- 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
- To Learn More About Breast Cancer and Pregnancy
- Get More Information From NCI
- Changes to This Summary (08 / 21 / 2009)
- About PDQ
Breast Cancer Treatment and Pregnancy (PDQ®): Treatment - Patient Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER
Breast Cancer Treatment and Pregnancy
General Information about Breast Cancer and Pregnancy
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.
Anatomy of the breast, showing lymph nodes and lymph vessels.
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 exam: 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.
Mammography of the right breast.
- Biopsy: The removal of cells or tissues by a pathologist 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.
Stages of Breast Cancer
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 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
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. 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.
For some patients, taking part in a clinical trial may be the best treatment choice. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials is available from the NCI Web site.
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:
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.
Total (simple) mastectomy. The dotted line shows where the entire breast is removed. Some lymph nodes under the arm may also be removed.
- 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.
Modified radical mastectomy. The dotted line shows where the entire breast and some lymph nodes are removed. Part of the chest wall muscle may also be removed.
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.
Breast-conserving surgery. Dotted lines show the area containing the tumor that is removed and some of the lymph nodes that may be removed.
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 lower the risk that the cancer will come back, is called adjuvant 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 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, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). 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.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
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. 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.
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 stagebreast cancer (stage I and stage II) may be surgery followed by adjuvant therapy as follows:
- Modified radical mastectomy.
- Breast-conserving surgery: Lumpectomy, partial mastectomy or segmental mastectomy.
- Breast-conserving surgery during pregnancy followed by radiation therapy after the baby is born.
- Surgery during pregnancy followed by chemotherapy after the first 3 months of pregnancy.
- Clinical trials of surgery followed by hormone therapy with or without chemotherapy.
Late Stage Breast Cancer (Stage III and Stage IV)
Treatment of late stagebreast cancer (stage III and stage IV) may include the following:
- Radiation therapy.
Radiation therapy and chemotherapy should not be given during the first 3 months of pregnancy.
Other Considerations for Pregnancy and Breast Cancer
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 cancercells 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.
To Learn More About Breast Cancer and Pregnancy
For more information from the National Cancer Institute about breast cancer and pregnancy, see the following:
- Breast Cancer Home Page
- What You Need to Know About™ Breast Cancer
- Breast Cancer Prevention
- Breast Cancer Screening
- Surgery Choices for Women with Early-Stage Breast Cancer
- Pregnancy and Breast Cancer Risk
For general cancer information and other resources from the National Cancer Institute, see the following:
- What You Need to Know About™ Cancer - An Overview
- Understanding Cancer Series: Cancer
- Staging: Questions and Answers
- Chemotherapy and You: Support for People With Cancer
- Radiation Therapy and You: Support for People With Cancer
- Coping with Cancer: Supportive and Palliative Care
- Cancer Library
- Information For Survivors/Caregivers/Advocates
Get More Information From NCI
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. A trained Cancer Information Specialist is available to answer your questions.
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 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 TO US
For more information from the NCI, please write to this address:
|NCI Public Inquiries Office|
|6116 Executive Boulevard, MSC8322|
|Bethesda, MD 20892-8322|
SEARCH THE NCI WEB SITE
The NCI 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. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
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. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
Changes to This Summary (08 / 21 / 2009)
The PDQcancer 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.
PDQ IS A COMPREHENSIVE CANCER DATABASE AVAILABLE ON NCI'S WEB SITE.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at 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.
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 the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. 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).
Date Last Modified: 2009-08-21
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.