Receiving the news that you’re pregnant can bring about many emotions, and in the weeks and months that follow, many mothers-to-be concentrate on picking a name, preparing their home for the baby, attending appointments, and ensuring they’re doing all that is necessary for their baby’s and their health. But one aspect of a woman’s health often gets missed during pregnancy – their regularly scheduled preventative breast cancer screenings. Although breast cancer diagnosis in pregnancy is rare, it can happen. In the attached column, Susan Branton, M.D., and Kathryn Swatkowski, C.N.M., UPMC Magee-Womens in northcentral Pennsylvania, discuss why screening is important, how to conduct a self-exam, and how to talk to your provider about your risk and screening recommendations. 

By: Susan Branton, M.D., and Kathryn Swatkowski, C.N.M.
UPMC Magee-Womens, UPMC in North Central Pa.

Receiving the news that you’re pregnant can bring about many emotions, and in the weeks and months that follow, many mothers-to-be concentrate on picking a name, preparing their home for the baby, attending appointments, and ensuring they’re doing all that is necessary for their baby’s and their health. But one aspect of a woman’s health often gets missed during pregnancy – their regularly scheduled preventative breast cancer screenings.

Although breast cancer diagnosis is rare in pregnant women, and the cancer is not caused by the pregnancy, it can happen. Breast cancer is found in about 1 in every 3,000 pregnant women. It is the most common type of cancer found during pregnancy.

A woman’s body undergoes significant changes due to the normal hormone changes of pregnancy which can include larger, denser, tender, or lumpy breasts which can make it difficult to detect breast cancer in pregnant or nursing women. Additionally, many women will put off mammograms and other screenings while pregnant or breastfeeding for fear of radiation exposure.

Because of these challenges, when a pregnant woman develops breast cancer, it’s often diagnosed at a later stage than it usually is in women who are not pregnant. Simply put, regular breast exams should be part of prenatal and postnatal care.

While changes to the body are normal during pregnancy, women need to understand what changes they are going through and when in doubt, talk to their provider. Statistics show that 40% of diagnosed breast cancers are found in women who feel a lump, often during regular activity like bathing or dressing. However, most breast changes aren’t cancer. We know our bodies best, and when something doesn’t feel or seem right, it’s safer to have an expert evaluation than to worry about the what if.

To detect breast cancer, pregnant and nursing women should examine their breasts themselves. Make it a habit to self-check your breasts, preferably in front of a mirror without clothes, and look for changes in your breasts. In addition to a quick visual check, you should do a self-exam at the same time each month or regular intervals throughout your pregnancy and after giving birth. By checking your breasts regularly, you will notice if something looks or feels different or if one area is firmer than during a previous exam. All breasts are different, so it is important to know what your normal is. If you do notice any of the following breast changes, be sure to call your provider:

• Dimpling or puckering of the skin
• Itchy, scaly, sore rash on the nipple
• Lump, hard knot, or thickening inside the breast or underarm area
• Nipple changes or discharge that starts suddenly
• New pain in one spot that doesn’t go away
• Pulling in of your nipple or other parts of the breast
• Swelling, warmth, redness, or darkening of the breast

Women should also receive clinical breast exams during their regular prenatal and postnatal check-ups. The provider will carefully feel the breasts and under the arms for lumps or anything else that seems unusual. If something is detected, further testing is necessary for diagnosis.

While mammograms may pose a risk for radiation exposure to the fetus, Ultrasound exams of the breast do not use radiation and are thought to be safe during pregnancy. This is typically an easy test to have, so it’s often the first test used to evaluate a change in the breast (such as a lump) during pregnancy. Biopsy, the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer, is also a safe option for pregnant women.

Cancer during pregnancy can be managed, and you can deliver a healthy baby. If you are diagnosed with cancer while pregnant, treatment options are available if you and your oncologists decide treatment during pregnancy is right for you. With you and your unborn baby’s safety in mind, your healthcare team considers many factors before recommending a treatment plan. They will evaluate the type of cancer, the baby’s gestational age, and your decision to be treated or not treated during pregnancy.

Early detection is critical. If you’re pregnant or nursing, include regular breast self-examinations in your routine and talk to your provider about including clinical breast exams in your check-ups.

Susan Branton, M.D., F.A.C.S., is a breast surgeon at UPMC Magee-Womens, Breast Health Center in Williamsport, and Kathryn Swatkowski, C.N.M., is a certified midwife with UPMC Magee-Womens in northcentral Pennsylvania. UPMC Magee-Womens offers comprehensive women’s health services focused on the unique care needs of women of all ages. To learn more about UPMC Magee-Womens in northcentral Pa., visit UPMC.com/MageeNCPA.