Being diagnosed with breast cancer during pregnancy is very rare, but it can happen so continuing to check your breasts throughout pregnancy is crucial.
What are the signs of breast cancer?
Symptoms of breast cancer can include a change in the size or shape of the breasts, a lump or thickening of the breast tissue, puckering or dimpling of the skin, a rash on the skin or nipple, an inverted nipple, discharge from the nipple and constant pain in the breast or armpit.
All women should be aware of how their breasts look and feel normally so they can be confident in noticing any unusual changes, but this can be more difficult during pregnancy as breasts naturally begin to change.
How do breasts change during pregnancy?
During the early stages of pregnancy, breasts may become tender and increase in size. As the pregnancy progresses, many women feel tingling or soreness in their breasts especially in the nipples because of the increased levels of the hormone progesterone and the development of the milk ducts. Sometimes, the nipples will become darker in colour and the veins on the surface of the breast may become more noticeable.
From around 16 weeks, the nipples may leak as the breasts begin to produce a fluid called ‘colostrum’ – this is completely normal.
Breast lumps sometimes occur during pregnancy, but Carolyn Rogers, Clinical Nurse Specialist at Breast Cancer Care, says: ‘It’s important to remember that breast cancer in younger women and during pregnancy is rare. The vast majority of these lumps will be benign (not cancer), for example fibroadenomas or fluid -filled cysts. But it’s always best to get any new lumps checked by your GP, or inform your midwife or GP if an existing lump changes in any way.’
How is breast cancer diagnosed during pregnancy?
Breast cancer is usually diagnosed by ‘triple assessment’. Carolyn Rogers explains: ‘First, you’ll be examined by a specialist, then you will usually have an ultrasound of the breast. This is completely safe and will not harm your baby. You may also be offered a mammogram, where shielding can be used to protect your baby from the radiation used in the x-ray. The final part of the assessment includes either a biopsy or fine needle aspiration to take a sample of tissue or cells for analysis. Both of these tests are completely safe for you and your baby.’
What treatment options are available?
‘If you are diagnosed with breast cancer during your pregnancy, the choices you may have to make can seem overwhelming,’ says Carolyn Rogers. ‘Women tell us that it’s a huge emotional struggle at what should be a very exciting time. But it’s absolutely possible to have a healthy pregnancy and healthy baby while undergoing treatment for breast cancer.’
The treatments you may be given will depend on your trimester. If you are near to the end of your pregnancy, treatment may be delayed until after the birth, and you will be advised not to breastfeed so treatment can be given.
Surgery can be safely carried out during all trimesters. While pregnant, you’re more likely to be offered a mastectomy than breast-conserving surgery (where just the cancer, and not the whole breast, is removed); this is because not all women who have a mastectomy need radiotherapy afterwards, whereas radiotherapy is always needed after breast-conserving surgery. Radiotherapy is generally not recommended at any time during pregnancy as even a very low dose may carry a risk to the baby. If you’re in the late stages of pregnancy, you may be offered breast-conserving surgery if radiotherapy can be given after you have given birth.
Certain combinations of chemotherapy can be given during pregnancy, but it will generally be avoided during the first trimester to avoid any risk of miscarriage or harm to the baby.
Hormone therapy and/or targeted cancer treatment, like Tamoxifen and Herceptin, are often given after initial cancer treatments to reduce the chance of the cancer coming back. However, these will usually be avoided during pregnancy or when breast feeding.
It happened to me…
Donna, now 43, found a lump while lying in the bath. She was 35 and seven months pregnant with her second child. Initially she thought it must be a milk duct or hormone changes due to the pregnancy, but her midwife urged her to get it checked out.
It turned out to be breast cancer. Donna was induced three weeks early so that treatment could start straight away.
Fortunately, Amy was born without incident and Donna enjoyed the precious time she had with her new baby before her treatment started - on the day Amy was initially due to be born.
Donna says: “Having the little ones actually helped me through it. I had no time to sit around because they didn’t understand, they were still hungry or tired and still needed me.”
How to get support
Breast Cancer Care’s website has more information on pregnancy and breast cancer. If you have any questions about breast health or breast cancer, call their free support line on 0808 800 6000.