Breast cancer surgeons like me have noticed a startling trend lately: Younger women are being diagnosed with breast cancer more often. I’ve seen it in my practice, and it’s been backed up by recent data.
According to a new population-based study published in the Journal of the American Medical Association Network, the incidence rates of early onset cancers — in women younger than 50 — increased substantially from 2010 to 2019, and breast cancer had the highest number of cases.
Unfortunately, being diagnosed at younger ages means that a woman may be diagnosed during her reproductive years — specifically during pregnancy or immediately after giving birth (postpartum). Pregnancy-associated breast cancer is defined as breast cancer diagnosed either during pregnancy or within one year of giving birth. It accounts for approximately 20% of breast cancers diagnosed in women 25-29.
These more advanced and aggressive pregnancy-associated cancers pose many challenges for me and my medical colleagues. They also give rise to many fears and anxieties for young mothers who ask, Which treatments can I undergo while pregnant or breastfeeding? What effect will this have on my baby? Did I do something wrong to cause the cancer?
First of all, knowledge is power. I share these statistics not to impart fear but to raise awareness.
If you’re pregnant or breastfeeding and you feel a breast mass, promptly get it checked out! No matter the results, there are options. Undergo evaluation by your OB/GYN or primary care provider who can perform a physical exam and help you get the appropriate workup. Breast imaging is indeed possible and safe during pregnancy.
Breast ultrasounds pose no risk to the fetus or the breastfeeding infant and are a very good initial study. Mammograms have been deemed safe in pregnancy because the pregnant belly can be shielded with a lead apron during the exam and the total dose of radiation exposure is significantly lower than the threshold deemed harmful to the baby.
It is important to note that the pregnancy-related changes of the breast tissue may decrease the sensitivity of these studies and thus can be difficult to interpret. Breast MRI, however, cannot be obtained during pregnancy because the contrast used for the exam could be harmful to the developing baby. It can, however, be performed in a postpartum woman who is breastfeeding. We just ask that you pump immediately prior to the exam to optimize the ability to interpret the study.
If a cancer is diagnosed during pregnancy, there are treatment options. Patients can undergo surgery and anesthesia safely at any trimester. Even many chemotherapy regimens used in the treatment of breast cancer can be given during the second and third trimester. Treatments like radiation therapy are not recommended until after delivery.
So, if you’re thinking of starting a family or newly pregnant, make sure you have a thorough discussion with your OB/GYN about any family history of breast cancers, especially those diagnosed in young family members. If you’re due for your breast exam or breast imaging (like your screening mammogram), I’d advise getting it done before you start trying to conceive.
Kjirsten Carlson, M.D., is a breast surgical oncologist at Cedars-Sinai practicing in Marina del Rey, Tarzana and Santa Monica.