ABM Clinical Protocol #34: Breast Cancer and Breastfeeding

Abstract

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. Background B reast cancer is the most common malignancy in women worldwide, with 1 in 20 women developing the disease during her lifetime. 1 It represents the leading cause of cancer deaths and disability-adjusted life-years among women. 1 In addition, breast cancer imparts significant morbidity to women and children through its impacts on breastfeeding. Breast cancer treatments may affect breastfeeding in multiple ways. Breastfeeding women diagnosed with breast cancer may require medications or therapies that decrease milk production or are contraindicated during lactation. Women treated for breast cancer before or during pregnancy may have reduced lactational capacity due to surgical removal of breast tissue and/or irreversible effects of prior therapies. Given these unique challenges and the multitude of health risks associated with not breastfeeding, 2 women with a new or remote breast cancer diagnosis require unique support of lactation. The aim of this protocol is to guide clinicians in the delivery of optimal care of breastfeeding women as it relates to breast cancer, from screening to diagnosis, treatment, and survivorship. Throughout this protocol, the quality of evidence, based on the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence 3 (Levels 1-5), is noted in parentheses. Recommendations Screening breastfeeding women for breast cancer Breastfeeding management in women with a history of breast cancer As breast cancer treatments may reduce lactational capacity, women with a history of breast cancer who would like

Perinatal outcomes of women with gestational breast cancer in Australia and New Zealand: A prospective population‐based study

“…It has been suggested that women receiving chemotherapy experience difficulties in initiating breastfeeding because of decreased milk production. 43 Our data support this suggestion as only three of the six women who initiated breastfeeding after receiving chemotherapy during their pregnancy continued to breastfeed their babies at discharge. We did not collect postneonatal follow‐up data to determine whether breastfeeding after chemotherapy had any adverse impacts.…”

Benefits and limitations of breastfeeding for mothers with malignant tumors

“…В случае проведения РТ или частичной мастэктомии выработка молока снижена в той груди, где было проведено лечение [15]. Это связано с тем, что в результате лечения происходят необратимые изменения тканей железы, включая фиброз, атрофию и дольковый склероз [16].…”

Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases

“…Reduction in risk for breast and ovarian cancer is among the benefits of breastfeeding. Specialists who follow-up pregnant and lactating cancer survivors should be aware of the close monitoring necessary throughout this period [ 126 ]. Healthcare providers need to reassure women that breastfeeding has not proved to increase the risk of relapse.…”

“…Galactagogues are often phytoestrogens in a concentrated form, which could promote oncogenesis or decrease the efficacy of hormonal therapy [ 127 ]. Domperidone and other drugs inducing prolactin release may be contraindicated due to an increased risk of breast cancer development with elevated prolactin [ 126 , 128 ].…”