Being diagnosed with breast cancer during pregnancy is very rare, but it can happen! Continuing to check your breasts throughout pregnancy is crucial, but to do this you'll need to know what signs of breast cancer to look for.
As your breasts will naturally change during pregnancy this can be a bit confusing, so we've sought expert advice from Clinical Nurse Specialist at Breast Cancer Care, Carolyn Rogers. She goes through the changes in your breasts you should be looking out for and tells us when to be concerned. Carolyn has also provided us with insight into how breast cancer is diagnosed during pregnancy and the treatment options that are available.
We also share Donna's real-life story about how she found a lump in her breast while lying in the bath. She was 35 and seven months pregnant with her second child at the time. While the chances are low, this can happen to anyone, and we want you to be prepared. So keep reading to get informed, and find how to get support if you're worried.
How does breast cancer affect you when you're pregnant?
The National Cancer Institute explains that "Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast." They say that sometimes it occurs in pregnant women or those who have just given birth, and that it can be difficult to detect it during early pregnancy or in new mums who are nursing.
While breast cancer during pregnancy is rare, The NHS says that it's the most common type of cancer in women in the UK, and that how serious it will be depends on how big the cancer is, if the cancer has spread, and your general health. There are treatments available, although it's true that treatment options will be more complicated if you're diagnosed with breast cancer while pregnant, as you'll want to get the best treatment for your cancer while also protecting the baby.
It can be very upsetting if this happens to you, and will lead to a range of difficult emotions like anger, sadness or fear. However, Cancer Research UK says that most women are able to carry on with their pregnancy. They also say that there isn't any good research evidence to show that being pregnant makes a cancer grow more quickly.
What are the main signs of breast cancer in women?
All women should be aware of how their breasts look and feel normally so they can be confident in checking for breast lumps and noticing any unusual changes, but this can be more difficult during pregnancy as breasts naturally begin to change.
Things to look out for are changes in the way your breasts look or feel, particularly the size or shape, any lumps or thickening of breast tissue and changes in the skin, such as pukering or dimpling or a rash.
Pay attention to the nipples too as you may notice changes such as them inverting or producing an unexplained discharge. Pain in the vicinty is also something to be weary of.
According to the NHS, symptoms of breast cancer in women may include:
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a lump, or swelling in your breast, chest or armpit
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a change in the skin of your breast, such as dimpling that may look like orange peel; or redness, which may be harder to see on black or brown skin.
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a change in size or shape of one or both breasts
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nipple discharge, which may have blood in it - although this is if you are not pregnant or breastfeeding
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a change in the shape or look of your nipple, such as it turning inwards, which is called an 'inverted nipple'; or a rash on the nipple that may look like eczema.
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pain in your breast or armpit which does not go away – if the breast pain comes and goes it's usually not a symptom of breast cancer
The NHS advises to seek advice from your GP if:
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you have a lump or swelling in your breast, chest or armpit
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you have any changes in your breasts or nipples that are not normal for you
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you have pain in your breast or armpit that does not go away
How do breasts change during pregnancy?
It's easy to become alarmed when you become pregnant and start to notice changes in your body that are unfamiliar, especially if those changes are in your breasts and you're worried about breast cancer. Most of the changes you notice will be perfectly normal and nothing to worry about, so we've described some of these here for your peace of mind. However, if you're worried about any changes, you should always seek professional advice from a health expert, such as your GP or midwife.
Changes in your breasts during early pregnancy
During the early stages of pregnancy, breasts may become tender and increase in size. As the pregnancy progresses, many women feel tingling or soreness in their breasts especially in the nipples because of the increased levels of the hormone progesterone and the development of the milk ducts. Sometimes, the nipples will become darker in colour and the veins on the surface of the breast may become more noticeable.
Changes in your breasts during mid and late pregnancy
From around 16 weeks, the nipples may leak as the breasts begin to produce a fluid called ‘colostrum’ – don't worry, this is completely normal.
Breast lumps sometimes occur during pregnancy too, but Carolyn Rogers, Clinical Nurse Specialist at Breast Cancer Care, says: "It’s important to remember that breast cancer in younger women and during pregnancy is rare. The vast majority of these lumps will be benign (not cancer), for example fibroadenomas or fluid -filled cysts. But it’s always best to get any new lumps checked by your GP, or inform your midwife or GP if an existing lump changes in any way."
How is breast cancer diagnosed during pregnancy?
Breast cancer is usually diagnosed by ‘triple assessment’. Carolyn Rogers explains: "First, you’ll be examined by a specialist, then you will usually have an ultrasound of the breast. This is completely safe and will not harm your baby. You may also be offered a mammogram, where shielding can be used to protect your baby from the radiation used in the x-ray. The final part of the assessment includes either a biopsy or fine needle aspiration to take a sample of tissue or cells for analysis. Both of these tests are completely safe for you and your baby."
What treatment options are available?
"If you are diagnosed with breast cancer during your pregnancy, the choices you may have to make can seem overwhelming," says Carolyn Rogers. "Women tell us that it’s a huge emotional struggle at what should be a very exciting time. But it’s absolutely possible to have a healthy pregnancy and healthy baby while undergoing treatment for breast cancer."
"The aim is to balance treatment for your cancer and keeping your baby safe and well", says Cancer Research UK. They explain that you'll have a team including cancer doctors, obstetricians and midwives looking after you and making a plan for your treatment, and that doctors try and keep your treatment as close as possible to what someone who isn’t pregnant would have, which includes not delaying treatment.
Treatments for breast cancer
If you are near to the end of your pregnancy, treatment may be delayed until after the birth, and you will be advised not to breastfeed so treatment can be given. If not, the type of treatment you have will depend on which trimester you're in, what type of breast cancer you have and if it has spread, as well as you personal preferences...
Surgery
Surgery can be safely carried out during all trimesters. While pregnant, sadly, you’re more likely to be offered a mastectomy than breast-conserving surgery (where just the cancer, and not the whole breast, is removed); this is because not all women who have a mastectomy need radiotherapy afterwards, whereas radiotherapy is always needed after breast-conserving surgery.
Radiotherapy
Radiotherapy is generally not recommended at any time during pregnancy as even a very low dose may carry a risk to the baby. If you’re in the late stages of pregnancy, you may be offered breast-conserving surgery if radiotherapy can be given after you have given birth.
Chemotherapy
Certain combinations of chemotherapy can be given during pregnancy, but it will generally be avoided during the first trimester to avoid any risk of miscarriage or harm to the baby.
Hormone therapy, immunotherapy and targeted cancer drugs
Hormone therapy and/or targeted cancer treatment, like Tamoxifen and Herceptin, are often given after initial cancer treatments to reduce the chance of the cancer coming back. However, these will usually be avoided during pregnancy or when breast feeding.
It happened to me…
Donna, now 43, found a lump while lying in the bath. She was 35 and seven months pregnant with her second child. Initially she thought it must be a milk duct or hormone changes due to the pregnancy, but her midwife urged her to get it checked out.
It turned out to be breast cancer. Donna was induced three weeks early so that treatment could start straight away.
Fortunately, Amy was born without incident and Donna enjoyed the precious time she had with her new baby before her treatment started - on the day Amy was initially due to be born.
Donna says: “Having the little ones actually helped me through it. I had no time to sit around because they didn’t understand, they were still hungry or tired and still needed me.”
Breastfeeding and breast cancer
Breastfeeding advice will usually depend on where you are with your treatment plan, and your specialist doctor, nurse and midwife will be able to provide you with all the information you need.
However, here is some key info from Macmillan Cancer Support.
Chemotherapy and breastfeeding
You should be able to breastfeed straight away if your treatment finished a few weeks before little one is born. However, if your chemotherapy continues after the birth you'll be advised by health professionals not to breastfeed as drugs travel through your breast milk and be passed onto your newborn.
Expressing milk could be an option if you're not having other treatment after chemotherapy, but unfortunately you won't be able to keep the milk for your baby. it could still be a good idea to express your milk though, as it means you'll be able to continue to produce milk when the treatment ends and potentially start breastfeeding a few weeks later.
Other drugs and breastfeeding
Unfortunately, if you are receiving targeted therapy, immunotherapy drugs or hormonal therapy drugs, these can be passed to your baby through breast milk, which means you won't be able to breastfeed during this time.
Radiotherapy and breastfeeding
It is usually safe to continue breastfeeding if you're having radiotherapy to parts of the body that are away from your chest. If the radiotherapy is targeted to the breast or chest that breast may not actually be able to product any milk. This won't stop you from breastfeeding from the other breast if it hasn't been treated.
Donor breast milk
If you do not have enough of your own breast milk, it doesn't mean your newborn has to miss out. Some hospitals offer donated breast milk for babies born prematurely. The United Kingdom Association for Milk Banking is a registered charity that supports milk banking in the UK, with strict processes to make sure donor breast milk is safe.
How to get support
Breast Cancer Care’s website has more information on pregnancy and breast cancer. If you have any questions about breast health or breast cancer, call their free support line on 0808 800 6000.
About the experts
Carolyn Rogers is a Clinical Nurse Specialist at Breast Cancer Care.
Proud aunt to her teen niece, Zara Mohammed is a Digital Writer for Mother&Baby. She has 10 years freelance writing experience creating lifestyle content for various platforms, including pregnancy, women’s health, parenting, child development and child mental health, plus lots of fun seasonal family articles and celebrity news.