delayed childbirth associated with pregnancy-associated breast cancer
Anita Logan thought the lump she felt in her breast was the result of feeding three month old Riley. Pregnancy, after all, plays havoc with a woman’s hormones, she reasoned. But Logan’s lump was not benign.
The 40-year-old Mississauga, Ont. mom, who prefers that we not use her real name, found out that the mass was a breast cancer that now threatens her life.
In fact, pregnancy-associated breast cancer (PABC) is on the rise, say experts. It can be diagnosed while a woman is pregnant or up to 12 months after completion of a pregnancy. And while it occurs in only three in 10,000 pregnancies, accounting for 3% of all breast carcinomas diagnosed, its incidence is expected to increase.
There are several reasons, says Dr. Tulin Cil, a breast surgeon with Princess Margaret Hospital and an assistant professor at the University of Toronto. “One is that more women are delaying childbearing until later and, as a result, we expect to be seeing an increased rate of the number of PABCs.”
Breast cancer risk rises with age, she explains, adding that the rate for women whose first pregnancy is over 35 has also been rising steadily in the last decade. Add that to the fact that the incidence of breast cancer for younger non-pregnant women has been going up, and you can see how both are contributing to a rise in PABC.
The actual mechanism that puts some women at risk is poorly understood. It may have something to do with the influence of hormones, particularly estrogen and progesterone, which surge during pregnancy.
“The breasts are preparing to become a lactational device in the sense that they are increasing the size of their milk producing glands and they are increasing the blood flow to the breasts,” says Cil.
While some women are more susceptible than others, it’s important to remember that a breast cancer usually takes several years to grow.
There are some features, however, that are different in PABCs than in other breast cancers.
“These tumours are not as responsive to estrogen and progesterone and as a result have a poorer prognosis,” says Cil. Because women with PABC have tumours that are at an advanced stage, they are two and a half times more likely to have metastatic breast cancer (cancer that has spread) than their non-pregnant counterpart.
The treatment can be aggressive. “Most of these patients present later on in pregnancy, so if they present in the second or third trimester we know that surgery is safe then. In the first trimester, it is not as safe because there is an increased rate of spontaneous abortion.”
Though chemo is thought to be safe during later pregnancy, it’s a hard sell.
“You can image that it’s a time period that is already incredibly stressful and emotional for the patient,” says Cil. “It’s supposed to be a joyous time and here they are dealing with a very serious disease. It’s important to have support from the family and also the surgeon, the oncologist, the radiation oncologist, the obstetrician, the family physician — it’s a team approach.”
—
BE VIGILANT
“There’s often a delay in diagnosis,” says breast surgeon Dr. Tulin Cyl. “Because of their younger age group, these women are not in the mammography screening programs.” Women who find breast lumps, notice puckering or dimpling in their breasts, or see a redness in the skin or a nipple discharge should be evaluated thoroughly and not attribute these changes to pregnancy.
The Edmonton Sun
Mon May 24 2010
Page: 41
Section: Lifestyle
Byline: BY MARILYN LINTON
Column: Health
Follow us on: