Last update: Aug. 6, 2019

Maternal Cancer

High Risk for breastfeeding


Poorly safe. Evaluate carefully.
Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives).
Read the Comment.

During breast cancer treatment, breastfeeding must be interrupted due to potentially serious side effects for the infant. Diagnostic procedures and treatment (antimetabolites, hormone inhibitors, radioisotopes) for proliferative breast diseases are contraindicated while breastfeeding, at the moment of administration and for a variable period of time after completion (Consult the file for each specific treatment).

Abrupt weaning can be psychologically traumatic for both the mother and the infant (Pistilli 2013). If the mother wishes, the production of milk can be maintained by regularly expressing milk from the breast, being able to return to breastfeeding in the periods in which no significant traces of the drug remain in the milk (Anderson 2016) or at the end of the treatment (Pistilli 2013).

Pharmacokinetics show that after 3 elimination half-lives (T½) 87.5% of the drug is eliminated from the body; after 4 T½ it is 94%, after 5 T½, 96.9%, after 6 T½, 98.4% and after 7 T½ it is 99%. From 7 T½ the plasmatic concentrations of drug in the body are negligible. In general, a period of at least five half-lives can be considered a safe waiting period before breastfeeding again (Anderson 2016).

When it is possible to do so, milk detections of each patient to determine the total elimination of the drug would be the best indicator to resume breastfeeding between two cycles of chemotherapy.

Chemotherapy does not affect milk production during or after treatment.
After cancer treatment, breastfeeding is possible (Johnson 2019).

Some chemotherapeutic agents with an antibiotic effect can alter the composition of the microbiota (bacterial set or bacterial flora) of the milk and the concentration of some of its components (Urbaniak 2014). This possibly occurs temporarily with subsequent recovery, although no harmful effects are assumed or have been reported in breastfed infants.

Women undergoing chemotherapy during pregnancy have lower rates of breastfeeding due to difficulties in breastfeeding (Stopenski 2017), needing more support to achieve it.

Given the strong evidence that exists regarding the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother who wishes to continue with breastfeeding (Koren 2013).
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In BREAST CANCER, when there is no residual tumor, breastfeeding can be achieved, either on the healthy or treated breast (Cardoso 2012, Gorman2009), whenever the patient has undergone conservative treatment. However, whether surgery or radiation is used, the latter instance may lead to less milk production, but always remaining the possibility of successful breastfeeding with one breast only. About 50% of women whose breast was irradiated may produce milk on that breast but only one in four women may breastfeed on it. Mechanical or manual removal of milk and/or formula supplementation may be required.
Breast irradiation induces to less milk production, although nutritionally adequate, the infant may refuse it because of more sodium content than on the non-radiated breast.

After radical and total mastectomy, there is not possibility to breastfeed in the future because of lacking to conservation of breast tissue, nipple or both. Only after partial subcutaneous mastectomy with preservation of part of breast tissue, breastfeeding may be feasible.

Breastfeeding after breast cancer poses no danger to the mother nor the child, either if it is from the healthy breast or not (Cardoso 2012, de Bree 2010, Azim 2010 y 2009, Hickey 2009, Bercovich 2009). The mother will require appropriate information and assistance along with professional and family support. Breastfeeding is often more difficult when it must be done on one breast only, with a lot of emotional and physical stress together with frustration if exclusive breastfeeding is not achieved.

You can read the personal testimony of a mother in E.D.- LactApp 2017.

Prestigious Medical and Oncology Societies offer support to mothers who want to breastfeed after such an ordeal (Cardoso 2012, Camune 2007).
Nursing mothers diagnosed with breast cancer who wish to breastfeed during breastfeeding or once cured or in the next lactation period are a vulnerable population that requires clinical support from oncologic multidisciplinary teams and lactation experts (Johnson 2019).


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Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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References

  1. Johnson HM, Mitchell KB. Breastfeeding and Breast Cancer: Managing Lactation in Survivors and Women with a New Diagnosis. Ann Surg Oncol. 2019 Jul 24. Abstract
  2. E.D. LactApp. MI testimonio con el cáncer y la lactancia. LactApp. 2018 Full text (link to original source) Full text (in our servers)
  3. Stopenski S, Aslam A, Zhang X, Cardonick E. After Chemotherapy Treatment for Maternal Cancer During Pregnancy, Is Breastfeeding Possible? Breastfeed Med. 2017 Mar;12:91-97. Abstract
  4. Anderson PO. Cancer Chemotherapy. Breastfeed Med. 2016 May;11:164-5. Abstract Full text (link to original source) Full text (in our servers)
  5. Urbaniak C, McMillan A, Angelini M, Gloor GB, Sumarah M, Burton JP, Reid G. Effect of chemotherapy on the microbiota and metabolome of human milk, a case report. Microbiome. 2014 Jul 11;2:24. Abstract Full text (link to original source) Full text (in our servers)
  6. Leal SC, Stuart SR, Carvalho Hde A. Breast irradiation and lactation: a review. Expert Rev Anticancer Ther. 2013 Abstract
  7. Koren G, Carey N, Gagnon R, Maxwell C, Nulman I, Senikas V; Society of Obstetricians and Gynaecologists of Canada. Cancer chemotherapy and pregnancy. J Obstet Gynaecol Can. 2013 Mar;35(3):263-278. Abstract Full text (link to original source) Full text (in our servers)
  8. Lawrence RM. Circumstances when breastfeeding is contraindicated. Pediatr Clin North Am. 2013 Feb;60(1):295-318. Abstract
  9. Pistilli B, Bellettini G, Giovannetti E, Codacci-Pisanelli G, Azim HA Jr, Benedetti G, Sarno MA, Peccatori FA. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013 May;39(3):207-11. Abstract
  10. Cardoso F, Loibl S, Pagani O, Graziottin A, Panizza P, Martincich L, Gentilini O, Peccatori F, Fourquet A, Delaloge S, Marotti L, Penault-Llorca F, Kotti-Kitromilidou AM, Rodger A, Harbeck N; European Society of Breast Cancer Specialists. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer. 2012 Abstract Full text (in our servers)
  11. Azim HA Jr, Bellettini G, Liptrott SJ, Armeni ME, Dell'Acqua V, Torti F, Di Nubila B, Galimberti V, Peccatori F. Breastfeeding in breast cancer survivors: pattern, behaviour and effect on breast cancer outcome. Breast. 2010 Abstract
  12. de Bree E, Makrigiannakis A, Askoxylakis J, Melissas J, Tsiftsis DD. Pregnancy after breast cancer. A comprehensive review. J Surg Oncol. 2010 Abstract
  13. Gorman JR, Usita PM, Madlensky L, Pierce JP. A qualitative investigation of breast cancer survivors' experiences with breastfeeding. J Cancer Surviv. 2009 Abstract Full text (link to original source) Full text (in our servers)
  14. Bercovich D, Goodman G. Pregnancy and lactation after breast cancer elevate plasma prolactin, do not shorten and may prolong survival. Med Hypotheses. 2009 Abstract
  15. Azim HA Jr, Bellettini G, Gelber S, Peccatori FA. Breast-feeding after breast cancer: if you wish, madam. Breast Cancer Res Treat. 2009 Abstract
  16. Hickey M, Peate M, Saunders CM, Friedlander M. Breast cancer in young women and its impact on reproductive function. Hum Reprod Update. 2009 Abstract Full text (link to original source) Full text (in our servers)
  17. Camune B, Gabzdyl E. Breast-feeding after breast cancer in childbearing women. J Perinat Neonatal Nurs. 2007 Abstract
  18. Connell S, Patterson C, Newman B. A qualitative analysis of reproductive issues raised by young Australian women with breast cancer. Health Care Women Int. 2006 Abstract
  19. Moran MS, Colasanto JM, Haffty BG, Wilson LD, Lund MW, Higgins SA. Effects of breast-conserving therapy on lactation after pregnancy. Cancer J. 2005 Abstract
  20. Helewa M, Lévesque P, Provencher D, Lea RH, Rosolowich V, Shapiro HM; Breast Disease Committee and Executive Committeee and Council, Society of Obstetricians and Gynaecologists of Canada. Breast cancer, pregnancy, and breastfeeding. J Obstet Gynaecol Can. 2002 Abstract
  21. Zimpelmann A, Kaufmann M. [Breastfeeding nursing after breast surgery]. Zentralbl Gynakol. 2002 Abstract
  22. Guix B, Tello JI, Finestres F, Palma C, Martínez A. Lactation after conservative treatment for breast cancer. Int J Radiat Oncol Biol Phys. 2000 Abstract
  23. Collichio FA, Agnello R, Staltzer J. Pregnancy after breast cancer: from psychosocial issues through conception. Oncology (Williston Park). 1998 Abstract
  24. Wobbes T. Effect of a breast saving procedure on lactation. Eur J Surg. 1996 Abstract
  25. Tralins AH. Lactation after conservative breast surgery combined with radiation therapy. Am J Clin Oncol. 1995 Abstract
  26. Dow KH, Harris JR, Roy C. Pregnancy after breast-conserving surgery and radiation therapy for breast cancer. J Natl Cancer Inst Monogr. 1994 Abstract
  27. Higgins S, Haffty BG. Pregnancy and lactation after breast-conserving therapy for early stage breast cancer. Cancer. 1994 Abstract
  28. Kudaĭbergenov TK, Nurmakova SI, Kudaĭvergenova RZ. [A favorable course of labor and lactation in a patient after a mastectomy for breast sarcoma]. Klin Khir. 1994 Abstract
  29. Soderstrom B. Helping the woman who has had breast surgery: a literature review. J Hum Lact. 1993 Abstract
  30. Robbins MJ. Breast-feeding in the face of adversity. MCN Am J Matern Child Nurs. 1992 Abstract
  31. Neifert M. Breastfeeding after breast surgical procedure or breast cancer. NAACOGS Clin Issu Perinat Womens Health Nurs. 1992 Abstract
  32. Varsos G, Yahalom J. Lactation following conservation surgery and radiotherapy for breast cancer. J Surg Oncol. 1991 Abstract
  33. Boyce KM. Case study: breast-feeding following mastectomy. Midwives Chron. 1991 Abstract
  34. Green JP. Post-irradiation lactation. Int J Radiat Oncol Biol Phys. 1989 Abstract
  35. Rodger A, Corbett PJ, Chetty U. Lactation after breast conserving therapy, including radiation therapy, for early breast cancer. Radiother Oncol. 1989 Abstract
  36. David FC. Lactation following primary radiation therapy for carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1985 Abstract

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