Pregnancy and breast cancer: Why a breast lump should never be ignored

Pregnancy brings significant changes to a woman’s body, including the breasts, which begin preparing for breastfeeding. However, while these changes are expected, a new lump or unusual breast symptom should never be dismissed as a normal part of pregnancy.

Breast cancer during pregnancy is uncommon, affecting approximately one in every 3,000 pregnant women. It is nevertheless considered the most common cancer diagnosed during pregnancy. The average age of pregnant women diagnosed with breast cancer is between 32 and 38 years, with incidence potentially increasing as more women delay childbearing.

Dr Derria Cornwall, consultant radiologist and head of the Women’s Imaging Centre at the University Hospital of the West Indies (UHWI), Mona, emphasises the importance of recognising changes in the breasts and seeking medical attention promptly.

“Although breast changes are expected during pregnancy, women should remain attentive to any unusual symptoms. A new lump should not be assumed to be related to pregnancy or breastfeeding,” Dr Cornwall said.

warning signs

A breast lump is the most common symptom of breast cancer. Cancerous lumps are often painless and may feel firm, making it important for women not to rely on pain as an indicator of whether a lump is serious.

Other warning signs include nipple discharge that is not breast milk, redness or dryness of the nipple, flaking of the breast or nipple skin, nipple inversion or retraction, breast or nipple pain, and dimpling of the skin that may resemble the texture of an orange peel. Swelling of the lymph nodes in the armpit may also be a sign.

“Women should pay attention to changes such as nipple retraction, skin dimpling, unusual discharge or swelling under the arm. These symptoms warrant medical evaluation, particularly when they are new or persistent,” she said.

During pregnancy, the breasts grow as milk ducts develop in preparation for lactation. After delivery, breastfeeding can cause engorgement, making the breasts feel fuller and sometimes making lumps more difficult to detect.

These changes can complicate the identification of an abnormality. However, Dr Cornwall cautions against delaying an assessment until after delivery or the completion of breastfeeding.

“Any new breast lump during pregnancy or while breastfeeding should be brought to the attention of a doctor promptly. Women should not wait until they have delivered their babies or stopped breastfeeding to have a concerning change investigated,” she advised.

Early evaluation is important because symptoms that appear to be associated with pregnancy may require further investigation to determine their cause.

choice of examination

When a pregnant woman presents with a breast lump, her doctor may recommend imaging to assess the area. Ultrasound is often used as an initial examination, while mammography may also be recommended when clinically indicated.

Concerns about radiation exposure can cause some women to hesitate about undergoing a mammogram during pregnancy. However, mammography is generally considered safe when medically necessary, because the radiation dose is very low and is directed at the breast. Abdominal shielding may further reduce exposure.

“Appropriate breast imaging should not be unnecessarily delayed because a woman is pregnant. The choice of examination depends on the clinical situation, and the benefits of investigating a suspicious finding must be considered,” Dr Cornwall explains.

Magnetic resonance imaging (MRI) is generally avoided during pregnancy when it requires gadolinium-based contrast agents. Gadolinium can cross the placenta, and potential effects on the developing foetus remain a concern.

The decision about which investigation is appropriate should therefore be made by the treating medical team, taking the woman’s symptoms and pregnancy into account.

remain vigilant

Breast cancer screening recommendations also apply to women who are pregnant or breastfeeding, depending on their age and level of risk.

According to screening criteria outlined by the American College of Radiology, pregnant and lactating women younger than 30 who are at high risk may require screening. Women ages 30 to 39 who have an elevated, intermediate or high risk should also be considered for appropriate screening, while women ages 40 and older may be eligible for screening based on average or increased risk.

Women who are due for screening should discuss the appropriate timing and examination with their healthcare provider rather than automatically postponing it until after pregnancy or breastfeeding.

Dr Cornwall encourages women to remain vigilant about their breast health throughout pregnancy and beyond. “Pregnancy and breastfeeding should not prevent women from seeking help when they notice something unusual. Knowing what is normal for your body and reporting changes early are important steps in protecting your health,” she said.

A breast lump may not be cancer, but determining its cause requires proper assessment. Prompt attention to unusual breast changes can help ensure that women receive the appropriate care when it is needed.

keisha.hill@gleanerjm.com