Breast Cancer Treatment During Pregnancy: Everything You Need to Know

This article is medically reviewed by Dr. Bhavisha Ghugare, Senior Consultant - Surgical Oncology & Breast Oncosurgery, HCG Cancer Centre, Borivali.

Table of Contents

• How is Breast Cancer Classified by Stage?
• What Causes Breast Cancer to Develop During Pregnancy?
• Is It Safe to Have Breast Cancer Treatment During Pregnancy?
• Available Treatment Options for Breast Cancer
• Treatment Options for Early-Stage Breast Cancer During Pregnancy
• Treatment Options For Late-Stage Breast Cancer During Pregnancy
• Can You Breastfeed While Undergoing Breast Cancer Treatment?
• What Are the Long-Term Effects of Breast Cancer Treatment on the Child?
• What Are the Dos and Don'ts for Protecting Your Baby During Cancer Treatment?
• Conclusion
• Frequently Asked Questions

Undergoing breast cancer treatment during pregnancy demands a lot of planning, as both the mother's and the baby's lives are at stake.

Breasts undergo many changes during pregnancy, which can make the early detection of breast cancer difficult. Hence, it is important to be aware of early signs and symptoms and seek medical attention for effective management of breast cancer during pregnancy.

There are several modern treatment approaches available for treating breast cancer during pregnancy. Read this article to know about the crucial aspects of undergoing breast cancer treatment while pregnant.

How is Breast Cancer Classified by Stage?

Staging helps doctors figure out how much cancer has grown and how it might affect treatment for breast cancer during pregnancy.

• Stage 0 means that there are strange cells only in the breast ducts.
• Stage I means there is a small tumor that stays inside the breast.
• Stage II includes bigger tumors or the first signs that the cancer has spread to nearby lymph nodes.
• Stage III means that the cancer has spread to more lymph nodes or tissues in the area.
• Stage IV means that breast cancer has spread to other parts of the body during pregnancy.

Breast cancer treatments during pregnancy are planned based on the stage of cancer, the trimester that the mother is in, and the mother's health needs.

What Causes Breast Cancer to Develop During Pregnancy?

Understanding what causes breast cancer during pregnancy is crucial for effective treatment planning.

Changes in hormones may make breast cells more active, which could affect the growth of tumors if there are already abnormal cells present. The fullness and tenderness that come with pregnancy may hide early lumps, making them harder to detect.

• Mutations in BRCA1 or BRCA2 genes
• A strong family history of breast cancer, especially among the closest relatives
• Dense breast tissue, which can hide lumps, and older maternal age may also play a role

Cancerous areola breast changes during pregnancy, like darkening of the nipple or swelling of the glands, can hide early signs of cancer. That said, many pregnant women develop breast cancer without any clear risk factors.

Additional Reading: How Can I Know if It Is Breast Cancer?

Is It Safe to Have Breast Cancer Treatment During Pregnancy?

It is important for specialists to know what both the mother and baby need in order to safely plan breast cancer treatment during pregnancy.

• Surgery: It is safe to have surgery at any time during pregnancy, and many women can do so without harming the baby.
• Chemotherapy: During the first trimester, chemotherapy is not recommended. However, it may be considered during the second and third trimesters when major organs are fully developed. Doctors are careful to recommend specific drugs that are both effective against cancer and safe for the baby.
• Treatments That Are Avoided During Pregnancy: Hormone therapy, targeted therapy, and radiation are some treatments that are usually put off until after the baby is born because they could put the fetus at risk for no reason.

While treating breast cancer during pregnancy, the medical team keeps a close eye on the health of the mother and the growth of the baby.

Treatment plans are changed as and when required to avoid problems and ensure that women receive safer breast cancer treatment while pregnant.

Available Treatment Options for Breast Cancer

There are multiple treatments for breast cancer, and doctors may use more than one of them depending on the stage of the cancer and the patient's needs.

The following are the commonly considered breast cancer treatment options during pregnancy:

• Surgery is usually the first line of treatment.
• Chemotherapy for breast cancer works by killing cancer cells that are dividing quickly.
• Radiation therapy helps control cancer growth by damaging the DNA structure in cancer cells.
• Targeted therapy are designed to identify and target specific tumor markers to control cancer growth.

These breast cancer treatments are carefully chosen to ensure that the care is safe and effective.

Treatment Options for Early-Stage Breast Cancer During Pregnancy

To treat early-stage breast cancer during pregnancy, the following are the options:

• Surgery for Breast Cancer: Procedures like lumpectomies and mastectomies are usually safe during pregnancy. After delivery, women who have had a lumpectomy often get radiation therapy. Mastectomy may be suggested earlier in pregnancy to minimize the need for immediate radiation therapy.
• Lymph Node Assessment: Lymph node assessment is done cautiously, and specialists may use pregnancy-safe dye techniques to examine for spread.
• Chemotherapy During Pregnancy: After the first trimester, pregnant women may be able to undergo chemotherapy with drugs that have been shown to be safe. To avoid low blood counts during labor, chemotherapy is usually stopped a few days before delivery.
• Targeted Systemic Therapies: Hormone therapy and targeted therapy are not done during pregnancy; they are started after delivery when it is safe to do so.

Radiation therapy for breast cancer is usually not recommended during pregnancy.

Treatment Options For Late-Stage Breast Cancer During Pregnancy

In pregnant women with late-stage breast cancer, the treatment plan focuses on controlling the disease while also protecting the fetus's development.

Surgery: Surgery may still be an option to remove or shrink the tumor, especially if it alleviates symptoms and complications.

Chemotherapy: After the first trimester, chemotherapy during pregnancy becomes an important part of treatment. It uses drugs that are safe for the developing fetus. Chemotherapy and surgery keep cancer from spreading until more treatments can begin after the delivery.

In some cases, doctors may suggest an early delivery if the baby is mature enough and the mother needs treatments that aren't safe during pregnancy.

Can You Breastfeed While Undergoing Breast Cancer Treatment?

Whether or not you can breastfeed while receiving treatments for breast cancer depends on the drugs you're taking and when you're getting them. If a woman has had surgery and is not yet getting any other treatment, she can safely breastfeed. Chemotherapy drugs used in breast cancer treatment, on the other hand, can get into breast milk, which can be hazardous for babies' health.

When treating breast cancer during pregnancy or shortly after childbirth, physicians frequently advise discontinuing breastfeeding to avert exposure to chemotherapy or other systemic therapies.

If only one breast has been surgically treated, the other breast may still produce milk, but a doctor should help you make this choice. Breastfeeding may be possible again after treatment is over and the medicines have left the body. Your care team will give you personalized advice based on your treatment plan, the medicine you're taking, and your baby's health needs.

What Are the Long-Term Effects of Breast Cancer Treatment on the Child?

Most studies indicate that children exposed to chemotherapy during pregnancy after the first trimester grow and develop normally. The drugs used at this stage don't affect the early stages of organ formation, which lowers the chance of serious problems.

That said, the following are some of the possible long-term effects seen among children when the mother receives breast cancer treatment during pregnancy:

• Problems Related to Cognition and Behavior: Some studies have reported lower verbal IQ, weaker emotional regulation, and visuospatial memory-related problems in children.
• Hearing Loss: Certain chemotherapy drugs are found to affect the auditory function in children.
• Cardiac Function: Some reports also suggest long-term cardiac effects with specific chemotherapy drugs.
• Other Problems: Other possible health problems include gastrointestinal reflux, speech delays, and pneumonia, among others.

Regular prenatal checkups ensure the early detection of any developmental problems. After the baby is born, pediatricians keep an eye on the child's health to ensure its proper growth.

In general, research shows that safely treating breast cancer during pregnancy doesn't usually cause long-term health problems, but each case is watched closely.

What Are the Dos and Don'ts for Protecting Your Baby During Cancer Treatment?

Close medical supervision and regular prenatal care are the first steps to keeping your baby safe while you get breast cancer treatment.

Dos:

• Eating a healthy diet helps you stay strong
• Informing your doctor about any new symptoms ensures timely treatment modifications.
• Effective stress management
• Getting enough sleep
• Staying away from laborious jobs

Don'ts:

• Don't self-medicate because many over-the-counter drugs and herbal supplements can make breast cancer treatment less effective.
• Don't drink alcohol or smoke.
• Avoid unnecessary radiation exposure.
• Don't miss chemotherapy sessions unless your doctor tells you to. Delays can change the results.

Mothers can benefit from their treatment plan when they stay informed and ask questions.

Working closely with the medical team ensures that both the mother and the baby receive the best and safest care possible.

Answering another important question, "Is anesthesia safe during pregnancy?" Yes, it is safe when administered as per the protocol. Patients hardly report any issues with anesthesia. Anesthesia is commonly recommended during lumpectomy and mastectomy, which are two commonly recommended surgical options for breast cancer. Hospitals will usually have experienced anesthesiologists who specialize in ensuring patient safety and comfort throughout the surgery.

Conclusion

When specialists plan treatment based on the trimester and stage of the cancer, it is safe to treat breast cancer during pregnancy. In most cases, it is possible to treat breast cancer effectively without putting the baby's health at risk. Early diagnosis gives you more options, and close monitoring makes sure that both the mother and child stay safe during treatment. When you notice changes in your breasts, talking to your doctor right away helps them evaluate you and give you personalized care.

Frequently Asked Questions

References

• Breast Cancer During Pregnancy - NCI
• Biology, staging, and treatment of breast cancer during pregnancy: reassessing the evidences - PMC
• Breast Cancer During Pregnancy

About the Reviewer

Dr. Bhavisha Ghugare

Senior Consultant - Surgical Oncology & Breast Oncosurgery
MBBS, MS (General Surgery), Fellowship in Breast Cancer Surgery