With extensive knowledge and experience in this field, our specialists can guide you through the process of breast cancer in pregnancy and ensure that you receive the best possible care. To schedule a consultation, please visit us at Thomson Breast Centre.