What Do Lactating Patients Need to Know about Breast Cancer Screening?

The Importance of a Self-Breast Exam

Breast changes are normal throughout a woman’s lifetime. Breast morphology varies during menstrual periods, pregnancy, lactation, menopause, or hormone therapy. Self-breast exams should be an integral part of every woman’s personal routine. In fact, women have detected breast cancer themselves in 25% of cases. Those statistics are a testament to the importance of “knowing your normal” breast.  There are times during the life of a breast that can present particular challenges when attempting a breast exam. The literature on breast exams during lactation has been varied and confusing. But here is what you need to know if airing on the side of caution during lactation.

What Happens to Breasts During Lactation?

In order to properly evaluate your breast, it is important to know what is happening inside. During pregnancy and postpartum, the breast undergoes three stages. Mammogenesis is the development of the mammary glands within the breast in preparation for milk production and actually begins during puberty. During this time, the breast is predominantly adipose (fat) tissue. During pregnancy, a rise in hormones causes the breast tissue to increase in water, electrolyte, fat content, and subsequently blood supply. Lactogenesis is the initiation of breast milk production following delivery. Hormones and the act of suckling are responsible for continued milk production from the mammary glands. Galactopoiesis is the continuation of milk production regulated by the frequent and regular removal of milk. Lactating breasts often feel nodular, heavy and sore. For this reason, it is best to do a self-evaluation with empty breasts.

What Does Cancer Feel Like?

Painless lumps in the breast that feel irregular in shape are the most concerning finding. Other symptoms include:

• skin dimpling
• nipple pain or discharge
• nipple retraction
• red, dry, flaking, or thickened breast/nipple skin
• swollen lymph nodes under the arm or near collar bone

These symptoms can be caused by non-cancerous breast conditions as well. It is important to speak with your healthcare provider for further evaluation if a lump or other concerning symptoms are detected during a self-breast exam.

If it is Not Cancer, Then What Could It Be?

Lactation complicates breast exams because of the physical changes of the breast in the presence of milk production. Benign lumps that are identified could be:

Fibroadenomas

The mass is a tumor comprised of glandular tissue. The mass moves freely and has clear borders. These masses can increase in size during pregnancy.  Additionally, a lactating adenoma can occur during pregnancy and breastfeeding due to hormone production.

Galactoceles

This is a milk-filled cyst that results from a clogged duct. It will be tender to the touch. Pain can be relieved with cool compresses and a supportive bra.

Mastitis

This is an infection that results in a red, inflamed and sore breast. Additional symptoms include fever, headache, nipple discharge, and possibly a pus-filled abscess. Mastitis needs to be treated with antibiotics.

It is still important to speak with a healthcare provider about any of these above conditions as further evaluation and treatment may still be necessary.

What is the Recommendation for Lactating Women?

It is recommended by ACOG (American College of Obstetrics and Gynecology) that lactating women undergo breast exams with the same frequency as their non-lactating counterparts. Women are having children at a more advanced age, an age when more frequent breast cancer diagnostics are beginning. It is important to evaluate your individual case with your physician regarding age-related and high-risk screening.

Further Testing for Patients Who Need Advanced Screening While Breastfeeding

The following diagnostic tools may be recommended if the patient’s age or other high-risk criteria require further evaluation.

• Diagnostic mammography
• Breast Ultrasound
• MRI (Magnetic Resonance Imaging)
• Ductography
• Biopsy

It is important to note that an infant does not need to be weaned prior to testing. Additionally, despite conflicting opinions, breastmilk does not need to be discarded following contrast dye imaging. This does not hold true for diagnostic tests that use radioactive materials. In this case, weaning from breastfeeding, or deferring elective tests are recommended.

---

References

NCI - Breast Changes and Conditions

NIH - Self-detection remains a key method of breast cancer detection for U.S. women

Breastcancer.org - Breast Self-Exam (BSE)

GLOWM - The Breast During Pregnancy and Lactation

Breastcancer.org - Benign Breast Changes Associated With Pregnancy and Breastfeeding

The Institute for Breastfeeding and Lactation Education (IABLE)  - Breast Imaging During Lactation

ACR Manual on Contrast Media