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Table of Contents General Information about Breast Cancer and Pregnancy
Stages of Breast Cancer
Treatment Option Overview
Treatment Options by Stage
Other Considerations for Pregnancy and Breast Cancer
Changes to This Summary (12/19/2003)
To Learn More
About PDQ
General Information about Breast Cancer and Pregnancy
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Breast cancer is a disease in which malignant (cancer) cells
form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called
lobes, which have many smaller sections called lobules. The lobes and lobules are connected by
thin tubes called ducts.
Each breast also contains blood
vessels and lymph
vessels. The lymph vessels carry an almost colorless fluid called lymph. The
lymph vessels lead to small, bean-shaped organs called
lymph nodes that help the body fight
infection and disease. Lymph nodes are found throughout the body. Clusters of
lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and
in the chest.
Breast cancer is sometimes detected (found) in women who are
pregnant or have just given birth.
In women who are pregnant or who have just given birth, breast
cancer occurs most often between the
ages of 32 and 38. Breast cancer occurs about once in every 3,000 pregnancies.
It may be difficult to detect (find) breast cancer early in
pregnant or nursing women, whose breasts are often tender and swollen.
Women who are pregnant, nursing, or have just given birth usually
have tender, swollen breasts. This can make small lumps difficult to detect and
may lead to delays in diagnosing breast cancer. Because of these
delays, cancers are often found at a later stage in these women.
Breast examination should be part of prenatal and postnatal care.
To detect breast cancer, pregnant and nursing women should examine
their breasts themselves. Women should also receive clinical breast
examinations during their routine prenatal and postnatal examinations.
Tests that examine the breasts are used to detect (find) and diagnose
breast cancer.
If an abnormality is found, one or all of the following tests may
be used:
- Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
- Mammogram: An x-ray of the breast. A mammogram can be performed with little
risk to the fetus. Mammograms in
pregnant women may appear negative even though cancer is present.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
Certain factors affect prognosis
(chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage
of the cancer (whether it is in the breast only or has spread to other places in the body).
- The size of
the tumor.
- The type of breast cancer.
- The age of the fetus.
- Whether there
are symptoms.
- The patient’s
general health.
Survival rates of pregnant women with breast cancer may be
lower than for women who are not pregnant.
Pregnant women with breast cancer may be less likely to survive
because the diagnosis of their cancer is often delayed and the cancers are more
advanced when they are found. Cancers found at later stages are more difficult
to treat successfully.
Stages of Breast Cancer
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After breast cancer has been diagnosed, tests are done
to find out if cancer cells have spread within the breast or to other parts of
the body.
The process used to find out if the cancer has spread within the breast or to other
parts of the body is called staging.
The information gathered from the
staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. (Refer to the PDQ summary on
Breast Cancer Treatment 1
for more information on the stages used for breast cancer.)
Methods used to stage breast cancer can be changed to make them
safer for the fetus.
Standard methods for giving imaging
scans can be adjusted so that the fetus is exposed to less radiation. Tests to
measure the level of hormones in the
blood may also be used in the staging process.
Treatment Option Overview
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There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with breast
cancer. Some treatments are standard (the currently used treatment), and some
are being tested in clinical trials.
Before starting treatment, patients may want to think about taking part in a
clinical trial. A treatment clinical trial is a research study meant to help
improve current treatments or obtain information on new treatments for patients
with cancer. When clinical trials show that a new treatment is better than the
"standard" treatment, the new
treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Cancer.gov Web site 2. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Treatment options for pregnant women depend on the stage of the
disease and the age of the fetus.
Three types of standard treatment are used:
Surgery
Most pregnant women with breast cancer have surgery to remove the breast. Some of the lymph
nodes under the arm are usually taken out and looked at under a
microscope to see if they contain cancer cells.
Types of surgery to remove the breast include: - Simple
mastectomy: A surgical procedure to remove the whole breast that contains cancer. Some of the lymph nodes under the arm may also be removed for biopsy. This procedure is also called a total mastectomy.
- Modified radical
mastectomy: A surgical procedure to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Breast-conserving
surgery, an operation to remove the cancer but not the breast
itself, includes the following:
- Lumpectomy:
A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it.
Most doctors also take out some of the lymph nodes under the arm.
- Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. Some of the lymph nodes under the arm may also be removed for biopsy. This procedure is also called a segmental mastectomy.
Even if the doctor removes all of the cancer that can be seen at
the time of surgery, the patient may be given radiation therapy,
chemotherapy, or
hormone therapy after surgery to try
to kill any cancer cells that may be left. Treatment given after surgery to
increase the chances of a cure is called adjuvant
therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Radiation therapy should not be given to pregnant women with early stage (stage I or II) breast cancer because it can harm the fetus. For women with late stage (stage III or IV) breast cancer, it should not be given during the first 3 months of pregnancy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated. Chemotherapy should not be given during the first 3 months
of pregnancy. Chemotherapy given after this time does not usually harm the
fetus but may cause early labor and
low birth weight.
Other types of treatment are being tested in clinical trials.
These include the following:
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. The effectiveness of hormone therapy, alone or combined with chemotherapy, in
treating breast cancer in pregnant women is not yet known.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Cancer.gov Web site 2.
Ending the pregnancy does not seem to improve the mother’s
chance of survival and is not usually a treatment option.
If the cancer must be treated with chemotherapy and radiation therapy, which may harm the
fetus, ending the pregnancy is
sometimes considered. This decision may depend on the stage of cancer, the age
of the fetus, and the mother’s chance of survival.
Treatment Options by Stage
Early Stage Breast Cancer (Stage I and Stage II)
Treatment of early stage breast cancer (stage
I and stage II) may be
surgery followed by adjuvant
therapy as follows:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Cancer.gov Web site 2.
Late Stage Breast Cancer (Stage III and Stage IV)
Treatment of late stage breast cancer (stage III and stage
IV) may include the following:
Radiation therapy and chemotherapy should not be given during the first 3 months of pregnancy. Other Considerations for Pregnancy and Breast Cancer
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Lactation (breast milk production) and breast-feeding should be
stopped if surgery or chemotherapy is planned.
If surgery is planned,
breast-feeding should be stopped to reduce blood flow in the breasts and make
them smaller. Breast-feeding should also be stopped if
chemotherapy is planned. Many
anticancer drugs, especially cyclophosphamide and
methotrexate,
may occur in high levels in breast milk and may harm the nursing baby. Women
receiving chemotherapy should not breast-feed. Stopping lactation does not
improve survival of the mother.
Breast cancer does not appear to harm the fetus.
Breast cancer
cells do not seem to pass from the
mother to the fetus.
Pregnancy does not seem to affect the survival of women who
have had breast cancer in the past.
Some doctors recommend that a woman wait 2 years after treatment
for breast cancer before trying to have a baby, so that any early return of the
cancer would be detected. This may affect a woman’s decision to become
pregnant. The fetus does not seem to be affected if the mother has previously
had breast cancer.
Effects of certain cancer treatments on later pregnancies are
not known.
The effects of treatment with high-dose chemotherapy and a
bone marrow transplant, with or
without radiation therapy, on later
pregnancies are not known.
Changes to This Summary (12/19/2003)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Editorial changes were made to this summary. To Learn More
Call For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions. Web sites and Organizations The NCI's Cancer.gov 3 Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment. Publications The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator 4. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615. LiveHelp The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer. Write For more information from the NCI, please write to this address: - NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
About PDQ
PDQ is a comprehensive cancer database available on Cancer.gov. PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov 3, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research. PDQ contains cancer information summaries. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information. The PDQ cancer information summaries are developed by cancer experts and reviewed regularly. Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change. PDQ also contains information on clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Listings of clinical trials are included in PDQ and are available online at Cancer.gov 5. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. |
