Breast cancer in pregnancy
Breast cancer in pregnancy — part of pregnancy and antenatal care at Dr. Najeeb Layyous's clinic in Amman.
In short: Pregnancy does not increase the risk of breast cancer, but it can be discovered during pregnancy. It is diagnosed mainly by ultrasound; mammography is allowed with protection of the abdomen, and biopsy is safe. Treatment is by a multidisciplinary team: chemotherapy is avoided in the first trimester, hormonal drugs are delayed until after delivery, and most cases do not require ending the pregnancy.
Does pregnancy increase the risk of breast cancer?
No, pregnancy does not cause breast cancer and in the long term it slightly lowers the risk. However, the normal breast changes of pregnancy can hide a lump, so any lump that lasts more than two weeks should be checked with an ultrasound.
What are the symptoms of breast cancer during pregnancy?
The symptoms are generally:
- Breast pain
- Feeling of swelling or a lump
- Changes in the position and protrusion of the nipple
- Changes in the skin covering the breast
- Bloody discharge from the nipple
- Weight loss and loss of appetite
- Symptoms of the spread of the tumor to other organs (for example, headache if it spreads to the brain)
How are breast lumps treated during pregnancy?
They are evaluated using breast ultrasound
Can a mammogram be used during pregnancy?
Yes, but a shield must be used to cover the abdomen and protect the fetus
Can a breast biopsy be performed during pregnancy?
Yes
Can a CT scan be used during pregnancy?
It is avoided where possible, and staging is usually done with a chest X-ray (with abdominal shielding), liver ultrasound and, if needed, MRI without contrast. If a CT scan of the chest is essential for the mother’s care, it can be done, because the dose reaching the fetus is low.
Can a bone scan using radioisotopes be used during pregnancy to assess the extent of the tumor spread?
It is usually avoided, and bone spread is assessed with MRI without contrast if symptoms suggest it. In special cases where it is essential, a modified low-dose bone scan can be considered.
Is breast cancer during pregnancy a reason to terminate pregnancy?
This depends on the extent of the disease, its stage, the patient’s need for treatment, and the expected survival rate.
Ending the pregnancy has not been shown to improve the mother’s chance of survival, and with proper treatment the outcome is similar to that of non-pregnant women with the same stage of cancer.
Preparing for a future pregnancy is the subject of our article on pre-conception care.
What is the treatment for breast cancer during pregnancy?
Care should be shared between the gynecologist, obstetrician, breast surgeon, oncologist, and other related specialties to ensure the best outcome for the woman.
Treatment may be:
- Surgery, which can be safely performed in any trimester — either removal of the breast or, in suitable cases, breast-conserving surgery, with sentinel lymph node biopsy or removal of the armpit lymph nodes
- Radiotherapy
- Chemotherapy
What are the precautions for radiation therapy during pregnancy?
Other exposures discussed for expectant mothers are listed in our guide to what to avoid during pregnancy.
Radiotherapy is generally postponed until after delivery, because even with an abdominal shield the fetus receives scattered radiation. It is given during pregnancy only in exceptional, life-threatening situations after specialist discussion.
What are the precautions for chemotherapy during pregnancy?
It should be avoided in the first trimester of pregnancy because it can cause fetal anomalies. From about 14 weeks, most standard chemotherapy can be given safely, and it is usually stopped about 3 weeks before delivery. Targeted treatment such as trastuzumab (Herceptin) is not used in pregnancy because it can reduce the amniotic fluid.
Can drugs that act on estrogen receptors be used during pregnancy?
No, their use should be postponed until after delivery
When should delivery take place?
This depends on the degree and stage of the disease, the mother’s health condition and her treatment requirements
Can a woman who was treated for breast cancer during pregnancy breastfeed after giving birth?
If there is breast tissue left that produces milk, then yes she can breastfeed, but there are some treatments that are secreted with milk and therefore breastfeeding should be avoided while using them
Can women who have had breast cancer use birth control pills?
No. All hormonal methods (including the combined pill, progestogen-only pill, implant, injection and hormonal coil) should be avoided, and non-hormonal methods such as the copper IUD or condoms are recommended.
When can a woman get pregnant after recovering from breast cancer?
This depends on each case, the stage of the cancer and the treatment still needed, so it should be planned with the oncologist. Many women are advised to wait about two years after finishing treatment, and women taking hormonal (endocrine) therapy can sometimes pause it to conceive after about 18-30 months under specialist supervision. Pregnancy after breast cancer does not appear to increase the risk of the cancer returning.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
The finest doctor in Jordan — may God bless him and his whole medical team. A doctor in every sense of the word. I advise anyone planning a pregnancy to visit Dr. Najeeb Layyous. His manner is wonderful, always smiling, with the highest ethics; he gives every patient her due, and the patient’s comfort matters most to him. We had been to many doctors and none understood and treated my case except him. Special thanks to him and the whole team, and to Dina in particular — a lovely person. I recommend anyone considering IVF or pregnancy to visit his clinic.