Pregnancy & Breast Cancer

Excerpted from
Bosom Buddies: Lessons and Laughter on Breast Health and Cancer
By Rosie O'Donnell, Deborah Axelrod, M.D., F.A.C.S., Tracy Chutorian Semler

Can I Be Treated For Breast Cancer During Pregnancy?

As a breast surgeon, my primary concern is the health of the mother, though certainly our goal is to protect the health of both mother and baby. But there are many different scenarios to consider. For instance, if invasive breast cancer is found early in the pregnancy, mastectomy is recommended as part of treatment, because it is simply too dangerous for an early-stage fetus to be exposed to radiation treatments. If breast cancer is found later in pregnancy, even a month before delivery, then we will often go ahead and do lumpectomy surgery on the woman while she is pregnant, and then wait until after delivery to do the radiation therapy. Chemotherapy is a different story, which I will discuss shortly.

Naturally, we take special precautions during surgery on a pregnant woman-such as extra care with anesthesia, and special positioning of the mother in order to reduce pressure on the main vein that supplies blood to the uterus. We are also especially careful about controlling bleeding, since the breasts are rich with blood vessels at this time, as the body anticipates breast-feeding. If I operate on someone who is breast-feeding, I ask her to continue to feed the baby or to pump her milk shortly afterward. You can pump out your first milk after surgery to get rid of the residual anesthetic. But the idea is to get the milk out of the breast so it doesn't build up and force its way through your surgical incision, causing a "milk fistula." Milk also happens to be a great medium for bacteria to grow in, so ask your doctor for antibiotics around the time of surgery to help you avoid mastitis (a breast infection). The bottom line, however, is that despite these various concerns and subsequent precautions, you want to have treatment for breast cancer ASAP. Don't let breast-feeding, or pregnancy for that matter, delay treatments that can save your life. Chemotherapy is another issue in pregnancy. Some drugs are considered relatively safe for the developing fetus, while others would be too toxic. This is something to discuss with your doctor.

Much more complex emotional and philosophical questions come into play as well. For example, you have to think very carefully about bringing a new life into the world if, for example, your prognosis is not good. What support systems are in place for the baby if you are not able to care for it? What, if any, is the decrease in your survival chances if you go through with the pregnancy? Do you have other young children who need your care? These enormously serious and painful questions cannot be worked out with your medical doctors alone. This is a time when other support people, including loved ones, social workers and other therapists, and spiritual advisers like clergy can help you sort out your feelings and priorities. Talking to other women who have gone through the same experience can help as well-you can often get phone numbers from your doctor. Ultimately, of course, these critical decisions will be your own. But the more support you can garner in making them, the easier the load on your shoulders-which are already bearing quite a burden.

Can I Become Pregnant After Being Treated For Breast Cancer?

Yes. However, there is a risk of going into early menopause after taking some anticancer drugs. The younger you are, the lower the risk of losing your fertility due to breast cancer treatments. One somewhat reassuring study has found that among women treated with a common breast cancer drug regimen CMF (for cyclophosphamide, methotrexate, and 5-fluorouracil), the risk of ovarian failure is 0 percent for women under thirty years of age; 33 percent for women aged thirty to thirty-nine; 96 percent for those forty to forty-nine; and 100 percent only for those over fifty, who have almost reached the average age of natural menopause anyway.

Studies have shown that if you still ovulate after breast cancer treatment, you can successfully carry a pregnancy. (Some studies have even found a better prognosis among women who become pregnant after breast cancer, but this could be a result of the fact that women with earlier cancers are more likely to become pregnant.) Since it is known that invasive breast cancer recurrence is most likely in the first two years after treatment, I urge women to wait two to three years to become pregnant after treatment. But talk to your doctor about your own particular case.

Can I Breast-Feed After Breast Cancer?

If your surgery and/or radiation treatment did not interfere with your milk production (by creating a mechanical blockage so that the milk cannot travel through your nipples), you can, technically, still breast-feed. But there may be some complications. For instance, if you develop an infection in your breast during breast-feeding (known as a mastitis), it would be harder to treat because of the inner scarring from more extensive surgery and/or radiation treatment. A major infection would be hard to treat with antibiotics and it would be more difficult to fully empty the breast of milk, which is important in the treatment of mastitis. You could, therefore, end up with an abscess (a cavity filled with pus).