Could this lump be breast cancer or a blocked milk duct?
During pregnancy and the postpartum period, you will experience changes in your breasts, most of which are harmless. However, in a very small subset of women, these changes are not benign and are in fact the beginnings of breast cancer. Because the consequences of delaying treatment can be serious, any lump you feel in your breast should be seen by a health professional.
I have a friend who unfortunately waited too long to be seen after finding a lump in her breast soon after giving birth to her son. She initially asked her midwife what it might be, and the midwife told her not to worry – that it was more than likely a blocked milk duct. A few months, later the lump had still not disappeared and even seemed to be getting bigger so this woman went to the doctor where she got a biopsy. Unfortunately, this was not a blocked milk duct but was breast cancer, and following a scan she was diagnosed with stage IV breast cancer, which is terminal. I don’t recount this story to scare readers but to emphasize the point that ANY lump in the breast should be looked at by a doctor, even if your midwife or other health professional thinks it is not important. It is more than likely the lump is something benign such as a blocked milk duct or fibrous tissue but there is also a possibility that it might be something more serious. As well as having any lump found examined by a doctor, this should also be done as soon as possible because if it is cancer, it is extremely important to catch it early on when it is still potentially curable.
Therefore, monthly breast exams are very important and if you find any lumps, bumps, or other concerning breast symptoms, you need to make an appointment with your doctor straight away.
How do I perform a breast self-exam in front of the mirror?
When standing in front of a mirror:
- Look for any changes in size, shape, position, or any discoloration
- Check your nipples for any sores, peeling, or change in their direction
- Place your hands on your hips and press down firmly to tighten the chest muscles underneath your breasts
- Turn from side to side so you can see the outer areas of your breasts
- Bend forward towards the mirror and roll your shoulders and elbows forward to tighten your chest muscles
- Your breasts will fall forward, and when they do look for any changes in their contour or shape
- Clasp your hands behind your head and press your hands forward
- Turn from side to side, inspecting your breasts’ outer areas as well as the border underneath them
Pregnancy-associated breast cancer
In general, pregnancy has a protective effect on a woman developing breast cancer later in life, in particular if her pregnancies are before the age of 30 years. However, there is a small subset of women for whom pregnancy increases the risk of developing breast cancer either during the actual pregnancy or within the first five years following birth. This type of breast cancer is called pregnancy-associated breast cancer and the subset of women affected is growing, due to women having babies at older ages. However, this subset is still quite small, with less than one percent of new moms being diagnosed each year.
Therefore, monthly breast exams are very important and if you find any lumps, bumps, or other concerning breast symptoms, you need to make an appointment with your doctor straight away.
What causes pregnancy-associated breast cancer?
There are a few factors specific to pregnancy that may lead to a woman developing pregnancy-associated breast cancer. These include:
- Effect of the fetus on weakening the immune system. This allows the fetus to develop normally but may also lead to increased susceptibility to infections or cancer.
- Increased levels of the hormones, estrogen and progesterone, both of which have been linked to promotion of cancer growth.
- Involution – the process of the breasts returning to their pre-lactation state after weaning (or directly following birth if the woman is not breastfeeding). Involution may lead to inflammation and this can also promote cancer growth.
How can I prevent pregnancy-associated breast cancer?
The steps you can take to prevent pregnancy-associated breast cancer are the same as what you should take to prevent breast cancer in general. These are the following:
- Regular exercise
- Drinking in moderation (no more than one glass of wine, or equivalent, per day)
- Avoiding exposure to excess estrogen in the environment
Treatment options for pregnancy-associated breast cancer
Most women with pregnancy-associated breast cancer undergo mastectomy as the first therapy of choice. This can be performed either following birth or during birth, with the main risk to the fetus being spontaneous abortion during the first trimester from the general anesthesia.
Adjuvant chemotherapy has been shown to be beneficial in women who are at high risk of breast cancer occurring again after surgery. Chemotherapy is not recommended during the first trimester as this is when the fetus’ organs are forming and it may lead to birth defects.However, it is usually safe to undergo chemotherapy during the second and third trimesters. Chemotherapy is usually stopped three weeks before your due date in order to avoid complications at birth, such as infection and blood disorders in the newborn.
Radiotherapy is not recommended in pregnant women because there is a risk of deformities and/or delays in neurocognitive development in the fetus. Consequently, radiotherapy is usually administered following birth, when there is no risk to the developing baby.
What questions should I ask my healthcare provider?
If you are pregnant and have recently been diagnosed with cancer, consider asking your health care provider these questions:
- Is it safe to continue the pregnancy?
- Could delaying treatment affect my chance of recovery?
- What are the short- and long-term risks of my treatment plan to me? To the baby?
- Do I need to have any special tests?
- How much experience do you have treating pregnant women with cancer?
- How will you work with my obstetrician?
- Do I need to begin treatment right away, or should I wait?
- Will treatment affect my delivery? How?
- Will I be able to breastfeed?
Support following a diagnosis of breast cancer during or soon after pregnancy
Caring for a newborn baby is demanding at the best of times, and much more so when you also have to deal with both the diagnosis of breast cancer and the treatment for it. Talk to your healthcare team to see if you are eligible for any assistance, and talk to family and friends about the practical support they could offer in order for you to get adequate rest and to recover from your birth and your treatment.
