According to the Susan B. Komen Breast Cancer Foundation, breast cancer occurs in about one of every 3,000 pregnancies. But since women are having babies at older ages and the risk of developing breast cancer increases as women get older, more cases of breast cancer during pregnancy may emerge in the future, according to the American Cancer Society. While pregnancy is already a complex time in a woman's life, the addition of the diagnosis of breast cancer can bring more complications.
Later Diagnosis of Breast Cancer
Breast cancer during pregnancy is typically diagnosed as the patient or the doctor finds a breast lump when conducting a breast examination, according to the Susan B. Komen Breast Cancer Foundation. Since a pregnant woman's breasts tend to be larger, more lumpy and painful because of hormones, it is more difficult to properly examine the breasts. Thus, any breast cancer lump that may be detected is often at a more advanced stage.
Mammograms that are performed during pregnancy are also more difficult to read because of the change in the texture of the breasts, according to the American Cancer Society. The common tools used to diagnose breast cancer, which include mammograms or ultrasounds, are considered safe during pregnancy. Pregnant women, especially those over the age of 40, should discuss breast exams and health with the doctor.
Biopsy Challenges
According to the BreastCancer.org website, a breast mass requires a biopsy, which involves either excisional or needle biopsy, to accurately make the diagnosis of breast cancer. Usually, the biopsy can be done in an outpatient setting and is of little risk to the fetus. However, the biopsy must occasionally be done under general anesthesia, which holds a small risk to the pregnancy, according to the American Cancer Society.
The biopsied tissue itself can be difficult for the pathologist to read in a pregnant woman when the tissue is obtained through a needle biopsy, as noted on the BreastCancer.org website. Experienced pathologists are able to tell the difference between rapidly dividing breast tissue and breast cancer.
Challenges with Staging
Once breast cancer has been diagnosed, the physician must stage the cancer to determine if it has spread beyond the breast. The staging tests to look for cancer outside of the breast involve radiation and contrast dye, which can be damaging to the fetus. In order to protect the fetus, the doctors usually avoid the tests that use radiation or contrast dye, according to the American Cancer Society. The pregnant woman and the doctor must take these factors into consideration when determining next steps in the staging of breast cancer.
Treatment Challenges
Many of the treatment options for breast cancer in pregnant women can be damaging to the fetus; the risk to the fetus should be weighed with the well-being of the mother. According to the American Cancer Society, surgery is the safest type of treatment for the pregnant woman; lumpectomy, mastectomy or lymph node removal can be performed during pregnancy without any problems for the fetus.
Radiation, chemotherapy or hormone therapy is riskier for the fetus. As noted by the Susan B. Komen Breast Cancer Foundation, radiation therapy is potentially dangerous for the fetus, but many women have a lumpectomy during the pregnancy and then have radiation therapy after the baby is born. Some forms of chemotherapy can be given after the first trimester of the pregnancy, because first trimester chemotherapy can cause birth defects, according to the American Cancer Society. The chemotherapy should also not be given less than one month before delivery, as the risk of infection and bleeding will increase. Hormone therapy should be avoided during pregnancy.
