Breastfeeding AFTER Breast Cancer
In honor of October and Breast Cancer Awareness month, we are running a mini-series on breast health and the role of breastfeeding.
We're back with another post for breast cancer awareness month. Let's pick up where we left off. We have discussed some of the mechanisms of how breastfeeding protects our bodies from developing breast cancer and where this benefit seems to lie as far as factors such as duration and exclusivity. Breast cancer is the most common cancer for women and while your risk for developing breast cancer rises with age, the disease does not discriminate based on age alone. This means that some women will be diagnosed with breast cancer during their childbearing years. In fact, a third of the women who get cancer in their childbearing years will get breast cancer and survivors in this age group often report an intention for future pregnancy which means we, as a community, need to know how to support these amazing survivors on their journey through pregnancy and breastfeeding (1).
WHY IS THIS IMPORTANT?
Cancer sucks. Plain and simple and treatment is very hard on the body. Chemotherapy, mastectomy and other treatments and surgeries can impact not only the breast itself but also other parts of the reproductive system, nerves and hormones which all have a role in getting pregnant and of course, lactation. But say you're 30 and a survivor, you may still want children and you may still want to breastfeed in some capacity.
Remember, breastfeeding is not an all or nothing experience.
So what is being done to support and respect women who develop breast cancer early in life but who still want the choice of having children and breastfeeding?
LET'S TALK SAFETY AND FEASIBILITY.
With breastfeeding post breast cancer, there are two perspectives to consider - safety and feasibility. Is it safe to nurse and is it physically possible? Alright, so there are some unknowns here simply because breastfeeding and breast cancer is understudied but the research that does exist out there tells us there is no evidence indicating that breastfeeding can cause relapse or increase risk for secondary cancer and as such, OBGYNs and oncologists should encourage and support survivors who wish to nurse their children (8). Some researchers recommend following guidelines for those wishing to get pregnant and breastfeed to wait at least 6 months since you've finished chemotherapy or, for those who do not undergo chemo, 2-3 years since being diagnosed with breast cancer to be on the more conservative side - these guidelines seem to be more for pregnancy than breastfeeding (3,4). One study of survivors who breastfed showed improved survival rates compared to those who bottle-fed; though this study had several limitations so we take it with a grain of salt - it is however, promising that breastfeeding is does not worsen outcomes and may be protective for breast cancer survivors.
Okay, so what about feasibility? The research shows it is safe for most survivors, but is lactation possible? This is a tricky one. We know from our anatomy and physiology posts that we need the gears and the signals to make the system produce and eject milk. Breast cancer treatments like mastectomies and radiation, can definitely impact the body's ability to make milk. Many factors will come into play here during treatment such as incision location, whether one or both breast were removed, the extent of surgery, where the tumor is located, and the type of radiation or therapy (6). But some women don't know their options during treatment. Having information is empowering. Perhaps you didn't know that removing the breast in a mastectomy or removing the infected breast and the healthy breast in a double mastectomy does not improve survival outcomes when compared to using "breast conserving" treatments with radiation (2). In fact, researchers are advocating for physicians to limit the use of mastectomy and double mastectomy to high risk individuals in favor of "breast conserving" treatments especially in women of reproductive age. This may not be an option for everyone but it may be a treatment option that your medical team supports and its worth discussing if you're planning for a future pregnancy.
Alright so aside from breast conserving treatments, what else is there? Some women may find they can lactate from one breast - that's pretty cool. Our bodies work on demand and supply, even if we're only demanding from one breast that breast is pretty good at making enough milk as long as we're consistently demanding it (5). There are some moms who actively choose to breastfeed exclusively from one side with success (7). Others may find that they can produce enough from the healthy breast and they can even produce some milk from the breast that underwent treatment. It's worth reiterating here - breastfeeding is not all or nothing. For those survivors who wish to breastfeed, we definitely recommend finding support and assistance with a board certified lactation consultant to help along your journey whether its assessing your breast tissue, monitoring your milk production, keeping track of baby's weight gain, basically anything to ease your mind and help you reach your goals. We've mentioned it before but we are big fans of all hands on deck approach, so if breastfeeding is your goal after breast cancer - get your medical team on board, get some support, encouragement and assistance from a lactation professional, ask your loved ones to cheer you on and know you've got this. Breastfeeding can be possible in some capacity and every drop counts.
Breast cancer survivors are warriors. No doubt about it.
Breast cancer does not discriminate based on age alone - women in their childbearing years are still at risk for developing breast cancer and they may want to have children and/or breastfeed in the future.
Research shows it is generally safe to get pregnancy and breastfeed as long as you fit some criteria (6+ months since last chemo or 2-3 years since diagnosis).
Information is power. Know your options. Discuss your goals with your medical team and find out if breast and fertility preserving treatments may be an option for you.
Reach out to an IBCLC to get the support and assistance in getting off to a right start whether you can breastfeed from one breast, partially breastfeed, or even chestfeed - whatever your goal is, whatever is most important to you know that you're supported.
(1) Alianmoghaddam, N. et al. (2017). Breast cancer, breastfeeding and mastectomy: A call for more research. Journal of Human Lactation, 33(2), 454-457.
(2) Kurian et al. (2014). Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011. Journal of the American Medical Association, 312(9), 902-914.
(3) Pagani et al. (2012). Pregnancy after breast cancer: Myths and facts. Breast Care, 7(3), 210-214.
(4) Raphael et al. (2014). Outcome of patients with pregnancy during or after breast cancer: A review of the recent literature. Current Oncology, 22, 8-18.
(5) Azim et al. (2009). Breast-feeding after breast cancer: If you wish, madame. Breast Cancer Res Treat, 114, 7-12.
(6) Schnit, S.J. et al. (1993). Mammary ducts in the areola: Implications for patients undergoing reconstructive surgery of the breast. Plast Reconstr Surg, 92, 1290-1293.
(7) Ing, R. et al. (1977). Unilateral breast-feeding and breast cancer. Lancet, 2, 124-127.
(8) Helewa, M. (2002). Breast cancer, pregnancy, and breastfeeding. J Obstet Gynaecol Can, 24, 164-180.