What Are The Challenges Faced By New Mothers Diagnosed With Breast Cancer? - Dr Lakhan Kashyap

Motherhood is a rollercoaster of intense feelings and changes. Bringing a new life into the world is both beautiful and tough. A woman's body goes through big shifts that can be hard to understand at first. It's easy for a new mom to feel lost in all the baby duties. Breast cancer, can strike women at any age, making it a serious health concern worldwide.

Being pregnant adds another layer of worry on top of the already difficult challenge. However, some hospitals specialise in helping pregnant women with cancer. Cancer-specific hospitals can provide the best care for both mom and baby, helping them get healthy and overcome cancer. There are challenges when new mothers are diagnosed with breast cancer.

Pregnancy-associated breast cancer (PABC) is breast cancer diagnosed during pregnancy, within one year of delivery, or during lactation. This is a challenging situation as the welfare of both mother and fetus/newborn must be considered while planning evaluation and treatment. Pregnancy-associated breast cancer is an uncommon event.

The incidence of PABC is estimated to be around 15 to 30 per 100000 deliveries, with more cases diagnosed in the first year after delivery than during pregnancy. Women diagnosed with PABC often have similar prognoses when compared to women with breast cancer, however, the evaluation and management might pose certain challenges.

Delay in Diagnosis

Normal physiologic changes in breast during pregnancy and lactation make it difficult to identify lumps in breast. This can lead to a delay of two to three months in diagnosis. This may also result in advanced stages of breast cancer at diagnosis. As per one report from TMH Mumbai, nearly half of women with PABC have advanced breast cancer.

Evaluation

Mammography cannot be done during pregnancy due to risk of radiation exposure to the fetus. The women with PABC need to undergo ultrasound or MRI. Similarly, PET-CT is contraindicated, and staging evaluation often requires MRI. This often results in an increased cost of evaluation.

How does breast cancer in a pregnant woman progress?

The body undergoes remarkable changes throughout pregnancy, with cells quickly dividing, which encourages the development of new life. Rapid cell activity, meanwhile, may sometimes result in unanticipated problems, like the possible emergence of breast cancer. Knowing this biological process will enable pregnant women to put their breast health first.

Risks related to ageing and genetics

Age and family history become significant on this journey. Women with a family history of breast cancer or those who become mothers later in life may be at higher risk. It's like learning one's way around a family history or understanding past health chapters and preparing for the coming ones.

Treatment Decisions

One of the most daunting challenges for pregnant women with breast cancer is determining the best course of treatment. Balancing the urgent need to eradicate cancer while safeguarding the health of the unborn baby requires careful consideration and expert medical guidance.

Surgery (either breast conservation or mastectomy) for PABC in eligible women is safe and feasible during any trimester of pregnancy. The women with PABC can receive chemotherapy after the first trimester. However, biologic agents such as trastuzumab and endocrine therapy such as tamoxifen are contraindicated during pregnancy and breastfeeding. Radiation therapy is contraindicated during pregnancy and is often delayed till after delivery.

Choosing the right treatment path is important for patients. A doctor can suggest various treatment options, such as lumpectomy (removal of the tumour and surrounding tissue) or mastectomy (removal of the entire breast), which may be considered depending on the size and location of the tumour.

Chemotherapy uses powerful drugs to kill cancer cells. The timing and choice of chemotherapy drugs will be carefully tailored to minimise potential harm to the developing fetus. Also, radiation therapy uses high-energy beams to target and destroy cancer cells. It may be used post-surgery to eliminate any remaining cancer cells.

Although radiation treatment can be delayed till after delivery , if deemed necessary during pregnancy, specialised techniques, such as shielding the abdomen to protect the foetus, are employed to minimise radiation exposure to the unborn child. Such treatment options can be used for new mothers who have been diagnosed with breast cancer.

Making tough decisions

Women who are pregnant and have been diagnosed with breast cancer often have to make very personal and challenging decisions involving their treatment and the health of their unborn child.

Delaying treatment until after delivery or doing chemotherapy during pregnancy, requires careful consideration. Pregnant women who have breast cancer must have open discussions with their doctors about available treatments, risks, and benefits.

Timing of delivery

Timing of delivery with respect to chemotherapy is carefully considered and recovery of mother’s white blood cell counts, and platelet counts is ensured to prevent complications during delivery.

Breastfeeding

Breastfeeding - Breastfeeding is often possible from the opposite breast. However, patients receiving chemotherapy, biologic therapy, or endocrine therapy should not breastfeed infants.