Diagnosis of breast cancer during pregnancy

Breast cancer is rare during pregnancy. But if you feel a lump or notice any changes in your breasts, talk to your doctor right away. If breast cancer is suspected, there are tests that a pregnant woman can do, and if you are pregnant, there are options for treating breast cancer.

Having breast cancer during pregnancy is called gestational breast cancer or pregnancy-related breast cancer (PABC).

What is the prevalence of breast cancer during pregnancy?

Out of every 3,000 pregnant women, one gets breast cancer. But it is the most common type of cancer found during pregnancy.

Breast cancer is more difficult to diagnose during pregnancy.

Hormone changes during pregnancy cause the breasts to change. They may become larger, more prominent, or stiffer. This means that you and your doctor will not be able to diagnose a cancerous mass until it has grown.

Another reason for the difficulty in finding breast cancer early in pregnancy is that many women prefer to delay breast cancer screening with mammography until the end of the pregnancy. On the other hand, because pregnancy and breastfeeding can make breast tissue denser, early detection of cancer on mammography is more difficult.

Because of these challenges, a pregnant woman’s breast cancer often develops at a more advanced stage than being diagnosed during non-pregnancy. And therefore more likely to spread to the lymph nodes.

What to look for?

If you feel a lump or notice changes in your breasts that are of concern to you, do not ignore them and talk to your doctor or midwife immediately. If your doctor does not recommend a mammogram, ask about other types of imaging procedures, such as ultrasound or MRI. You may need to talk to another doctor. Any suspicious changes in the breast should be checked or even sampled before it is considered a normal pregnancy change.

Are mammograms and other imaging tests safe during pregnancy?

The main concern about imaging tests during pregnancy is the exposure of the fetus to radiation, which can be harmful, especially in the first trimester of pregnancy.

Mammograms can also detect most breast cancers during pregnancy, and it is generally thought that having a mammogram during pregnancy is safe. The dose of radiation used in mammography is small and the radiation is focused on the breasts, so that most of it does not reach other parts of the body. A lead shield is placed on the lower abdomen to further protect and prevent radiation from reaching the uterus. However, small amounts of radiation may reach the fetus, and scientists are unsure about the effect of a very small dose of radiation on an unborn baby.

Breast ultrasound examinations do not use radiation and are thought to be safe during pregnancy. This test is usually easy, so it is often the first test recommended during pregnancy to assess changes in the breast.

MRI scans do not use radiation and are thought to be safe during pregnancy. But the contrast material (dye) used in MRI can pass through the placenta, the organ that connects the mother to the fetus. This color has been associated with fetal abnormalities in laboratory animals. For this reason, many doctors do not use contrast dyes on MRI during pregnancy. Contrast-enhanced MRI can be used if necessary.

Other tests, such as PET scans, bone scans, and computed tomography (CT) scans, may expose the fetus to radiation.

Breast sampling during pregnancy

Breast sampling is often done using a hollow needle, and even during pregnancy, it is usually done on an outpatient basis. The doctor uses medication to numb the suspected area of the breast. This poses little risk to the fetus.

If the needle biopsy does not respond, the next step is usually sampling during surgery. This means removing a larger piece through a small incision in the breast. Surgical biopsies are often performed under general anesthesia (where you are given medicine to put you to deep sleep), which carries little risk to the fetus.

Breast cancer stage tests

If breast cancer is found, you may need other tests to see if the cancer cells have spread to other parts of the body. This process is called staging. Depending on your case, different staging tests may be required.

As mentioned above, tests such as ultrasound and MRI scans do not use radiation and are thought to be safe during pregnancy. But the contrast agent (dye) that is sometimes used in MRI is usually not recommended during pregnancy. Contrast-enhanced MRI can be used if necessary.

Chest X-rays are sometimes needed to help make treatment decisions. This method uses a small dose of radiation. It is thought to be safe during pregnancy by using a lead belly protector.