Breast Health And Pregnancy
Breast Health During Pregnancy…
October has come and gone but there are many more women that have questions related to breast health and then those women who have questions about breast health during pregnancy.
Recently ShowMe was introduced to Professor Justus Apffelstaedt, who assisted us with common questions asked by women concerned about breast cancer and the affects treatment could possibly have on their unborn baby.
Compiled by: Professor Justus Apffelstaedt: Associate Professor, University of Stellenbosch and Head of the Breast Clinic: Tygerberg Hospital
Q. How do the breasts change during pregnancy and breastfeeding?
A. The breasts can become very tender to the touch during the first three months of pregnancy. They may become fuller as well, which is the primary reason for the increased sensitivity.
As the pregnancy progresses, so does the expansion of the breasts. The extreme sensitivity usually diminishes but expect quite a gain in the bust area.
The middle months of pregnancy also bring a change to the nipples. The nipple and areola can double in size and may stay that way after delivery. The typically pinkish-brown skin will darken and continue to do so for the remainder of the pregnancy. This is due to the increased blood circulation to the breasts.
As the due date is neared, the breasts continue to expand. They will feel much heavier, especially once they begin to produce colostrum. You will also notice tiny bumps around the areola called Montgomery’s tubercles. These glands produce an oil that will help make breastfeeding more comfortable when the time comes. The nipples will become much more elastic, too.
Q: Can a pregnant woman have a mammogram?
A: Regular screening mammography in women without any symptoms is usually not done during pregnancy. However mammography during pregnancy may be considered carefully for women with signs or symptoms of a possible breast problem. It is preferable, however, to use other diagnostic modalities that do not involve radiation or administration of contrast agents.
Q: Can a mammogram harm a foetus?
A: Small studies have found that mammography poses little to no harm to the foetus during pregnancy if a lead shield is placed on the belly to block any possible radiation scatter.
But the accuracy of mammography is limited during pregnancy. In three different studies, the percentage of breast cancers in pregnant women that mammography detected was between 62% and 78%. This is significantly lower than the average 85% detection rate in non-pregnant women.
Q: How often does breast cancer occur in pregnant women?
A: Breast cancer occurs in about one in every 3,000 pregnancies, most often in women between the ages of 32 and 38.
Q: Can breast cancer spread to your baby when you are pregnant?
A: No. A barrier between the mother’s and the baby’s body blocks any cancer cells from entering the baby or its blood supply.
Q: Do pregnant women respond to cancer treatment as well as women who are not pregnant?
A: Research has shown that women diagnosed during pregnancy respond just as well to cancer treatment as women with cancer at the same stages that are not pregnant.
Q: What are the treatment options for pregnant women with breast cancer?
A: In the first trimester of pregnancy, serious consideration must be given to perform an abortion. This obviously is a very difficult decision and must be made in consultation with the obstetric and oncologist teams. If the decision is taken, to proceed with the pregnancy, mastectomy is usually well tolerated during pregnancy. Findings from several recent studies suggest that chemotherapy may be administered with moderate safety if the pregnancy has passed the first three months, which is a critical period for foetal organ formation. It is suggested that patients who are in the first three months of pregnancy may wait until the critical period of foetal organ formation is over before receiving chemotherapy. Hormonal therapy of breast cancer is impossible at any time during pregnancy. No data are available on the safety of biologicals in pregnancy. Pregnant women cannot have radiation therapy as it will cause serious damage to the foetus in a large number of cases.
Q: When is suppression of lactation necessary?
A: Suppression of lactation does not improve prognosis. If surgery is planned, however, lactation should be suppressed to decrease the size and vascularity of the breasts. If chemotherapy is to be given, lactation should also be suppressed because many antineoplastics (specifically cyclophosphamide and methotrexate), when given systemically, may occur in high levels in breast milk and would affect the nursing baby. In general, women receiving chemotherapy should not breastfeed.
Q: Does pregnancy have an impact on the risk of recurrence of breast cancer?
A: Studies have shown that women who were diagnosed with breast cancer during pregnancy did as well in the long term as women with the same type and stage of cancer that were not pregnant when they were diagnosed. There is no apparent long-term increased risk of cancer recurrence or death in women who became pregnant after a breast cancer diagnosis.