A lot of this is aimed at specialists. There are some useful bits about preconception counselling in a woman who’s had breast cancer and also advice about breast feeding. The most useful things are:
New presentation of breast lump – ensure you refer women as you would if they weren’t pregnant. Women can have treatment (including some chemo) whilst pregnant.
Contraception matters – generally non-hormonal methods would be advised first. They advise seeking specialist advice if a woman wants to use hormonal methods (they are absolutely contra-indicated until 5 years of being disease free). This includes Mirena use.
- Involve obstetric / oncology – each case is going to be individual, so seek advice.
- Generally pregnancy wouldn’t be advised for at least 2 yrs, when recurrence is highest (though with some cancers, this may not be the case).
- Prognosis is not affected by pregnancy or breast feeding (once clear of disease).
- Stop tamoxifen at least 3 months before conceiving (generally if the woman was oestrogen receptor positive, pregnancy wouldn't be advised before 5 years).
- Ensure any necessary imaging is done before conception.
Risks to the pregnancy:
- No increased risk of malformation.
- Can do BRCA pre-implantation testing.
- Echo for the mother may be advised, as many chemos can cause cardiomyopathy.
- Breast-feeding from an untreated breast is normally fine.
- Some medications will be a contraindication for breastfeeding (eg tamoxifen / Herceptin / chemo).