RCOG | Breast cancer and pregnancy

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.

Pre-conception counselling:

  • 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).

 

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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