Do breast exams regularly and check with your doctor if you find anything suspicious, and learn what treatment options are available for gestational breast cancer.
Gestational breast cancer, diagnosed during pregnancy or during the first year postpartum, affects about 1 in 3,000 pregnant women between 32 to 38 years old. The risk of breast cancer increases with age. As the number of older pregnant women grows, there may also be an increase in gestational breast cancer patients. Learn how to detect it early and what treatment options are available during pregnancy and postpartum.
Breast Cancer Awareness Month
Faith’s second chemotherapy session at KK Women and Children Hospital.
October marks Breast Cancer Awareness Month, which aims to raise awareness for this cause. This year’s theme focuses on finding support so no one has to fight cancer alone. Instead, team up with your loved ones and go for regular mammograms and practice breast self-examination for early detection.
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Nooridah Bte Mohd Noor shares her story of undergoing chemotherapy for breast cancer while pregnant.
Detecting Gestational Breast Cancer
Check for any lumps in your breasts, nipple discharge, lingering breast pain, itchy or sore rashes on the nipple. Other signs of breast cancer may include redness or darkening, swelling or warmth of the breast. As these are similar to breast changes during pregnancy, diagnoses are often made at a later, more advanced stage compared to non-pregnant patients.
See a doctor if the lump remains after a week, or comes back in the same place after it has been treated for a blocked duct. If it keeps growing, doesn’t move, is firm or hard, or causes dimpling of the skin, or you notice any other changes to your breast, check with your doctor. More than 80 per cent of breast masses in pregnancy are benign.
Generally, women with a family history of breast cancer should be extra vigilant, and bring this up to their OB-GYN before trying to get pregnant. Published data has been varied on the outcomes for gestational breast cancer patients. Some indicate similar outcomes as non-pregnant patients, while others indicate a poorer prognosis.
Treatment Of Gestational Breast Cancer
If you’re pregnant and you have any suspicious symptoms or lumps, you’ll get a diagnosis via an ultrasound. This will also keep track of your baby’s growth through the treatment.
During Pregnancy
Ensure that your medical team treating your breast cancer factors in your maternal and foetal well-being. Hence, your team may include diagnostic imaging professionals, oncologists, breast surgeons and breast care nurses and obstetricians. If you have any suspicious symptoms, you'll be diagnosed via breast ultrasonography without ionising radiation. This diagnostic tool has high sensitivity and specificity, and can look for changes in the size and consistency of lymph nodes in your armpit.
The first line of treatment for breast cancer is usually surgery to remove the tumour. This is safe throughout all the trimesters of your pregnancy. You may consider inserting temporary implants or tissue expanders during pregnancy for breast reconstruction after delivery. After the first trimester, chemotherapy is a safe option. The risk of foetal malformations is similar to those not exposed to chemotherapy during pregnancy. However, it’s unadvisable to undergo radiation, anti-HER2 or endocrine therapy with tamoxifen during pregnancy. Take these after giving birth to your baby.
Postpartum Treatments
After giving birth to your baby, you can try other treatment options if necessary. These include radiation therapy, often used after the breast-conserving surgery to reduce the risk of the cancer returning. As the high doses of radiation can harm the baby, causing miscarriage, birth defects or a higher risk of childhood cancer, start on this after giving birth. However, waiting too long to start radiation may increase the chances of the cancer returning.
Another option is hormone therapy to treat advanced breast cancer in women who have hormone receptor positive breast cancer. These drugs include tamoxifen, anastrozole, letrozole and exemestane. If you have HER2-type cancer, which is a growth-promoting protein on the outside of breast cells, you may need to try targeted therapy and take trastuzumab or pertuzumab.
Taking Care of Your Baby
In Utero Monitoring
While treating the cancer, your foetus will also be monitored closely. Risks from in-utero chemotherapy include intrauterine growth restriction, low birth weight, preterm delivery and temporary leukopenia - where she has lesser disease fighting white blood cells. You will need to have growth scans and a detailed anatomy scan, if you've been taking medication in the first trimester. Should your baby be growing slower than expected, you may have to go for growth scans more frequently, which may include Doppler interrogation and antenatal testing for your foetus’ well being.
Effects of Chemotherapy in Utero on Children
While there are no cases of the cancer spreading from the breast to the foetus, there have been isolated reports of it travelling to the placenta. After delivery, the placenta should be sent for pathologic evaluation. Children have no adverse effects after being exposed to chemotherapy in the womb. A study involving 84 children exposed to chemotherapy in utero to treat cancers affecting the blood, bone marrow and lymph nodes found no abnormalities nor cancer.
Delivery
Try to deliver close to term or at term and naturally if possible. You may consider induction or Caesarean section if you're close to term when you discover breast cancer, so you can take hormone, targeted and radiation therapy if necessary. You may stop chemotherapy treatments before 36 weeks to have sufficient disease-fighting white blood cells during delivery. These blood cells fight bacterial infection around the membranes that surround the foetus and the amniotic fluid and operatic infection. If absent, these may lead to increased morbidity or mortality during Caesarean deliveries.
Breastfeeding After Breast Cancer
Depending on your treatment options, you may or may not be able to breastfeed your child. Rest assured that feeding your newborn infant formula or getting milk from milk banks are great options to help her thrive. You may be able to breastfeed your baby if you’ve had a lumpectomy, where the tumour and margin of healthy breast tumour have been removed. Women who have undergone single mastectomies can feed from the remaining breast. If you’ve undergone radiation, some of your breasts' lobules may be damaged, rendering them unable to make milk. Additionally, the breast milk may look thicker and darker. While no evidence suggests that it’s dangerous to feed babies this milk, you can choose not to.
Motherswork Recommends: Newborn Infant Formula (up to $59)
Pregnancy After Breast Cancer
Use safe contraceptive options, such as intrauterine devices or barrier methods, rather than hormone therapies. Wait at least two years from remission before conceiving again. For future conception, freeze your eggs or embryos before undergoing chemotherapy, which affects your ovarian reserve. As less than 10 per cent of PABC women became pregnant after treatment, it's unknown how a future pregnancy affects a breast cancer relapse. The few case series suggest no adverse effects so far.
Breast Cancer Support Groups
Rally your support system around you, including your medical team, friends, family and your spouse.
Getting such news can be extremely worrying and terrifying. Not only do you have to worry about your own health, but also about the tiny foetus that’s growing inside you. Build a support system around you, consisting of your healthcare team, your partner, family and friends. Ensure that your doctors provide clear information about the disease, treatment plans and risks, while taking care of your growing baby. You may also want to reach out to various support groups in Singapore to help you get through this tough time.
Breast Cancer Foundation: membership@bcf.org.sg
Singapore General Hospital Breast Cancer Support Group: +65 6321 4474
National University Cancer Institute of Singapore: ncis_survivorship@nuhs.edu.sg.
Singapore Cancer Society Reach to Recovery
Relevant Reads: All About Pregnancy
Credits: tirachardz, therealrabbitmommy, MART PRODUCTION, Thirdman
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