Pregnancy-associated breast cancer (PABC) is the most common type of cancer found during pregnancy. PABC is defined as breast cancer occurring during pregnancy, up to one-year postpartum, or during lactation. Roughly 1 in 3000 pregnant women will be affected by this disease, with an increased incidence up to 6 months into the postpartum period. This disease can be quite aggressive, if not detected and treated early. Therefore, the importance of routine breast exams and monitoring cannot be expressed enough.
Breast Self-Exams
What? A breast self-exam, or BSE, is a visual and physical exam of your breasts and underarms for significant changes in size, shape, texture, lumpiness, appearance, or discharge. Used in addition to annual, clinical breast health screenings, BSE is a quick and cost-effective way to help detect potential breast cancer.
When? During pregnancy, it is recommended that women perform a BSE on the same day of each month; the most common recommendation is to perform on the 1st of every month to keep things simple. After pregnancy, you’ll want to perform BSE 5-10 days after the start of your period, as breasts are less likely to be swollen or tender at this time. If you are breastfeeding, perform BSE on the first day of each month after emptying your breasts.
How?
Visual Inspection: While standing in front of a mirror, visually check both breasts for any unusual appearance. Check for any changes to the shape, size or contour of the breasts, any changes in texture, such as scaliness or puckering of the skin, and for any discharge coming from the nipples.
Physical Inspection:
1. Standing: While raising one arm slightly, use the pads of your fingers on the other hand to physically inspect the opposite breast and underarm firmly and meticulously. You’ll want to move your finger pads in a repeated pattern (i.e. small circles or in straight lines up and down along the area), making sure to overlap areas roughly the size of a dime. Make sure to apply light, medium, and hard pressures in each area to assess different tissues of the breasts and surrounding area. Perform the same actions to assess the opposite breast.
2. Lying down: Perform the same steps from item #1 while lying down on your back. You can fully lift the arm overhead, as tissues surrounding the breast will be less tight in this position.
**Of these methods listed, current literature suggests performing BSE while lying down is the most preferred, as it places the breast tissue in a flatter position, making it easier to detect any lumps.
Other Breast Screening Methods
If a lump were to be detected, there are tests that can be performed to evaluate changes in the breasts. One such test is ultrasound, which is commonly the first used, as it does not use radiation to provide imaging of the breast tissue during pregnancy. Breast biopsy is another test used, where a small piece of the breast tissue is taken from any area of concern. Each of these methods are minimally invasive and carry little to no risk on the fetus and, therefore, are most often used to rule cancer out.
Mammograms can detect most breast cancers in pregnant women as well. However, they do run the risk of use of radiation. That said, the amount of radiation needed for this test is quite small and is mainly focused on the breasts. Measures can be taken to reduce the likelihood of exposing the fetus to radiation, though, such as use of a shield over the mother’s belly.
When to Reach Out to a Primary Care Provider
Contact your physician if you experience breast changes that may include:
- A hard lump(s) or mass
- Swelling, redness, and/or warmth
- Skin puckering, irritation, scaliness, or rash of nipple or breast tissue
- Nipple discharge that is not breastmilk
- Retraction, or pulling in, of the nipple(s)
- Abnormal changes in size or shape
While changes to breast tissue throughout pregnancy and into the postpartum period is common, it is important to remember that you know your body better than anyone else. If you see or feel any changes that bring you concern, advocate for yourself and get them checked out. In this case, it is definitely better safe than sorry!
