Breast Cancer Treatment and Pregnancy (PDQ®)
[Back to top]General Information about Breast Cancer and Pregnancy
Key Points:Breast cancer is a disease in which malignant (cancer) cells
form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called
lobes, which have many smaller sections called lobules. The lobes and lobules are connected by
thin tubes called ducts.
Drawing of female breast anatomy showing the lymph nodes, nipple, areola, chest wall, ribs, muscle, fatty tissue, lobe, and ducts.
Each breast also contains blood
vessels and lymph
vessels. The lymph vessels carry an almost colorless fluid called lymph. The
lymph vessels lead to small, bean-shaped organs called
lymph nodes that help the body fight
infection and disease. Lymph nodes are found throughout the body. Clusters of
lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and
in the chest.
Breast cancer is sometimes detected (found) in women who are
pregnant or have just given birth.
In women who are pregnant or who have just given birth, breast cancer occurs most often between the
ages of 32 and 38. Breast cancer occurs about once in every 3,000 pregnancies.
Possible signs of breast cancer include a lump or change in the breast.
Breast cancer may cause any of the following signs and symptoms. Check with your doctor if you have any of the following problems:
- A lump or thickening in or near the breast or in the underarm area.
-
A change in the size or shape of the breast.
-
A dimple or puckering in the skin of the breast.
-
A nipple turned inward into the breast.
- Fluid, other than breast milk, from the nipple, especially if it's bloody.
- Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin that is around the nipple).
- Dimples in the breast that look like the skin of an orange, called peau
d’orange.
Other conditions that are not breast cancer may cause these same symptoms.
It may be difficult to detect (find) breast cancer early in
pregnant or nursing women, whose breasts are often tender and swollen.
Women who are pregnant, nursing, or have just given birth usually
have tender, swollen breasts. This can make small lumps difficult to detect and
may lead to delays in diagnosing breast cancer. Because of these
delays, cancers are often found at a later stage in these women.
Breast examination should be part of prenatal and postnatal care.
To detect breast cancer, pregnant and nursing women should examine
their breasts themselves. Women should also receive clinical breast
examinations during their routine prenatal and postnatal examinations.
Tests that examine the breasts are used to detect (find) and diagnose
breast cancer.
A doctor should be seen if changes in the breast are noticed. The
following tests and procedures may be used:
If cancer is found, tests are done to study the cancer cells.
Decisions about the best treatment are based on the results of these tests. The tests give information about:
- How quickly the cancer may grow.
- How likely it is that the cancer will spread through the body.
- How well certain treatments might work.
- How likely the cancer is to recur (come back).
Tests include the following:
- Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
- Human epidermal growth factor type 2 receptor (HER2/neu) test: A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab (Herceptin) and lapatinib (Tykerb).
- Multigene tests: Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).
- Oncotype DX: This test helps predict whether stage I or stage II breast cancer that is estrogen receptor positive and node-negative will spread to other parts of the body. If the risk of the cancer spreading is high, chemotherapy may be given to lower the risk.
- MammaPrint: This test helps predict whether stage I or stage II breast cancer that is node-negative will spread to other parts of the body. If the risk of the cancer spreading is high, chemotherapy may be given to lower the risk.
Certain factors affect prognosis
(chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage
of the cancer (whether it is in the breast only or has spread to other places in the body).
- The size of
the tumor.
- The type of breast cancer.
- The age of the fetus.
- Whether there
are symptoms.
- The patient’s
general health.
[Back to top]Stages of Breast Cancer
Key Points:After breast cancer has been diagnosed, tests are done
to find out if cancer cells have spread within the breast or to other parts of
the body.
The process used to find out if the cancer has spread within the breast or to other
parts of the body is called staging.
The information gathered from the
staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
Methods used to stage breast cancer can be changed to make them
safer for the fetus.
Standard methods for giving imaging
scans can be adjusted so that the fetus is exposed to less radiation. The following tests and procedures may be used in
the staging process:
- Sentinel lymph node biopsy: The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
-
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for breast cancer:
This section describes the stages of breast cancer. The breast cancer stage is based on the results of testing that is done on the tumor and lymph nodes removed during surgery and other tests.
Stage 0 (carcinoma in situ)
There are 3 types of breast carcinoma in situ:
- Ductal carcinoma in
situ (DCIS) is a noninvasivecondition in which abnormalcells are found in the lining of a breastduct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues. At this time, there is no way to know which lesions could become invasive.
Ductal carcinoma in situ (DCIS); drawing shows a lobe, ducts, and fatty tissue in a cross section of the breast. The inset shows a normal duct and a duct with abnormal cells.
- Lobular carcinoma in
situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of developing breast cancer in either breast.
Lobular carcinoma in situ (LCIS); drawing shows a lobe, ducts, lobules, and fatty tissue in a cross section of the breast. Three separate pullouts show a normal lobe, a normal lobule, and a lobule with abnormal cells.
- Paget disease of the nipple is a condition in which abnormal cells are found in the nipple only.
Stage I
Stage I breast cancer. Drawing shows stage IA on the left; the tumor is 2 cm or smaller and has not spread outside the breast. Drawings in the middle and on the right show stage IB. In the middle, no tumor is found in the breast, but small clusters of cancer cells are found in the lymph nodes. In the drawing on the right, the tumor is 2 cm or smaller and small clusters of cancer cells are found in the lymph nodes.
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
Stage II
Stage II is divided into stages IIA and IIB.
- In stage IIA:
Stage IIA breast cancer. Drawing on the left shows no tumor in the breast, but cancer is found in 3 axillary lymph nodes. Drawing in the middle shows the tumor size is 2 cm or smaller and cancer is found in 3 axillary lymph nodes. Drawing on the right shows the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the lymph nodes.
- In stage IIB, the tumor is:
Stage IIB breast cancer. The drawing on the left shows the tumor is larger than 2 cm but not larger than 5 cm and small clusters of cancer cells are in the lymph nodes. The drawing in the middle shows the tumor is larger than 2 centimeters but not larger than 5 centimeters and cancer is in 3 axillary lymph nodes. The drawing on the right shows the tumor is larger than 5 cm but has not spread to the lymph nodes.
Stage IIIA
Stage IIIA breast cancer. The drawing on the left shows no tumor in the breast; cancer is found in 8 axillary lymph nodes. In the drawing in the middle, the tumor is larger than 5 centimeters and small clusters of cancer cells are in the lymph nodes. The drawing on the right shows the tumor is larger than 5 cm and cancer is in 3 axillary lymph nodes.
In stage IIIA:
Stage IIIB
Stage IIIB breast cancer. The drawing on the left is a cross section of the breast showing that cancer has spread to the chest wall. The ribs, muscle, and fatty tissue are also shown. The drawing on the right shows the tumor has spread to the skin of the breast. An inset shows inflammatory breast cancer.
In stage IIIB, the
tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Also, cancer may have spread to:
Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.
Stage IIIC
Stage IIIC breast cancer. Drawing on the left shows cancer in lymph nodes in the axilla. Drawing in the middle shows cancer is in lymph nodes above the collarbone. Drawing on the right shows cancer in the axillary lymph nodes and in lymph nodes near the breastbone.
In stage IIIC, no tumor is found in the breast or the tumor may be any size. Cancer may have spread to the skin of the breast and caused swelling or an ulcer and/or has spread to the chest wall. Also, cancer has spread to:
Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.
For treatment, stage IIIC breast cancer is divided into operable and inoperable stage IIIC.
Stage IV
Stage IV breast cancer. Drawing shows cancer has spread from lymph nodes through the blood to other parts of the body, such as the brain, lungs, liver, and bone.
In stage IV, cancer
has spread to other organs of the body, most often the bones,
lungs, liver, or brain.
[Back to top]Inflammatory Breast Cancer
In inflammatory breast
cancer, cancer has spread to the skin of the breast and the breast looks red and swollen and feels warm. The
redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast
may also show the dimpled appearance called peau
d’orange (like the skin of an orange). There may not be any lumps in the breast that can be felt. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.
Inflammatory breast cancer of the left breast with redness, peau d'orange, and inverted nipple.
[Back to top]Recurrent Breast Cancer
Recurrentbreast
cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come back in
the breast, in the chest wall, or
in other parts of the body.
[Back to top]Treatment Option Overview
Key Points:There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with breast
cancer. Some treatments are standard (the currently used treatment), and some
are being tested in clinical trials.
A treatment clinical trial is a research study meant to help
improve current treatments or obtain information on new treatments for patients
with cancer. When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
For some patients, taking part in a clinical trial may be the best treatment choice. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country.
Information about clinical trials is available from the
NCI Web site.
Treatment options for pregnant women depend on the stage of the
disease and the age of the fetus.
Three types of standard treatment are used:
Surgery
Most pregnant women with breast cancer have surgery to remove the breast. Some of the lymph
nodes under the arm are usually taken out and looked at under a
microscope to see if they contain cancer cells.
Types of surgery to remove the breast include:
- Simple
mastectomy: A surgical procedure to remove the whole breast that contains cancer. Some of the lymph nodes under the arm may also be removed for biopsy. This procedure is also called a total mastectomy.
Total (simple) mastectomy; drawing shows removal of the breast and lymph nodes.
- Modified radical
mastectomy: A surgical procedure to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Modified radical mastectomy. The drawing on the left shows the removal of the breast, most or all of the lymph nodes under the arm, the lining over the chest muscles and sometimes part of the chest wall muscles. The drawing on the right shows a cross-section of the breast including the chest wall (ribs and muscle), fatty tissue, and the tumor.
Breast-conserving
surgery, an operation to remove the cancer but not the breast
itself, includes the following:
- Lumpectomy:
A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it.
Most doctors also take out some of the lymph nodes under the arm.
- Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. Some of the lymph nodes under the arm may also be removed for biopsy. This procedure is also called a segmental mastectomy.
Breast-conserving surgery; drawing shows removal of the tumor and axillary lymph nodes.
Even if the doctor removes all of the cancer that can be seen at
the time of surgery, the patient may be given radiation therapy,
chemotherapy, or
hormone therapy after surgery to try
to kill any cancer cells that may be left. Treatment given after surgery, to
lower the risk that the cancer will come back, is called adjuvant
therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Radiation therapy should not be given to pregnant women with early stage (stage I or II) breast cancer because it can harm the fetus. For women with late stage (stage III or IV) breast cancer, it should not be given during the first 3 months of pregnancy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Chemotherapy should not be given during the first 3 months
of pregnancy. Chemotherapy given after this time does not usually harm the
fetus but may cause early labor and
low birth weight.
See Drugs Approved for Breast Cancer for more information.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in
clinical trials. It may not mention every new treatment being studied.
Information about clinical trials is available from the
NCI Web site.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working.
The effectiveness of hormone therapy, alone or combined with chemotherapy, in
treating breast cancer in pregnant women is not yet known.
Ending the pregnancy does not seem to improve the mother’s
chance of survival.
Because ending the pregnancy is not likely to improve the mother’s chance of survival, it is not usually a treatment option.
[Back to top]Treatment Options by Stage
[Back to top]Early Stage Breast Cancer (Stage I and Stage II)
Treatment of early stagebreast cancer (stage
I and stage II) may be
surgery followed by adjuvant
therapy as follows:
[Back to top]Late Stage Breast Cancer (Stage III and Stage IV)
Treatment of late stagebreast cancer (stage III and stage
IV) may include the following:
Radiation therapy and chemotherapy should not be given during the first 3 months of pregnancy.
[Back to top]Other Considerations for Pregnancy and Breast Cancer
Key Points:Lactation (breast milk production) and breast-feeding should be
stopped if surgery or chemotherapy is planned.
If surgery is planned,
breast-feeding should be stopped to reduce blood flow in the breasts and make
them smaller. Breast-feeding should also be stopped if
chemotherapy is planned. Many
anticancer drugs, especially cyclophosphamide and
methotrexate,
may occur in high levels in breast milk and may harm the nursing baby. Women
receiving chemotherapy should not breast-feed. Stopping lactation does not
improve survival of the mother.
Breast cancer does not appear to harm the fetus.
Breast cancercells do not seem to pass from the
mother to the fetus.
Pregnancy does not seem to affect the survival of women who
have had breast cancer in the past.
Some doctors recommend that a woman wait 2 years after treatment
for breast cancer before trying to have a baby, so that any early return of the
cancer would be detected. This may affect a woman’s decision to become
pregnant. The fetus does not seem to be affected if the mother has previously
had breast cancer.
Effects of certain cancer treatments on later pregnancies are
not known.
The effects of treatment with high-dose chemotherapy and a
bone marrow transplant, with or
without radiation therapy, on later
pregnancies are not known.
[Back to top]To Learn More About Breast Cancer and Pregnancy
For more information from the National Cancer Institute about breast cancer and pregnancy, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
[Back to top]Changes to This Summary (03/07/2013)
The PDQcancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Editorial changes were made to this summary.