July 8, 2015 | by City of Hope
Many women think they can't develop breast cancer while pregnant or nursing. They can.
In fact, breast cancer is the most common type of cancer detected during pregnancy or while breast-feeding, according to the American Cancer Society. It's rare, to be sure, but the incidence is expected to rise as women delay childbirth, leading them to have children later in life.
A City of Hope breast cancer surgeon wants to make women aware of this risk.
Remain vigilant, advised Courtney Vito, M.D., an assistant clinical professor in the Division of Surgical Oncology at City of Hope. Know your body, be aware of any changes in your breasts, and if something seems amiss, have it checked out, she said. In short:
“Yes, you can get breast cancer while you are pregnant. Yes, you can get breast cancer while you are nursing. Yes, it is rare. But no, it is not normal to have a persistent hard area or mass in your breast."Vito continued: "You should have a doctor look at it – and by look at it, I don’t mean just tell you it’s normal. Look at the skin of your breast and your nipple, touch and feel the whole breast not just the hard area, and then at least check it with an ultrasound. Every woman needs to know this information.”
Vito is passionate about this message because more than once she has had to tell a new mother that she has cancer, and that it is advanced. She also understands how frightening a potential breast cancer diagnosis can be – especially in the midst of prenatal appointments, picking out nursery essentials, and the excitement and anticipation of holding your baby for the first time.
She’s been there, and had a scare herself.
A lesson learned firsthand
When Vito was pregnant with her first child, she noticed a small lump in her breast. Her obstetrician could not feel it. Later in her pregnancy, she changed doctors due to availability issues, and told her new doctor about the lump. Her doctor checked the lump with an ultrasound and discovered a benign mass.
"It was a fibroadenoma, which cannot turn into cancer but does grow during pregnancy," she said. "With good, quality imaging and a quality clinical exam, you can usually identify it."
What she learned from the experience is that every woman should persist until they have proof that the change in their body is normal.
"You should be totally comfortable with pushing an issue to get an 'OK, it's no big deal' diagnosis," she said.
"I've had several pregnant or new moms in my practice, and the striking feature about all of their stories is that they had a gut feeling. They knew there was something wrong, and they pushed for the diagnosis. For me, it ended up not to be a big deal, but I wanted that proof and I pushed. I don't deserve anything more as a patient than anyone else. Every woman deserves to have that proof in hand."
Breast cancer during pregnancy is a challenging diagnosis to make, because it's a period of time when a woman's anatomy and physiology changes significantly -- and it's difficult to discern what changes are related to pregnancy and which are not. Even so, doctors should consider whether there are other reasons a woman might be experiencing pain or other symptoms during pregnancy.
"Always have an expert looking over something you feel is outside the normal change. Never be embarrassed."As for the doctors' perspective, Vito said, "we love giving negative imagining and biopsy results."
Rare but not rare enough
About one in every 3,000 pregnant women is diagnosed with breast cancer, according to the American Cancer Society – so the condition is far from common. However, breast cancer is often diagnosed at a later stage in women who are pregnant, and is more likely to have spread to the lymph nodes, partly because of hormone changes during pregnancy.
Estrogen and progesterone levels increase during pregnancy. Prolactin, a hormone that prepares the breasts for nursing, also increases. Breasts naturally, due to these changes, tend to become lumpier, larger and tender – which makes it more difficult for women and their doctors to notice a lump until it is very large.
Mammograms are also often delayed during pregnancy. Pregnancy and breastfeeding can also lead to denser breasts, which can make identifying a cancer on a mammogram more difficult.
But, Vito stressed, don't take chances. And above all, remain vigilant.
Consider a mammogram if you find a lump. Discuss the risks with your doctor. Mammograms can detect most cancers during pregnancy, and the amount of radiation necessary is small and focused on the breasts. The belly is shielded to prevent radiation from reaching the womb. There is still some risk, as scientists are not certain about the effects of even a small dose of radiation on an unborn baby. However, the risks and benefits should be fully explored in a conversation with your doctor if you’ve found a lump or abnormality in the breast.
Remember that breast cancer can be treated during pregnancy. Surgery for breast cancer is generally safe during pregnancy, and other treatment options may also be possible. It will vary from woman to woman. However, it’s important for women to know that it is possible to confront their breast cancer and deliver a healthy baby.
Read about Stephanie Hosford, now a mother of three, who is sharing her story, "Bald, Fat & Crazy: How I Beat Cancer While Pregnant," about being treated at City of Hope for triple-negative breast cancer while pregnant.
Learn more about becoming a patient or getting a second opinion by visiting our website or by calling800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.