During pregnancy, a woman’s body undergoes countless changes, including in her breasts. While changes in your body during this time are completely normal, it is still important to be aware of your own health and what is normal for you — even though anything unusual that is discovered will usually not be cancer.
While rare, breast cancer can occur during pregnancy. Oftentimes, it can be difficult to separate a cancerous mass or lump, or another common sign of breast cancer, from what is a normal part of pregnancy. Ultimately, if you notice any changes to your body or anything unusual, it is important to report it to your health care provider.
“If you find something that’s worrisome, make sure to have it professionally evaluated, and don’t be afraid to seek a second opinion,” says Ann Partridge, MD, MPH, co-founder and director of the Young and Strong Program for Young Women with Breast Cancer at the Susan F. Smith Center for Women’s Cancers at Dana-Farber/Brigham and Women’s Cancer Center. “Research is constantly evolving, and it’s important for patients to get medically accurate information.”
Signs and symptoms of breast cancer
The symptoms of breast cancer do not change if you are pregnant. However, they may be overlooked more often or dismissed as a result of the pregnancy, so it is important to be aware of them.
The most common symptom of breast cancer is a new mass or lump, though most lumps are not breast cancer. Cancerous lumps do not all feel the same but tend to be irregular in shape and may feel firm or solid. These lumps can vary in size, and whether you can feel it may depend on where the lump is located in the breast, how big the breast is, and how deep the lump is positioned within the breast.
Ultimately, it is impossible to diagnose a breast lump just by touch, so it is important for you to speak with your doctor if you notice any changes in your breasts.
Other common signs and symptoms that may indicate breast cancer include:
- Mass or lump
- Dimpling of the skin or nipple (also referred to as peau d’orange)
- Asymmetry or one side feeling/looking more swollen
- Hard, round bumps in armpits
- Redness or flaky skin in the nipple or breast area
- Skin that is warm to touch
- Nipple discharge other than breast milk
- Nipple turning inward (retraction)
Even if you are experiencing one or more of the symptoms above, it does not mean you have cancer. For women who are pregnant, this is especially true, as common symptoms of breast cancer often overlap with benign causes.
This is one of the reasons why it is important to have open communication with your health care provider and report any changes to your body.
[Learn more about the signs of breast cancer.]
Inflammatory breast cancer
Inflammatory breast cancer (IBC) is a very rare and aggressive disease in which cancer cells block the lymph vessels (thin tubes that carry fluids and white blood cells through the lymphatic system) in the skin of the breast. IBC gets its name because it often causes the breast to appear red or inflamed.
Someone with IBC will usually be able to pinpoint the exact moment they noticed a change in their breast. Symptoms typically present over a 24-hour period, and this form of breast cancer can often be detected without a lump. Common symptoms of IBC include:
- Redness of the breast
- Rapid swelling or enlargement of the breast
- Pain or itchiness of the breast
- Thickening of the skin on the breast and ridged or dimpled skin texture (peau d’orange)
- Swelling of the lymph nodes in your armpit or above/below the collarbone
For patients who are pregnant or breast feeding, IBC is often originally misdiagnosed as mastitis: an inflammation of the breast due to an infection. Mastitis, which most frequently occurs in women who are breast feeding, is treated with antibiotics and typically resolves within a week of starting medication.
If after a week your symptoms do not improve, it is important for patients and healthcare providers to follow up and seek a specialist. Persistent symptoms do not necessarily mean you have IBC, but they should be examined by a trained specialist.
“If worrisome changes in the breast don’t improve with antibiotics, don’t be afraid to be your own advocate,” explains Beth Overmoyer, MD, director of the Inflammatory Breast Cancer Program at the Susan F. Smith Center. “While incredibly rare, IBC can develop in pregnant women, and catching it early may lead to more effective treatment.”
Treatment during pregnancy
A breast cancer diagnosis can be a difficult and life-altering discovery. For patients who are also pregnant, the news can be incredibly overwhelming.
However, if you are diagnosed with breast cancer while pregnant, there will almost always be treatment options available to you. Furthermore, there is no evidence that breast cancer itself can harm a developing baby.
Most women diagnosed with breast cancer can still undergo many routine parts of breast cancer therapy including surgery. Likewise, if necessary, some chemotherapy regimens are considered generally safe in the second and third trimester of pregnancy. Chemotherapy can also lower the mother’s blood cell counts, so it is recommended to stop chemotherapy when nearing the time of delivery.
Other therapies used in breast cancer treatment, such as radiation therapy, hormone therapy, targeted therapy, as well as the vast majority of clinical trials, must be held off until after delivery.
A breast cancer diagnosis during pregnancy may lead to delicate conversations with your oncologist, and it is important to be honest and open so that you can come to the best decision for you and your child.
“Regardless of your situation, there are almost always safe and effective treatments for breast cancer care in pregnancy,” says Erica Mayer, MD, MPH, director of the Breast Cancer in Pregnancy Program, and a senior physician in the Breast Oncology Program at the Susan F. Smith Center. “It is important for a woman and her doctor to discuss all of the aspects of cancer care in pregnancy.
“Small compromises may be necessary as a treatment plan is formulated; however, the overall plan will be directed towards a goal of providing effective and modern cancer care while protecting the developing baby.”
If you have any questions regarding your specific situation, please bring them to your healthcare provider.
About the Medical Reviewer
Dr. Partridge received her MD from Cornell University Medical College in 1995. She completed her residency in internal medicine at the Hospital of the University of Pennsylvania and went on to complete fellowships in medical oncology and hematology at DFCI. Later she received an MPH from Harvard School of Public Health. She is a medical oncologist focusing on the care of women with breast cancer, and she has a particular interest in the psychosocial, behavioral, and communication issues in breast cancer care and treatment.