Monique Rainford

Several years ago, when I had my first private practice in Florida, a 39-year-old patient of mine discovered a breast lump while she was examining her breast. It was quite small but she feared the worst. When the testing was complete, I had the difficult task of confirming her worst fears. She had breast cancer.

Even though I have had to break news like this several more times, it does not get any easier. It is especially difficult when it is associated with pregnancy. Between 0.2 and 3.8 per cent of women have this association and are diagnosed during pregnancy or within one year of delivery. These women not only have to deal with the battle of their lives, but have the added fears that their unborn baby or newborn infant may never know them.

Breast cancer is the most common cancer in Jamaican women and it is also one of the most common cancers in pregnancy worldwide. A woman is at higher risk if she has never been pregnant, if her period starts at an early age or if she has her first pregnancy at a late age. However, there is also a slightly increased risk after a woman has a full-term pregnancy. Breast-feeding especially for prolonged periods of time lowers her risk.

Symptoms that a woman may experience include a new growth in her breast or a bloody or purulent nipple discharge in only one duct. If the nipple discharge is normal, it is usually clear or slightly milky and comes from several ducts.

Shielded mammogram

Women should have a breast exam early in their pregnancy and if a mass is palpated by the physician, they should have a shielded mammogram and breast ultrasound. It is important that she obtain the tests as soon as possible. She may require an injection into the growth to remove fluid which can be examined or she may need to have a part of the growth removed (a biopsy) to determine whether or not the growth is cancerous.

If cancer is confirmed, the treatment usually includes surgery and chemotherapy, and sometimes radiation. Fortunately, the expecting mother does not have to terminate her pregnancy to improve her chances of cure. However, if chemotherapy is given in the first trimester of pregnancy, the infant could have birth defects. It is possible to delay treatment until the second trimester without further affecting the mother's health. Breast conservation surgery and radiation can also be performed but the radiation could affect the developing baby. The patient and her doctors should have careful consultation to determine the best treatment option.

Another pregnancy

Women can get pregnant again after being treated for breast cancer but, in some cases, especially in women over 30, the chemotherapy can cause an early menopause. Treatment may also increase her risk of miscarriage.

Having another pregnancy does not affect her likelihood to survive the cancer. However, some experts recommend that she wait about two to three years between pregnancies to check for recurrences of her breast cancer. If she was able to have breast conserving surgery, she may even be able to breast feed.

The earlier breast cancer is diagnosed, whether or not a woman is pregnant, the more likely it can be cured. Therefore, I encourage women to do their self breast examinations, get their annual breast exam by a physician and start regular mammograms at age 40.