Nursing encouraged after pregnancy in breast cancer survivors

ESMO 35th Congress

MILAN — New mothers who were previously treated for breast cancer are encouraged to breastfeed and should not be denied the opportunity by their physician, according to Hatem Azim, MD.

Although there is no current evidence suggesting that breastfeeding poses harm to mother or child after treatment for breast cancer, women are often denied the opportunity to breastfeed their children, Azim, of the department of medical oncology, Jules Bordet Institute in Brussels, said during a press conference at the 35th ESMO Congress.

For the study, researchers pooled data from the European Institute of Oncology database between 1988 and 2006 for women aged 40 years or younger at breast cancer diagnosis. Questionnaires on lactation behaviors and the effect on overall breast cancer outcome were administered to 20 women who completed pregnancy following breast cancer therapy. Median follow-up was 4 years after delivery.

Ten women attempted breastfeeding; 10 did not. One breast cancer relapse occurred in both the non-breastfeeding group and the breastfeeding group. The main reasons for not initiating breastfeeding were uncertainty regarding maternal safety and prior unfeasibility expressed by the physician.

Of those who breastfed, four women stopped within 1 month; six women had long-term success for a median of 11 months. Two women breastfed from both breasts for 2 weeks.

Out of 15 women who underwent surgery for breast cancer and radiotherapy, 14 had hypoplasia of the irradiated breast during pregnancy; milk production was significantly reduced in seven out of 15 women who attempted to breastfeed from the affected breast.

The type of breast surgery performed and post-delivery lactation counseling were two main factors associated with successful long-term breastfeeding. Women with breast-conserving surgery had an increased chance of successful breastfeeding.

“Breastfeeding is a very normal aspect of life,” Azim said during a press conference. “It is a pity that women are denied the opportunity to experience normal motherhood and newborns are denied the endless benefits of lactation due to fears not based on any evidence. Denying breast cancer survivors the opportunity to become pregnant or breastfeed remains unjustified in the absence of supporting evidence.”

We have progressed from extensive, mutilating treatments such as enlarged mastectomies, extensive radiation therapy and aggressive chemotherapy to minimal interventions such as breast conservation, sentinel node biopsy and tailored systemic therapies that allow a normal life after breast cancer. Yet, pregnancy and breastfeeding were not always encouraged in breast cancer survivors. The important findings of this study add to the body of evidence helping us to better advise our ex-cancer patients and future mothers: breastfeeding after breast cancer is not dangerous for the mother or the child. Decisions about fertility and future pregnancies are important for an increasing number of patients. Dr. Azim and colleagues have shown that, especially for patients undergoing breast conserving surgery, breastfeeding from the contralateral breast can be successful and should be encouraged.

– Alexandru Eniu, MD
Cancer Institute, Cluj-Napoca, Romania

For more information:

Azim H. #251P. Presented at: the 35th Congress of the ESMO; Oct. 8-12, 2010; Milan, Italy.

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