Breast cancer during and after pregnancy

If you have any symptoms of breast cancer, your GP will examine your breasts and decide whether to refer you to a breast clinic.

At the clinic you’ll usually have a breast examination and one or more of the following tests.

Ultrasound scan

You’ll usually be offered an ultrasound scan. This is safe and will not affect your baby in any way.

Mammogram

You may also be offered a mammogram (breast x-ray). Shielding can be used to protect your baby from the radiation.

MRI scan

Although ultrasound and mammograms are usually the best way of detecting any early changes in the breast, occasionally an MRI (magnetic resonance imaging) scan is used as well. An MRI does not expose the body to x-ray radiation.

The safety of using breast MRI during pregnancy has not been established. However, most small studies looking at MRI during pregnancy show it’s safe, especially after the first 12 weeks (the first trimester).

Core biopsy or fine needle aspiration

A core biopsy uses a hollow needle to take a sample of breast tissue.

A fine needle aspiration (FNA) uses a fine needle and syringe to take a sample of breast cells.

The sample is sent to the laboratory where it’s looked at under a microscope.

Both tests are safe for you and your baby.

Core biopsies are more commonly used for pregnant women and may be more reliable in making a diagnosis.

Bruising to the breast is common after a biopsy in pregnant women because of an increased blood supply to the breast at this time.

You’ll usually be able to have a breast biopsy if you are breastfeeding, although there may be a risk of developing an infected duct and milk leaking (a milk fistula).

Occasionally, it’s not possible to make a diagnosis using a core biopsy. In this case you may have a vacuum assisted biopsy or an excision biopsy under local anaesthetic. This involves taking a larger sample of breast tissue.

Other scans

CT (computerised tomography) scans and bone scans are usually not recommended during pregnancy due to the risk of radiation to the baby.

Terminating a pregnancy is not usually recommended when breast cancer is diagnosed.

Most women continue their pregnancy while having breast cancer treatment. However, some women choose not to.

The decision to terminate a pregnancy is a very personal one. It can be made only by you, or you and your partner if you have one, after a discussion with your treatment team and obstetrician (pregnancy and childbirth doctor).

There’s no evidence to suggest a termination will improve the outcome for women with breast cancer during pregnancy.

However, a termination may be discussed if chemotherapy is recommended during the first 12 weeks (first trimester) of pregnancy. This might be the case if you've been diagnosed with secondary breast cancer.

Take time to make the right choice for you after discussions with your treatment team.

There’s no evidence that having breast cancer during pregnancy affects your baby’s development in the womb.

You cannot pass cancer on to your baby. And there’s no evidence that your child will develop cancer in later life because you had breast cancer while pregnant.

There’s no conclusive evidence that breast cancer during pregnancy is more aggressive than breast cancer at other times.

However, it can be more difficult to detect a cancer in the breast during pregnancy. This means there could be a delay in diagnosis and the cancer could be found at a later stage.

The teams looking after you will include cancer specialists, obstetricians and midwives.

You may be referred to a breast cancer team with expertise in treating women diagnosed during pregnancy.

Your maternity care should be given by an obstetrician and midwife who have experience in caring for women with cancer in pregnancy.

Effective breast cancer treatment can be given during pregnancy and your team will discuss your options.

Generally, the treatment you’re offered will depend on the type and extent of your breast cancer, your individual situation and how far you are into your pregnancy.

The aim will be to give you the most effective treatment for your breast cancer while keeping your baby safe.

If you’re near the end of your pregnancy, your treatment team may delay treatment until after the birth.

Surgery

Surgery can safely be done during all trimesters of pregnancy.

You may be offered a choice between:

1. A mastectomy: removal of all the breast tissue including the nipple area
2. Breast-conserving surgery: removal of the cancer with a margin (border) of normal breast tissue around it, also known as wide local excision or lumpectomy

During the first trimester (first 12 weeks)

You’re more likely to be offered a mastectomy in the first trimester of pregnancy.

This is because not all women who have a mastectomy need radiotherapy, whereas radiotherapy is usually needed after breast-conserving surgery.

Radiotherapy is generally not recommended at any time during pregnancy because of the small risk of radiation to the baby.

During the second trimester (13 to 27 weeks)

If you’re diagnosed in your second trimester and will be having chemotherapy after your surgery, breast-conserving surgery may be an option.

This is because radiotherapy will be given after your chemotherapy has finished and after your baby has been born.

During the third trimester (28 weeks to delivery)

If you’re in your third trimester, breast-conserving surgery may be an option as radiotherapy can be given after the baby is born.

Having a general anaesthetic

Whichever type of surgery you have, it will involve having a general anaesthetic.

This is generally considered safe while you’re pregnant although there’s a very slight risk of miscarriage in early pregnancy.

Breast reconstruction

Breast reconstruction at the time of surgery (immediate reconstruction) is not usually offered during pregnancy. Reasons include a higher risk of bleeding during pregnancy and minimising the time under general anaesthetic.

Breast reconstruction will generally be offered at a later date (delayed reconstruction).

Surgery to the lymph nodes

Your treatment team will usually want to check if any cancer cells have spread to the lymph nodes under the arm.

You may have one or a few lymph nodes removed for testing. This is a sentinel lymph node biopsy and is usually done at the same time as your cancer surgery.

A sentinel lymph node biopsy involves injecting a small amount of radioactive material (radioisotope) into the area around the cancer. This will not affect the baby.

However, a blue dye that’s usually injected with the radioisotope is generally not recommended during pregnancy. Your surgeon will discuss whether a sentinel node biopsy is a suitable option for you.

Some people will have all the lymph nodes removed, known as a lymph node clearance.

Chemotherapy

Certain combinations of chemotherapy drugs can be given during pregnancy.

Anti-sickness and steroid treatments, used to control side effects of chemotherapy, are also considered safe for pregnant women.

Chemotherapy should not be given during the first trimester as it may affect the development of an unborn baby or cause miscarriage.

Generally, chemotherapy during the second and third trimesters is safe. Most women treated during this time go on to have healthy babies, although there’s some evidence to suggest they may be born early and have a slightly lower birth weight.

The growth and wellbeing of your baby will be monitored by ultrasound.

You’ll be advised to stop having chemotherapy three to four weeks before your due date to avoid complications like infection during or after the birth.

Chemotherapy can continue after your baby is born.

Radiotherapy

Radiotherapy is not usually recommended at any stage of pregnancy, as even a very low dose may carry a risk to the baby.

Your treatment plan during pregnancy will try to avoid radiotherapy or delay it until after the birth.

If there’s no other option than to have radiotherapy during pregnancy, there are some changes that can be made to protect the baby.

Hormone (endocrine) therapy

Hormone therapies are not given during pregnancy.

Hormone therapy is used to treat breast cancers that are oestrogen receptor positive (ER-positive).

Breast cancers diagnosed during pregnancy are less likely to be ER-positive.

If your breast cancer is ER-positive, you’ll begin hormone therapy after your baby is born.

Targeted (biological) therapy

Targeted therapies are not usually given during pregnancy.

If targeted therapy is suitable for you, you will start it after your baby is born.

The most widely used targeted therapies are for HER2 positive breast cancer.

Many women diagnosed during pregnancy complete the full term of their pregnancy and do not have any problems during childbirth because of their breast cancer treatment.

When you have your baby will depend on the treatment you need and your expected due date.

If your baby is likely to be born early, you’ll be offered a course of steroid injections. This is to help your baby’s lung development and reduce the chance of the baby developing breathing problems.

Where possible your treatment team will avoid a caesarean section as there can be complications from it. For example, you can be more likely to develop an infection if your immune system has been affected by chemotherapy.

Breastfeeding

Find out about breastfeeding and breast cancer treatment.

Contraception after pregnancy

It's possible to become pregnant again very soon after the birth of your baby, even if you're breastfeeding and your periods have not returned.

You'll have a chance to discuss contraception after your baby is born. Your treatment team will usually recommend barrier methods of contraception, such as condoms.

The contraceptive pill is not recommended for women who have had breast cancer because it contains hormones.

An intrauterine device (IUD or coil) may be used as long as it’s not the type that releases hormones. The IUD can be inserted within 48 hours of the birth. If not inserted within 48 hours, you'll be advised to wait until four weeks after the birth.

Future fertility

If having more children of your own in the future is important to you, and you want to find out about possible options for preserving fertility, you can discuss this with your treatment team before starting treatment. This may be possible if you are diagnosed after pregnancy.

Being pregnant or caring for a new baby while having treatment for breast cancer is both physically and emotionally draining.

Talk to people close to you about how you feel and take up any offers of practical support and help.

You can also talk to your treatment team or your midwife if you are feeling overwhelmed or have any concerns.

Finding support

As breast cancer during pregnancy is not very common, you may feel alone at this time.

You might find it helpful to share your feelings with others who have had a similar experience to you.

You can find support and speak to other people in a similar position through:

1. Our Someone Like Me phone or email service, or Younger Women Together events - see below
2. The Younger Breast Cancer Network private Facebook group
3. Mummy’s Star

If you’re struggling with extra costs, you may be able to get financial support or information from:

• Macmillan Cancer Support: Financial help
• Turn2us
• Mummy’s Star: Support for me

More information

The Royal College of Obstetricians and Gynaecologists has information about pregnancy and breast cancer, including a resource for healthcare professionals.