Last update: Aug. 6, 2019
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).
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).
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.
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.
e-lactancia is a resource recommended by Asociación Española de Bancos de Leche Humana from Spain
Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM