Breast cancer is the UK's most common cancer, with around 55 000 women and 370 men being diagnosed each year (an average total of UK invasive breast cancer cases between 2014–2016 were recorded at 55 214) (Breast Cancer Now, 2020). Around 10 000 women are diagnosed with breast cancer under the age of 50 every year in the UK (Cancer Research UK, 2017) and being diagnosed during pregnancy or soon after giving birth is rare, with the disease reported in just 1 in every 3 000 pregnancies (Cancer Research UK, 2017).
Receiving a breast cancer diagnosis at this usually happy time can be extremely distressing and can take away the joy of pregnancy. It can cause sadness and anxiety about the baby's development in the womb and fears about not seeing the child grow up. Also, with relatively few women diagnosed while pregnant or soon after, people can often feel incredibly isolated and alone. Being pregnant or caring for a newborn while having treatment for breast cancer is both physically and emotionally draining, and may mean some women find it difficult to bond with their baby. It can sometimes feel that there is nowhere to turn which is why access to information and support at this time is crucial.
Breast Cancer Now is the UK's first comprehensive breast cancer charity, combining worldclass research and life-changing care to provide tailored, specialist information and support for women diagnosed during and shortly after pregnancy. We also work alongside healthcare professionals in the NHS to help ensure people affected by breast cancer get the best treatment and care, providing learning and development opportunities, and specialist breast cancer groups. Joint working between midwives and clinical nurse specialists is vital to deliver care and support to any patient diagnosed with breast cancer during pregnancy. Collaborative working between all the experts involved in a patient's care – obstetricians, midwives, breastfeeding experts and the oncology team – will help to facilitate discussions and allow for any concerns or questions to be raised and addressed promptly.
Breast Cancer Now's breast care nurses, award-winning information, and expertly trained staff and volunteers are also here to make sure anyone diagnosed can get the support they need to live well with the physical and emotional impacts of the disease. We are available on-hand for any questions via a free telephone helpline and ‘ask our nurses’ email service, and offer up-to-date health information in our ‘Breast cancer during and after pregnancy’ booklet which is available to download or order from the our website.
Sharing experiences with someone who has been there can often make a huge difference. Breast Cancer Now's free ‘Someone like me’ service can put women in touch with someone who was diagnosed with breast cancer during pregnancy or cared for their newborn while having treatment. For the majority of women using the service, this will be the first time they have spoken to another woman in a similar situation. While there is no evidence that having breast cancer during pregnancy affects the baby's development in the womb, it can naturally be a very worrying time. Terminating the pregnancy is not usually recommended when breast cancer is diagnosed, and most women will continue their pregnancy while having breast cancer treatment.
However, some women choose not to continue, and this will be a very difficult and personal decision. When planning treatment, the medical team will discuss all options with each patient and tailor the approach to each woman, the type and extent of their breast cancer, their circumstances and how far they are into the pregnancy. The aim will be to balance offering the most effective treatment for the breast cancer while keeping the baby safe.
‘Sharing experiences with someone who has been there can often make a huge difference’
Breast surgery can be done safely during all trimesters of pregnancy and chemotherapy can be given after the first trimester. Other treatments like radiotherapy, hormone (endocrine) therapy and targeted therapy can be given after the baby has been born. If someone is nearing the end of their pregnancy, the specialist team may recommend delaying treatment until after the birth. Breastfeeding is also a common concern for women diagnosed with breast cancer during pregnancy and with information on best practice changing regularly, women will often need extra support and guidance from their midwife. Breastfeeding can be possible for some women after surgery but not during chemotherapy, radiotherapy, hormone therapy or targeted therapy. Women will often be looking for support if they are coming to terms with not being able to breastfeed due to their treatment or how to cope with treatment-related fatigue.
As well as providing the care and support needed for women who have been diagnosed with breast cancer during pregnancy, pregnancy is also a crucial time to encourage all women to be breast aware. Midwives have an important role to play in both informing and supporting women about getting to know their breasts during and after pregnancy. In many cases, a midwife will be the first port of call for women with concerns about a potential breast symptom. Some women calling our helpline say they find it difficult to know how their breasts should look and feel, and what changes may indicate breast cancer.
Breasts go through a lot of changes during and after pregnancy which can vary from woman to woman. So it is essential that women have access to clear information about potential breast changes during pregnancy and the signs and symptoms of breast cancer. Breast Cancer Now offers a simple ‘Touch, look, check’ mini guide that women can follow as well as information specifically about breast changes during pregnancy.
Being breast aware is all about women regularly looking and feeling for any unusual changes and reporting anything different or new to their GP as soon as possible to get it checked out. There's no special technique—it's as simple as TLC: touch, look, check. Knowing all the signs and symptoms of breast cancer, like a lump, redness or a change in size or shape, can help women check themselves with more confidence. While breast cancer in women of child-bearing age is uncommon, it is still important to get anything different or new checked out, as the sooner breast cancer is diagnosed, the more effective treatment can be. If a woman has found an unusual breast change and visits the GP, they will do an examination and decide whether to refer to a breast clinic for further assessment which will be carried out safely to not affect the baby in any way.
It is so important that we all work together to care for women during pregnancy, to help equip women with the tools and understanding to start or continue to be breast aware, and ensure those diagnosed with breast cancer have a network of support to help them face the physical and emotional effects, and feel less alone.