Pregnancy Associated Breast Cancer
- Meghan Schanie was 31 years old when her doctor dismissed a lump in her breast as a blocked milk duct or an infection, but self-advocacy helped her get answers. It was breast cancer. Now, 50, she’s encouraging other women not to ignore symptoms.
- Pregnancy-associated breast Cancer is rare. The American Cancer Society reports that breast cancer is diagnosed in approximately one out of every 3,000 pregnancies. This condition primarily occurs in women in their 30s.
- Detecting breast cancer during pregnancy can be challenging due to breasts undergoing natural changes in size, shape, and texture. These changes can easily be masked by the body’s natural response to pregnancy; often leading to diagnoses at more advanced stages.
- Surgery is often the first line of treatment for pregnancy-associated breast cancer. Chemotherapy can be administered in most cases during pregnancy. After giving birth, additional treatments may begin, such as radiation or hormone therapy.
- If you have questions regarding your health, SurvivorNet’s My Health Questions allows patients and caregivers to get personalized, doctor-backed answers to their cancer care questions in real time by typing them in or using voice command technology.
Now, 50, she’s encouraging other women not to ignore symptoms. Sharing her story with the Courier Journal, Schanie recounted being a mom of two toddlers, working a full-time job, when she informed her doctor about the lump. However she was reassured it was likely a blocked milk duct or infection, both which are possible while breastfeeding.
Read MoreSchanie, who works as the Manager of School and Teacher Programs at Frazier History Museum, told the Courier Journal, “I was too young to be having mammograms. If I hadn’t gone in myself, who knows when they would have found it?””View this post on Instagram
Reflecting on how breast cancer awareness wasn’t heavily emphasized in her community, she said, “I had always kind of grown up being told that you should check monthly and those kinds of things and to pay attention to that kind of stuff.”
Schanie also recalled the stress of dealing with insurance after her diagnosis.
Initially, coverage for a double mastectomy was denied, but after advocating for herself, the procedure was ultimately approved.
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She remains appreciative of the health insurance she received through her employer and the hospital resources that supported her during her cancer battle.
However, she still acknowledges that managing a cancer diagnosis can be incredibly challenging for people already balancing demanding schedules and daily responsibilities.
“I have access to a car. What if you don’t have anybody to watch your kid? I also have a very flexible job, which a lot of people don’t have,” she said.
Schanie is now cancer-free and hoping her story will inspire other women to have better trust in themselves and push for answers despite being “too young” for cancer.
“You know your body better than anyone. If something feels wrong, don’t let it go,” she concluded.
The museum which Schanie works for previously praised the mom of two on Instagram, writing, “Megan Schanie is many things: a history buff, a talented educator, an Atherton alum, a loving wife, a proud mother to two college-age daughters, a rain-or-shine U of L fan, a former college basketball player, and a cancer survivor.
“She also happens to be the longest-tenured employee of the Frazier History Museum!”
Recounting one of her top favorite memories working for the museum for 20 years, she wrote in an article, “Standing Ovation. In 2006, as a two-year Frazier employee and the mother of an infant and a toddler, I was diagnosed with breast cancer.
“Not only did the museum staff rally around me and give me all the support and time off I needed, they also created a safe haven of normalcy when I was well enough to return to work.”
She continued, “I wore a scarf during chemo. One day, after I gave a field trip presentation, a young student raised his hand and asked why I was wearing the scarf.
“After I gave a brief explanation to the school group, the student just stood up and started to applaud. Then the rest of the students stood up with him and started to applaud. Can you imagine that? It was incredible.”
Helpful Information On Breast Cancer During Pregnancy
Schanie is not the first, and unfortunately not the last, pregnant woman to be diagnosed with breast cancer.
It’s important to note that in approximately one in every 3,000 pregnancies breast cancer occurs, Dr. Natalie J. Klar, MD, medical oncologist at NYU Langone Perlmutter Cancer Center, previously told SurvivorNet.
According to the National Cancer Institute (NCI), “a new breast cancer diagnosis that occurs in a woman who is pregnant, within a year of giving birth, or anytime during lactation is called pregnancy-associated breast cancer.”
“Breast cancer is one of the most common cancers diagnosed during pregnancy. It occurs in about 1 out of every 3,000 pregnancies, most often in women ages 32 to 38 years. The incidence of pregnancy-associated breast cancer is likely to increase because the average age at pregnancy is increasing and overall incidence of breast cancer increases with age,” the NCI adds.
Getting to Know Your Breasts with Self-Exams
Dr. Klar says the definition of a pregnancy associated breast cancer varies from practitioner to practitioner, but it’s generally defined as a breast cancer diagnosed and discovered during pregnancy, or within the first few years after childbirth.
Expert Breast Cancer Resources
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“Usually we say within one to two years of delivery, some people say within one to two years of completion of breastfeeding, so that can sometimes even be a little longer depending on how long you breastfeed for,” Dr. Klar explained.
The frequency of these incidents has been increasing recently, adds Dr. Klar. Which she attributes to the rise in women deciding to have children later in life.
Dr. Linda Moy, a radiologist that specializes in breast imaging at NYU Langone’s Perlmutter Cancer Center, previously spoke to SurvivorNet on the topic of pregnancy-associated breast cancer, advising woman to bring a lump or any concern to a doctors attention immediately.
“I would say for any woman that has a lump in a late stage [pregnancy], they should go ahead and see their doctor,” Dr. Moy explained.
“But for those in particular who are a late maternal age or any family history of breast cancer, those are the ones that really need to see the doctor and I would recommend additional imaging with a breast ultrasound to begin with.”
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During pregnancy and while you’re breastfeeding your body is changing, so one of the most important things to do is to watch for signs that seem abnormal to you, added Dr. Klar.
Dr. Klar added, “I think it’s always important for young women because typically the mammogram screenings start at 40. So young women aren’t used to necessarily screening tests on their breasts, but I think they know their body.
It’s important to advocate for yourself and to tell your doctor you’re worried if the doctor doesn’t seem as concerned, Dr. Klar said. Additionally, with the rise in pregnancy associated breast cancer primary care physicians and obstetrician/gynecologists (OBGYNs) should become more educated on this diagnosis.
What To Do If You Discover a Lump During Pregnancy and Need to Talk to Your Doctor
If you find a lump or an abnormality with your breasts the number one thing to do is to push your doctor for additional testing, such as an ultrasound, according to the experts.
As hormone levels increase during pregnancy, the breasts will get bigger and continue to grow throughout your pregnancy. The breast feel more swollen and sore due to increased blood flow and fluid retention, according to Dr. Moy.
“So it’s easy to assume that a new lump is related to these physiologic (normal changes). Oftentimes we may ignore the lump and say, ‘oh, you know, it’s a lump, it’s normal.’ So these women are diagnosed a little bit later and may present with a more advanced cancer,” she added.
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Similarly, Dr. Klar says worst case scenario is an extra test or ultrasound that shows normal results. Women should “get an ultrasound or get get the imaging of their breasts to make sure that it’s nothing more than just normal pregnancy or breastfeeding related changes.”
The main message here is ask your doctor for additional tests and don’t be afraid to stand up for yourself.
Dr. Michelle Specht, a breast surgeon in the division of surgical oncology at Massachusetts General Hospital Cancer Center, who also spoke to SurvivorNet in an interview, said, “During pregnancy, the breasts are really hard to examine. They’re lumpy, they’re bumpy, they change you know and doing a self breast exam and having a low threshold to see your obstetrician or even a breast specialist for an ultrasound evaluation it’s easy, do it.”
For women over 40, specifically, who are trying to get pregnant continued screening is extremely important, says Dr. Specht.
According to experts, there is a wide consensus that women should have annual mammograms between the ages of 45 and 54. But there is some disagreement among doctors as to whether mammograms are beneficial for women between the ages of 40 and 45. This is an option you should, of course, discuss with your own doctor.
“We really emphasize that even if you’re actively trying to get pregnant, you should be doing screening mammograms starting at 40. Or, if you’re about to embark on a cycle of IVF [in vitro fertilization] and you’re thinking of getting pregnant, why not get that mammogram in the bank to give yourself the all clear,” said Dr. Specht.
In addition, she says to pay attention to your family history; if you’re at high-risk based on your family history and you have additional screening modalities, such as a breast MRI, make sure it’s up to date before you consider getting pregnant.
It is okay to do mammography and MRIs if someone’s breastfeeding, says Dr. Specht. The images are not as perfect “as we like them. But there’s no reason that you should not do it.”
Meaning women shouldn’t wait an entire two years to have their next mammogram because they got pregnant and breastfed for a year. Dr. Specht says she typically tells patients once they’re really good at breastfeeding and once they can decompress the breasts (or pump prior to a screening) they can get their mammogram.
Treatment for Pregnant Associated Breast Cancer
While it is an extremely scary and serious situation, Dr. Specht says, surgery when someone is pregnant is an option and has shown success. And even chemotherapy is a fine treatment option.
“The only thing you can’t give a pregnant woman is radiation. And so, you know, even if someone were to discover they were pregnant and faced with the decision to keep the pregnancy or continue the pregnancy from a oncologic perspective, most commonly we can get around,” said Dr. Specht.
She adds, most often women don’t have to terminate a pregnancy because they have breast cancer. The women are typically able to have chemotherapy and/or surgery, and can wait for the radiation until after delivery if they need it.
“But I would say that I’ve treated you know at least one pregnant patient a year or or probably two. And I can think of you know, maybe two or three patients who actually needed to go through with a termination because of their cancer,” said Dr. Specht.
Leading Experts Urge Us to Be Proactive
“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care,” National Cancer Institute Chief of Surgery Steven Rosenberg told us in a previous interview, “because finding a doctor who is up to the latest of information is important.”
As highlighted in several areas of SurvivorNet, highly respected doctors sometimes disagree on the right course of treatment, and advances in genetics and immunotherapy are creating new options. Also, in some instances the specific course of treatment is not clear cut. That makes it even more important to understand the possible approaches to treating your disease.
At the National Cancer Institute, there is a patient referral service that will “guide patients to the right group depending on their disease state so that they can gain access to these new experimental treatments,” Rosenberg says.
Cancer Research Legend Urges Patients to Get Multiple Opinions
Additionally, seeking a second opinion can help you avoid potential doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon that is recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.
More reasons to obtain a second opinion include:
- To see a doctor who has more experience treating your type of cancer
- You have a rare type of cancer
- There are several ways to treat your cancer
- You feel like your doctor isn’t listening to you, or isn’t giving you good advice
- You have trouble understanding your doctor
- You don’t like the treatment your doctor is recommending, or you’re worried about its possible side effects
- Your insurance company wants you to get another medical opinion
- Your cancer isn’t improving on your current treatment
Ultimately, being proactive about your health can be a matter of life or death. The more you learn—and the more expert perspectives you gather—the more confident you can be that you’ve done everything possible to take control of your health.
Helpful Information About Breast Cancer Screening
The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives.
For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.
Women with a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.
WATCH: Understanding the BRCA gene mutation
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.
RELATED: 3D Mammography Detects 34% More Breast Cancers Than Traditional Mammography
Family History & Breast Cancer Risk
Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:
- Older age
- Having a gene mutation such as the BRCA1 or BRCA2
- Added exposure to estrogen
- Having children after the age of 30
- Exposure to radiation early in life
- Family history of the disease
Contributing: SurvivorNet Staff
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