Impact of Breast Cancer on the Pregnant Woman and Fetus

Approximately 3% to 4% of women are pregnant or lactating at the time of diagnosis of breast cancer. Breast cancer complicates about 1 in 3000 pregnancies. The prognosis for women who are diagnosed with breast cancer while pregnant is 15% to 20% below the overall survival rate because the disease is generally in the advanced stages when first diagnosed. Diagnosis is often delayed because breast engorgement may obscure the mass from palpation and increased density of the tissue makes mammography visualization more difficult. Also, increased vasculartiy and lymphatic drainage in the breast of a pregnant woman may increase the speed of metastasis.

Surgery is the usual treatment for breast cancer during pregnancy. Maternal fetal management considers the gestational age of the fetus, extent of disease, the tumor growth potential and the proposed treatment.

Termination of the pregnancy in early stages of the disease appears to have no impact on survival. Therapeutic abortion may become an issue in the presence of advanced disease and may be deemed necessary to achieve effective palliation. For advanced disease in the second or third trimester, chemotherapy agents are relatively safe for the fetus. Chemotherapy may significantly improve the survival of these women. Radiation therapy is avoided because of harm to the fetus.

There is no certain data about weather a women with breast cancer should breast feed. There are concerns that if one of the oncogens for breast cancer is a virus, the remaining breast may be contaminated and the virus may be passed to the newborn, possibly acting as a latent inducer of breast cancer. Also lactation increases vascularity in the remaining breast, which may contain a neoplasm as well (encouraging growth.)

Pregnancy incidence after mastectomy is influenced by many factors, including prior treatment and duration of survival. About 7% of women will have 1 or more pregnancies with in the first 5 years after mastectomy.

In general women with good prognoses (no positive nodes) are likely to be counseled to wait at least 3 years before attempting pregnancy.

In conclusion, while pregnancy immediately post treatment is not advised, successful pregnancies can be accomplished. Pre-planning is essential. It is important to communicate your wishes to your healthcare provider so that pre, during, and post pregnancy exams can be conducted to more effectively manage any cancerous inflammations before they severe. Frequent exams during pregnancy will also be necessary. With consistent care and precaution a women with breast cancer can possibly have a successful pregnancy outcome.